RESUMO
BACKGROUND: Roseman University of Health Sciences (RUHS) developed and delivers a mastery learning curriculum designed for students to acquire the knowledge and skills to become competent nurses. Despite a trend in nursing education to adopt competency-based education (CBE) models, there is little in the nursing literature about programs based on a mastery model. The aim of this study is to describe an undergraduate nursing program built on a mastery learning model and to report on program outcome measures. METHODS: The 18-month BSN nursing program is divided into blocks, varying in length and focusing on a single subject. Students must demonstrate mastery, defined as ≥90% on an assessment, to pass a block. Recognizing the critical nature of health care, educators seek methods to assure that practitioners become competent to perform the services they provide.Program outcomes reported include comparisons to national standards and RUHS student exit survey data. RESULTS: From 2013 to 2017 the RUHS College of Nursing students' pass rates ranged from 82 to 97% for the National Council Licensure Examination exam compared to national pass rates between 81.8-84.5% during the same time frame. The program completion rate ranged from 86 to 100% and employment rates exceeded accreditation standards. Students reported overall satisfaction with their education as 4.38 and with the block system as 4.74 (5 point Likert scale). CONCLUSIONS: Roseman University's mastery learning model appears successful as measured by high levels of student satisfaction, outcomes on exams, and degree completion when compared to national averages. The results suggest that other nursing and health profession's programs can develop a successful mastery based learning model.
RESUMO
BACKGROUND: Significant improvements in secondary prevention of osteoporotic fractures have been noted with fracture liaison services. However, similar models for the primary prevention of such fractures have not been reported. OBJECTIVE: To determine the impact of a Bone Health Team (BHT) on osteoporosis screening and treatment rates in U.S. veterans in primary care practices. DESIGN: Historical cohort study of a primary care-based intervention of a BHT from February 2013 to February 2015. SETTING: Community-based outpatient clinics of the Salt Lake City Veterans Affairs Health Care System. PARTICIPANTS: Men aged 70 years and older and women aged 65 years and older. INTERVENTION: Enrollment in the BHT. MEASUREMENTS: Rates of dual energy x-ray absorptiometry (DXA) completion, chart diagnosis of osteoporosis or osteopenia, completion of vitamin D measurement, and initiation of fracture reducing medication. RESULTS: Our cohort consisted of 7644 individuals, 975 of whom were exposed to the BHT and 6669 of whom were not. Comparison of patients exposed to the BHT versus non-exposed subjects demonstrated a substantial increase in all outcome measures studied. Hazard ratios (HRs) from multivariable cox proportional hazard models were: measurement of vitamin D, HR = 1.619 ( P < .001); chart diagnosis of osteopenia, HR = 37.00 ( P < .001); chart diagnosis of osteoporosis, HR = 16.38 ( P < .001); osteoporosis medication, HR = 17.03 ( P < .001); and completion of DXA, HR = 139.9 ( P < .001). CONCLUSIONS AND RELEVANCE: The implementation of a dedicated BHT produced significantly increased rates of intermediate osteoporosis outcome measures in US veterans in primary care practices. Additional research describing medication adherence rates and cost-effectiveness is forthcoming.