Isn't It the Right Time to Address the Impact of Pediatric Cardiac Intensive Care Units on Medical Education?

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Subspecialization seems to be an inevitable process in most medical specialties, and this phenomenon is certainly occurring in critical care medicine. In most large tertiary or quaternary medical centers, critically ill adult patients are cared for in highly specialized ICUs. At a minimum, most large centers cluster appropriate patients into medical, neurologic, or surgical ICUs. In some institutions, however, the subspecialization of critical care medicine has been taken even further, and there are specialized units for the care of trauma victims, burn patients, or patients recovering from major cardiothoracic procedures or solid organ transplantation operations. The impetus for this change are the advantages that such subspecialization brings. Focused care encourages a dedicated team to develop skills and expand their knowledge in a very specific clinical domain. Repetition promotes expertise for all staff involved. Opportunities for focused education develop as physicians and other staff choose to dedicate themselves to a subspecialty. Subspecialization is now occurring in pediatric critical care medicine as well. Over the past decade, pediatric cardiac intensive care has evolved into a specialized branch of the ICU. As of the last report in 2004, there were 15 reported cardiac ICUs (CICUs) in the United States.1 It has fostered the creation of a distinct staff, specialized training, and a professional society. Cardiovascular surgeons and cardiologists have certainly stimulated proliferation of separate units for the care of their patients. Working with a small, familiar staff promotes uniform management. Communication and team building are easier when the group is consistent and established, and team leaders can capitalize on the resulting esprit de corps to foster continuing development and appropriate change. Numerous challenges have already been identified, such as the need to demonstrate strong physician and nurse leadership, maintain morale, and perfect a multidisciplinary approach.2,3 Another challenge is attracting … Address correspondence to Lillian Su, MD, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. E-mail: sul{at}email.chop.edu