Adaptation of the Roseman 6-Point Mastery Learning Model to the College of Medicine Program.

Medical education has evolved over time toward a model which integrates clinical medicine with the basic sciences. More recently, medical education has put an emphasis on outcome-based education. Other areas of health care education have had a similar emphasis which can provide models to inform a new model for medical education. The Roseman University of Health Sciences has developed and implemented a model based on underlying tenets of mastery learning since 1999. The model has been implemented in pharmacy, nursing, and dental education. It was conceived as an integration of 6 key points which reinforce each other and interrelate to support learning. The model has been modified for application to medical education in support of medical education's outcome-based emphasis and to address the educational demands of the changing environment of the practice of medicine.

Low serum triglyceride levels as predictors of cardiac death in heart failure patients.

Understanding the influence of sex differences on predictors of cardiac mortality rates in chronic heart failure might enable us to lengthen lifetimes and to improve lives. This study describes the influence of sex on cardiovascular mortality rates among chronic heart failure patients. From January 2003 through December 2009, we evaluated 637 consecutive patients (409 men and 228 women) with chronic heart failure, who ranged in age from 18 through 94 years (mean age, 64 ± 13 yr) and ranged in New York Heart Association (NYHA) functional class from II through IV. The mean follow-up period was 38 ± 15 months, the mean age was 64 ± 13 years, and the mean left ventricular ejection fraction was 0.27 ±0.11. By the end of the study, both sexes had similar cardiovascular mortality rates (36% men vs 37% women, P=0.559). In Cox regression analysis, NYHA functional class, triglyceride level, and history of coronary artery disease were independent predictors of cardiovascular death for women with chronic heart failure. For men with chronic heart failure, the patient's age, ejection fraction, and sodium level were independent predictors of cardiovascular death. In a modern tertiary referral heart failure clinic, decreased triglyceride levels were, upon univariate analysis, predictors of poor outcomes for both men and women. However, upon Cox regression analysis, reduced triglyceride levels were independent predictors of cardiac death only in women.