Medical Toxicology

Medical Toxicology at UCSF

The UCSF Department of Emergency Medicine is pleased to offer a two-year Medical Toxicology Fellowship Program.  The program provides comprehensive training in a variety of clinical settings including the San Francisco Division of the California Poison Control System (CPCS-SF), Zuckerberg San Francisco General (ZSFG), and the Veterans Administration hospital of San Francisco (VA-SF). The program is designed to train physicians in all aspects of medical toxicology, and to prepare them for leadership roles in research, education, patient care, industry, and poison control center management.  The program is fully accredited by the ACGME, and is available to physicians who have completed residency training in emergency medicine.

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The Subspecialty of Medical Toxicology

Medical toxicology focuses on the diagnosis, management and prevention of poisoning due to drugs, occupational and environmental toxins, and biological agents. Examples of exposures commonly evaluated by medical toxicologists include acute drug overdoses, envenomations, ingestions of food borne or plant and mushroom toxins, hazardous exposures to chemical products, and the management of drug withdrawal syndromes. Medical toxicologists practice in a variety of professional settings including the direct treatment and consultation of acutely poisoned patients in emergency departments or intensive care units, poison control center management, industry and commerce, as well as government regulatory bodies (e.g., CDC, FDA, OSHA , EPA).

Medical toxicology is officially recognized as a medical subspecialty by the American Board of Medical Specialties. In July of 2000, the Accreditation Council for Graduate Medical Education (ACGME) established criteria for accreditation of medical toxicology fellowships. These criteria are rigorous and attempt to establish a baseline level of consistency in training among the various training programs.

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Faculty

Medical Toxicology Fellowship Director 

Craig Smollin, MD, FACMT

Associate Professor of Emergency Medicine, UCSF

Co-Medical Director, California Poison Control System – SF Division

 

Medical Toxicology Faculty 

Neal Benowitz, MD

Professor of Medicine, UCSF

Chief of the Division of Clinical Pharmacology, UCSF 

 

Paul Blanc MD, MSPH

Professor of Medicine, UCSF

Chief of the Division of Occupational and Environmental Medicine, UCSF

 

Timur Durrani, MD, MPH, MBA

Assistant Clinical Professor of Medicine, UCSF

Medical Director of Occupational Health Services, Zuckerberg San Francisco General Hospital 

 

Hallam Gugelmann, MD

MSP Physician, UCSF School of Pharmacy

Assistant Medical Director, California Poison Control System – SF Division

 

Thomas Kearney, PharmD

Professor, UCSF School of Pharmacy

Managing Director, California Poison Control System – SF Division

 

Derrick Lung, MD

Assistant Medical Director, California Poison Control System – SF Division

 

Kent R. Olson, MD

Clinical Professor of Medicine and Pharmacy

Co-Medical Director, California Poison Control System – SF Division

 

Daniel Repplinger, MD

Assistant Professor of Emergency Medicine, UCSF

Assistant Medical Director, California Poison Control System – SF Division

 

Alan Wu, PhD

Professor, UCSF

Chief of Clinical Chemistry and Toxicology Laboratories, Zuckerberg San Francisco General Hospital 

 

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Program Curriculum Overview

 

Year I (PGY-5)

The toxicology fellow spends 12 months running the Clinical Toxicology Consulting Service at the California Poison Control System – SF Division and Zuckerberg San Francisco General Hospital (ZSFG) under the supervision of medical toxicology attending physicians. The fellow also staffs the occupational medicine clinic at the VA-SF. The fellow develops core knowledge content and confidence in assessing and treating poisoning in a variety of clinical settings.

 

Year II (PGY-6)

The toxicology fellow focuses on her/his chosen research projects, while continuing to attend weekly and bi-weekly required conferences, and coursework in clinical study design. Time is provided for electives in laboratory toxicology, forensic toxicology, occupational medicine, pediatric environmental health (PEHSU), childhood lead poisoning and prevention, or other areas of interest.

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Didactics

Fellows participate in a number of regularly scheduled educational conferences.

 

Daily Attending Rounds

Daily attending rounds are conducted by the faculty of the medical toxicology fellowship program, in conjunction with the fellows, rotating residents, and medical and pharmacy students. During these sessions, fellows assist the residents and students in presenting cases that pose challenges in the diagnosis, clinical management, and treatment of poisonings. Fellows present cases called into the Poison Control Center as well as those seen directly at the bedside at San Francisco General Hospital. Daily rounds provide an opportunity for the faculty to answer questions and to provide general teaching points.

 

Toxicology Grand Rounds

Fellows present interesting cases from the prior week for further discussion with all medical toxicology faculty members and members of the laboratory staff at SFGH. In the ensuing discussion, faculty members provide constructive feedback about the management of each case. Fellows are expected to review the current literature relating to the management of each case. This may involve searching PubMed and other resources for pertinent case reports, original research and review articles.

