No CrossRef data available.
Article contents
High variability in cardiac education and experiences during United States paediatric critical care fellowships
Published online by Cambridge University Press: 04 March 2022
Abstract
Background:
Paediatric cardiac critical care continues to become more sub-specialised, and many institutions have transitioned to dedicated cardiac ICUs. Literature regarding the effects of these changes on paediatric critical care medicine fellowship training is limited.
Objective:
To describe the current landscape of cardiac critical care education during paediatric critical care medicine fellowship in the United States and demonstrate its variability.
Methods:
A review of publicly available information in 2021 was completed. A supplemental REDCap survey focusing on cardiac ICU experiences during paediatric critical care medicine fellowships was e-mailed to all United States Accreditation Council of Graduate Medical Education-accredited paediatric critical care medicine fellowship programme coordinators/directors. Results are reported using inferential statistics.
Results:
Data from 71 paediatric critical care medicine fellowship programme websites and 41 leadership responses were included. Median fellow complement was 8 (interquartile range: 6, 12). The majority (76%, 31/41) of programmes had a designated cardiac ICU. Median percentage of paediatric critical care medicine attending physicians with cardiac training was 25% (interquartile range: 0%, 69%). Mandatory cardiac ICU time was 16 weeks (interquartile range: 13, 20) with variability in night coverage and number of other learners present. A minority of programmes (29%, 12/41) mandated other cardiac experiences. Median CHD surgical cases per year were 215 (interquartile range: 132, 338). When considering the number of annual cases per fellow, programmes with higher case volume were not always associated with the highest case number per fellow.
Conclusions:
There is a continued trend toward dedicated cardiac ICUs in the United States, with significant variability in cardiac training during paediatric critical care medicine fellowship. As the trend toward dedicated cardiac ICUs continues and practices become more standardised, so should the education.
Keywords
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2022. Published by Cambridge University Press
References
Tabbutt, S, Krawczeski, C, McBride, M, et al. Standardized training for physicians practicing pediatric cardiac critical care. Pediatr Crit Care Med 2022; 23: 60–64
.
CrossRefGoogle ScholarPubMed
Horak, R, Bai Shasha, MB, et al. Workforce demographics and unit structure in pediatric cardiac critical care in the United States. Cardiol Young 2021; 1–5 [Preprint].Google ScholarPubMed
Tabbutt, S, Ghanayem, N, Almodovar, MC, et al. Training fellows and residents in paediatric cardiac critical care. Cardiol Young 2016; 26: 1531–1536.CrossRefGoogle ScholarPubMed
Penny, DJ, Shekerdemian, LS. The American Heart Association’s recent scientific statement on cardiac critical care: implications for pediatric practice. Congenit Heart Dis 2013; 8: 3–19.CrossRefGoogle ScholarPubMed
Horak, RV, Alexander, PM, Amirnovin, R, Klein, MJ, Bronicki, RA, Markovitz, BP. Pediatric cardiac intensive care distribution, service delivery, and staffing in the United States in 2018. Pediatr Crit Care Med 2020; 21: 797–803.CrossRefGoogle ScholarPubMed
Balachandran, R, Nair, SG, Gopalraj, SS, Vaidyanathan, B, Kumar, RK. Dedicated pediatric cardiac intensive care unit in a developing country: does it improve the outcome? Ann Pediatr Cardiol 2011; 4: 122–126.CrossRefGoogle Scholar
Rosenberg, DI, Moss, MM, American College of Critical Care Medicine of the Society of Critical Care. Guidelines and levels of care for pediatric intensive care units. Crit Care Med 2004; 32: 2117–2127.CrossRefGoogle ScholarPubMed
