Selection, training, and mentoring

Over the last two decades, there have been tremendous medical and surgical advancements in the care provided to children with congenital and acquired heart disease. Technologic improvements in extracorporeal cardiac support continue to decrease mortality rates in this group of patients. Patients with complex congenital and acquired heart disease often present significant management challenges for the cardiac intensive care unit (CICU) provider. To understand and meet the demands of this patient population, cardiology, critical care, and anesthesiology practitioners have been tailoring their education and training to provide optimal care. Academic pediatric centers offer additional education and training in pediatric subspecialties in the fields of critical care, cardiology, and anesthesiology to prepare providers for careers as pediatric cardiac intensivists. Available guidelines for training in pediatric cardiology, pediatric critical care, and pediatric anesthesia separately exist, but there is no consensus on the specific training pathway, the duration of that training, or in the specifics of mentoring and recruitment for the next generation of CICU providers. These challenges, along with the gradual transition nationally to dedicated pediatric cardiac critical care units and intensivists, have intensified the discussion to standardize training. This chapter provides a historical background in the field of pediatric critical care, highlighting the critical skills and expertise required by CICU providers. The various training pathways available for cardiac intensive care practitioners are summarized, followed by a proposed curriculum and possible assessment strategies for those in training. Finally, information regarding board certification, mentoring, and recruitment for CICU providers is presented.