Medical Toxicology is a medical subspecialty focusing on the diagnosis, management and prevention of poisoning/toxicity and other adverse health effects due to medications, chemicals, occupational and environmental toxins, and biological hazards. Medical Toxicology is officially recognized as a medical subspecialty by the American Board of Medical Specialties.
The George Washington University (GW) School of Medicine and Health Sciences (SMHS) Department of Emergency Medicine, in conjunction with the National Capital Poison Center, offers a two-year fellowship in medical toxicology. This Fellowship was approved by the Accreditation Council for Graduate Medical Education (ACGME) in September 2005.
The training opportunity is:
- Multi-institutional: Partners are The George Washington University, the National Capital Poison Center, Children’s National Health System, and the Uniformed Services University of the Health Sciences;
- Multi-disciplinary: The primary training site is the National Capital Poison Center, which is staffed by physicians, nurses, and pharmacists and trains students and practitioners of those disciplines, as well as physician assistants, and pre-hospital personnel;
- Multi-cultural: Individuals from more than 150 countries live in or visit – and seek health care in – the Washington, DC metropolitan area. In addition, the National Capital Poison Center provides services to United States diplomatic and military personnel overseas.
- Multi-faceted: In addition to the additional training opportunities afforded by partners (e.g. public health, health law, forensics), fellows can avail themselves of public, private, and government-sponsored activities and facilities to further their education and interests, ranging from participation in public policy development to on-site research.
This fellowship will provide closely integrated clinical and didactic instruction and experience. Guided by the fellowship director and with the assistance of specialty faculty, fellows will progress to competent independent practice, with a goal of achieving board certification in Medical Toxicology and enhancing a life-long practice of medicine.
Goals and Objectives
1. To maximize the care provided to possibly poisoned patients by:
- Providing fellows with in-depth, well-rounded clinical skills and academic background in medical toxicology;
- Fostering research skills and interests that will improve future patient care.
2. To provide career development opportunities by exposing fellows to:
- A variety of clinical sites;
- Multiple venues for specialized research;
- Opportunities for teaching; and
- A range of academic training opportunities.
At the conclusion of the two-year fellowship, participants will be able to:
- Assess and manage patients with acute poisoning from a variety of sources.
- Assess and manage patients with sub-acute/chronic exposures to toxic substances from a variety of sources.
- Assess the potential contribution of workplace and environmental poison exposures to the health of patients with physical complaints or documented illness.
- Select and apply relevant principles of pharmacology and toxicology to the management of poisoned patients.
- Select and interpret relevant assays and laboratory testing procedures when evaluating patients, potential research questions, and forensic studies.
- Identify poison prevention strategies relevant to common poison exposure scenarios in the home, workplace and environment as well as iatrogenic exposures.
- Incorporate epidemiologic data into research questions, protocol development, and poison prevention strategies.
- Complete a research project, including: selection of a research problem; selection of the appropriate methodology; development and execution of a research plan; data analysis; presentation of findings; and possible preparation of a scientific manuscript.
- Develop and present educational programs with objectives and content which are scientifically accurate and take into account the audience and learning environment.
- Participate in poison center operations with knowledge of administrative functions, essential elements of budgeting, staffing requirements, certification standards, computerized documentation of patient records, and legal elements of record keeping.
- Participate in agency and community disaster planning for toxic agent release as a result of industrial accidents, hazardous materials events and chemical and biological warfare events.
- Through exposure to patients and health care professionals of many backgrounds, consider the importance of culture, language, available resources and infrastructure when planning approaches to patient care, patient education and education of other health care workers.
Our 2 year curriculum seeks to foster the basis for a complete understanding of the many facets of toxicology, so that the fellow will be able to find the niche that is most suited to their future practice in medicine. The curriculum is a blend of conference-style didactic learning, course work, hands-on bedside (ICU, ED, floor patients) and clinic consultations, poison center based phone consultations, and research. Specific areas addressed by our curriculum include:
- The clinical manifestations, differential diagnosis and management of various poisoning.
- The pharmacology, pharmacokinetics, potential teratogenesis, and toxic effects of various therapeutic drugs.
- The biochemistry, metabolism, mechanisms of acute and chronic injury and carcinogensis of various compounds.
- Research skills include experimental design, statistical analysis, and the principles of epidemiologic study as well as skills to critically read, reviewing and interpret the scientific literature.
- Interpretation and methodology of analytical toxicology laboratory results and techniques.
- Occupational toxicology, including acute and chronic exposure in the workplace.
- Poisoning prevention and the role of regulation and legislation as effective tools to promote this, particularly in the workplace.
- Environmental toxicology including the basic principles of mass incidents including logistics of resource management and decontamination.
- The role of poison control centers as well as their financing and management.
- Educational skills particularly oral, visual, and written communication.
Diversity of experience is obtained by rotations and involvement at diverse clinical sites; GW SMHS, Children’s National Health System, National Capital Poison Center (NCPC), Uniformed Services of the Health Sciences (USU), District of Columbia Medical Examiner. There will be ample opportunity for the fellow to expand their exposure into areas of specific interest including; public health, health policy, HAZMAT.
Fellows will spend 9 months the first year and 10 months the second year at the NCPC. They will spend 2 months each year at USUHS and one month during the first year at SMHS. They will participate in Occupation and Environmental Clinic at Children’s National Health System.
The curriculum will follow the “Core Content for Medical Toxicology”, published in February 2004 (Wax, Ford, Bond et. al. The core content of medical toxicology. Ann Emerg Med 2004;43:209-214;
Fellows may use coursework in the Milken Institute School of Public Health completed during the Fellowship towards a Masters in Public Health or in the Graduate Certificate Program in Environmental and Occupational Health.
Cathleen Clancy M.D.
Associate Medical Director, National Capital Poison Center
3201 New Mexico Ave Washington D.C. 20016
Associate Professor, The George Washington University
Department of Emergency Medicine