Su, L, Munoz, R. Isn’t it the right time to address the impact of pediatric cardiac intensive care units on medical education? Pediatrics 2007; 120: e1117–e1119.CrossRefGoogle ScholarPubMed
ACGME Program Requirements for Graduate Medical Education in Pediatric Critical Care Medicine. Retrieved April 20, 2021, from https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/323_PediatricCriticalCareMedicine_2020.pdf?ver=2020-06-29-163401-677&ver=2020-06-29-163401-677. Updated July 1, 2020.Google Scholar
Fellowship and Residency Electronic Interactive Database (FREIDA). American Medical Association. Retrieved January, 2021, from https://freida.ama-assn.org/. Updated 2021.Google Scholar
Pediatric Critical Care Medicine (Pediatrics). Association of American Medical Colleges Electronic Residency Application Service (ERAS) website. Retrieved January, 2021, from https://services.aamc.org/eras/erasstats/par/display.cfm?NAV_ROW=PAR&SPEC_CD=323. Updated 2021.Google Scholar
Congenital Heart Surgery Public Reporting. The Society of Thoracic Surgeons (STS) Public Reporting website. Retrieved March, 2021, from https://publicreporting.sts.org/chsd. Updated 2020.Google Scholar
Morrison, WE, Helfaer, MA, Nadkarni, VM. National survey of pediatric critical care medicine fellowship clinical and research time allocation. Pediatr Crit Care Med 2009; 10: 397–399.CrossRefGoogle ScholarPubMed
Baden, HP, Zimmerman, JJ, Brilli, RJ, Wong, H, Wetzel, RC, Burns, JP. Intensivist-led team approach to critical care of children with heart disease. Pediatrics 2006; 117: 1854–1856; author reply 6–7.CrossRefGoogle ScholarPubMed
Owens, ST, Owens, GE, Rajput, SH, Charpie, JR, Kidwell, KK, Mullan, PB. Perceptions of 24/7 in-house attending coverage on fellow education and autonomy in a pediatric cardiothoracic intensive care unit. Congenit Heart Dis 2015; 10: E107–E112.CrossRefGoogle Scholar
Werho, DK, DeWitt, AG, Owens, ST, McBride, ME, Schaik, SV, Roth, SJ. Establishing entrustable professional activities in pediatric cardiac critical care. Pediatr Crit Care Med 2022; 23: 54–59.CrossRefGoogle Scholar
Hilvers, PS, Thammasitboon, S. Does ICU structure impact patient outcomes after congenital heart surgery? A critical appraisal of “care models and associated outcomes in congenital heart surgery” by Burstein et al (Pediatrics 2011; 127: e1482-e1489). Pediatr Crit Care Med 2014; 15: 77–81.CrossRefGoogle ScholarPubMed
Burstein, DS, Jacobs, JP, Li, JS, Sheng, S, O’Brien, SM, Rossi, AF. Care models and associated outcomes in congenital heart surgery. Pediatrics 2011; 127: e1482–e1489.CrossRefGoogle ScholarPubMed
McCoy, CP, Stenerson, MB, Halvorsen, AJ, Homme, JH, McDonald, FS. Association of volume of patient encounters with residents’ in-training examination performance. J Gen Intern Med 2013; 28: 1035–1041.CrossRefGoogle ScholarPubMed
Anand, V, Kwiatkowski, DM, Ghanayem, NS, Axelrod, DM, DiNardo, J, Klugman, D. Training pathways in pediatric cardiac intensive care: proceedings from the 10th international conference of the pediatric cardiac intensive care society. World J Pediatr Congenit Heart Surg 2016; 7: 81–88.CrossRefGoogle ScholarPubMed
The Pediatric Cardiac Intensive Care Society. PCICS website. Retrieved January, 2022, from https://pcics.org/programs/. Updated 2020.Google Scholar
Bergman, CM, Howell, J. Critical cardiopulmonary event series: four simulations for pediatric ICU fellows, critical care nurses, and pediatric residents. MedEdPORTAL 2020; 16: 10889.CrossRefGoogle ScholarPubMed
Couloures, KG, Allen, C. Use of simulation to improve cardiopulmonary resuscitation performance and code team communication for pediatric residents. MedEdPORTAL 2017; 13: 10555.CrossRefGoogle ScholarPubMed
Cashen, K, Petersen, T. Pediatric pulseless ventricular tachycardia: a simulation scenario for fellows, residents, medical students, and advanced practitioners. MedEdPORTAL 2016; 12: 10407.CrossRefGoogle ScholarPubMed