Why simulation can be efficient: on the preconditions of efficient learning in complex technology based practices

<p>Abstract</p> <p>Background</p> <p>It is important to demonstrate learning outcomes of simulation in technology based practices, such as in advanced health care. Although many studies show skills improvement and self-reported change to practice, there are few studies demonstrating patient outcome and societal efficiency.</p> <p>The objective of the study is to investigate if and why simulation can be effective and efficient in a hi-tech health care setting. This is important in order to decide whether and how to design simulation scenarios and outcome studies.</p> <p>Methods</p> <p>Core theoretical insights in Science and Technology Studies (STS) are applied to analyze the field of simulation in hi-tech health care education. In particular, a process-oriented framework where technology is characterized by its devices, methods and its organizational setting is applied.</p> <p>Results</p> <p>The analysis shows how advanced simulation can address core characteristics of technology beyond the knowledge of technology's functions. Simulation's ability to address skilful device handling as well as purposive aspects of technology provides a potential for effective and efficient learning. However, as technology is also constituted by organizational aspects, such as technology status, disease status, and resource constraints, the success of simulation depends on whether these aspects can be integrated in the simulation setting as well. This represents a challenge for future development of simulation and for demonstrating its effectiveness and efficiency.</p> <p>Conclusion</p> <p>Assessing the outcome of simulation in education in hi-tech health care settings is worthwhile if core characteristics of medical technology are addressed. This challenges the traditional technical versus non-technical divide in simulation, as organizational aspects appear to be part of technology's core characteristics.</p

Evidence in the learning organization

<p>Abstract</p> <p>Background</p> <p>Organizational leaders in business and medicine have been experiencing a similar dilemma: how to ensure that their organizational members are adopting work innovations in a timely fashion. Organizational leaders in healthcare have attempted to resolve this dilemma by offering specific solutions, such as evidence-based medicine (EBM), but organizations are still not systematically adopting evidence-based practice innovations as rapidly as expected by policy-makers (the knowing-doing gap problem). Some business leaders have adopted a systems-based perspective, called the learning organization (LO), to address a similar dilemma. Three years ago, the Society of General Internal Medicine's Evidence-based Medicine Task Force began an inquiry to integrate the EBM and LO concepts into one model to address the knowing-doing gap problem.</p> <p>Methods</p> <p>During the model development process, the authors searched several databases for relevant LO frameworks and their related concepts by using a broad search strategy. To identify the key LO frameworks and consolidate them into one model, the authors used consensus-based decision-making and a narrative thematic synthesis guided by several qualitative criteria. The authors subjected the model to external, independent review and improved upon its design with this feedback.</p> <p>Results</p> <p>The authors found seven LO frameworks particularly relevant to evidence-based practice innovations in organizations. The authors describe their interpretations of these frameworks for healthcare organizations, the process they used to integrate the LO frameworks with EBM principles, and the resulting Evidence in the Learning Organization (ELO) model. They also provide a health organization scenario to illustrate ELO concepts in application.</p> <p>Conclusion</p> <p>The authors intend, by sharing the LO frameworks and the ELO model, to help organizations identify their capacities to learn and share knowledge about evidence-based practice innovations. The ELO model will need further validation and improvement through its use in organizational settings and applied health services research.</p

Bond characteristics of corroding reinforcement in concrete beams

The results of an experimental study of the bond characteristics of reinforced concrete beams subjected to reinforcement corrosion are presented. Beam specimens recommended by the joint RILEM/CEB/FIP Committee were used, which comprised two halves of a reinforced concrete beam rotating about a hinge mechanism. Corrosion was induced at different levels of rebar diameter loss: 0, 0.3, 0.4, 0.5, 1, 2 and 5 percent by impressing direct current of intensity 0.8 and 2.4 mA/cm(2). The specimens were tested under four point bending to induce bond failure and load - free end slip curves were plotted. The tests showed that at up to 0.4% degree of corrosion, no free-end slip occurred in the reinforcement bars until complete breakdown of bond at failure. At higher degrees of reinforcement corrosion, free-end slip commenced immediately upon application of load and increased linearly with increasing load. The free-end slip at maximum load was a function of the degree of reinforcement corrosion. At small degrees of corrosion, the bond strength increased with increasing degree of corrosion, showing a maximum increase of over 25% at 0.4% corrosion. Higher degrees of corrosion led to a sharp decrease in bond strength

'Sameness' and 'Difference' Revisited: Which Way Forward For Equal Opportunity Initiatives?

Recent interest in 'managing diversity' has reopened debates about forms of equality in the workplace. Approaches to equality developed in the 1970s and 1980s have been characterized as an attempt to ensure that if individuals bring the same abilities to work, or perform in the same way, they should receive the same access to jobs and employment benefits, regardless of social group membership. Managing diversity appears to be about a more positive valuing of difference. Benefits are seen to derive from different perspectives and approaches and these should be nurtured and rewarded rather than suppressed. Feminists have long argued about the extent to which women are the same as, or different from, men, and about the political consequences of adopting these positions. Recent theoretical developments have led to some novel solutions to this dilemma. These include asserting claims to both 'sameness' and 'difference', the deconstruction of 'difference', and the reconstruction of 'sameness' on women's terms. This paper explores approaches to equal opportunities through both established and novel theoretical perspectives. It argues that existing practice cannot be fitted neatly into the conventional distinctions between 'sameness' and 'difference', and explores the potential characteristics and strengths and weaknesses of equality initiatives based on the new theoretical perspectives. Copyright 1996 Basil Blackwell Ltd.