 

Statewide Teleconference

Statewide Teleconference is a unique experience that allows for discussion and collaboration with the Fresno, Sacramento and San Diego Divisions of the California Poison Control System. The teleconference takes place every other week and is hosted by each division on a rotating basis. Fellows present 4-5 interesting cases, and lively debate typically ensues.

 

Journal Club

Articles are selected from the current scientific literature. Fellows are assigned one article for presentation. Journal Club offers the fellows an opportunity to critically evaluate the current literature, and to contemplate study design and execution for their own research projects.

 

Fellows Lecture Series

Medical toxicology faculty, poison center staff, invited lecturers, and both junior and senior fellows give ongoing lectures. Topics are selected based on the required core content of medical toxicology. A schedule is provided at the beginning of each academic year and fellows are required to attend all lectures.

 

Occupational and Environmental Medicine Clinic

Fellows see patients referred to this clinic for toxicology related exposures. Cases include both occupational and environmental exposures. Some families and pediatric cases are seen as referrals from the Pediatric Environmental Health Specialty Unit. Industrial hygiene and nursing students also participate in patient evaluations, as does our faculty Industrial Hygienist. Common presentations include: exposures to mold in the indoor environment; elevated blood or urine levels of metals such as arsenic or mercury; respiratory symptoms associated with inhaled allergens, dusts, or fumes; solvent and pesticide exposures.

 

Poison Control Center Quality Improvement Conferences:  

Fellows participate in reviewing cases involving poison control center staff, with specific management issues that may have resulted in adverse outcomes.  Typically the fellow is involved in researching a specific question and presenting a power point presentation.

 

Simulation

Faculty and fellows run through a series of toxicology simulation cases with rotating medical students, pharmacy students, and residents from various specialties.  The cases are designed to reflect the interdisciplinary approach to the management of acutely poisoned patients and allow the fellows to play an important educator role in controlled and safe environment. 

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Program Electives

During the second year of training, the following 1-month electives are available:

 

Childhood Lead Poisoning and Prevention

Fellows participate in lectures and meetings related to the functions of the CLPPB and may assist with the investigation of lead poisoning. Under the supervision of Dr. Valerie Charlton and the Department of Public Heath staff, they gain a greater understanding of the diagnosis and management of patients with exposure to lead.

 

Forensic Toxicology

Fellows participate in meetings and lectures related to the functions of the San Francisco Medical Examiner's Office. Under the supervision of the Chief Forensic Toxicologist, Nikolas Lemos, and the Medical Examiner's staff, fellows review results of toxicology test performed in the forensic lab. They also have the opportunity to tour the laboratories and learn about analytical techniques for drugs of abuse and comprehensive drug testing, as well as procedures related to chain of custody of biologic specimens.

 

Laboratory Medicine

Fellows participate in lectures and meetings related to the function of the Toxicology Laboratory at Zuckerberg San Francisco General Hospital. Under the supervision of Alan Wu, PhD they develop a greater understanding of basic analytical techniques for drugs of abuse and comprehensive drug screening including immunologic based urine screening techniques, the use of GC-MS, liquid chromatography, flame photometry, co-oximetry, and others.

 

Lawrence Livermore National Laboratory

During this rotation, fellows participate in the assessment of occupational exposures unique to the setting of the Lawrence Livermore National Laboratory. These may include radiation exposures and gas and heavy metal exposures.

 

Medical Intensive Care Unit

During this rotation fellows develop a better understanding of the management of adult critical care patients. They participate in lectures, case conferences, work rounds and attending rounds. Fellows are expected to research topics of interest for the housestaff and provide a short series of lectures on poisonings.

 

Pediatric Environmental Health Specialty Unit (PEHSU)

Fellows participate in lectures and meetings related to functions of the PEHSU and will assist with telephone response and case investigations. Under the supervision of Dr. Timur Duranni MD, MPH, MBA, fellows develop a further understanding of the environmental hazards within the pediatric community. They may also assist in the development of printed materials for the public.

 

Pediatric Intensive Care Unit

During this rotation, fellows develop a better understanding of the management of pediatric critical care patients. They participate in lectures, case conferences, work rounds, and attending rounds. It is expected that they research topics of interest for the house staff and provide a short series of lectures on poisonings.

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Application Process

Please submit the following application material via email to Fellowship Coordinator Sandra Lieu. If you have any questions about the program, please contact Fellowship Director Dr. Craig Smollin. The application deadline is September 1, 2017.

  • A cover letter explaining your interest in Medical Toxicology and any previous experience that you have.
  • Curriculum Vitae
  • Three letters of recommendation (one of which must be from your residency program director and another from your department’s Medical Toxicology Fellowship Director if you have one at your institution)
  • Prospective applicants must also register for the match through the National Resident Matching Program (NRMP).  Information with important deadlines can be found at http://www.nrmp.org/medical-toxicology-match/

 

Eligibility Requirements:

  • Graduate of an Emergency Medicine residency program
  • Board eligible or board certified in Emergency Medicine
  • Must hold a California Medical License and DEA license before starting the fellowship program