Medical Toxicology Fellowship

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.

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.

The UCSF Department of Emergency Medicine is pleased to offer a two-year training program in medical toxicology. The program provides for 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 Hospital (ZSFGH), UCSF Helen Diller Medical Center at Parnassus Heights, UCSF Benioff Children's Hospital, and the San Francisco Veterans Affairs Medical Center (SFVAMC). 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.

Medical Toxicology Fellowship Director 

Zhanna Livshits, MD

Clinical Professor of Emergency Medicine, UCSF

Assistant Medical Director, California Poison Control System - SF Division 

Medical Toxicology Faculty 

Craig Smollin, MD, FACMT

Professor of Emergency Medicine, UCSF

Medical Director, California Poison Control System - SF Division 

 Kathy LeSaint, MD

Associate Professor of Emergency Medicine, UCSF

Assistant Medical Director, California Poison Control System - SF Division

Neal Benowitz, MD

Professor of Medicine, UCSF

Paul Blanc, MD, MSPH

Professor of Medicine, UCSF

Chief of the Division of Occupational and Environmental Medicine, UCSF

Timur Durrani, MD, MPH, MBA

Clinical Professor of Medicine, UCSF

Medical Director, Health Services, Lawrence Berkeley National Laboratory

Alan Wu, PhD

Professor, UCSF

Chief of Clinical Chemistry and Toxicology Laboratories, ZSFGH

Current Medical Toxicology Fellows

Year I 

The medical toxicology fellow spends 9 months running the Clinical Toxicology Consulting Service at the California Poison Control System – SF Division, Zuckerberg San Francisco General Hospital (ZSFGH), UCSF Hellen Diller Medical Center at Parnassus Heights (UCSF Parnassus), and UCSF Benioff Children’s Hospital (UCSF Mission Bay) under the supervision of medical toxicology attending physicians. Dedicated evaluation of occupational medicine consults also takes place at the UCSF Occupational and Environmental Medicine clinic and SFVAMC occupational medicine clinic. The fellow develops core knowledge content and confidence in assessing and treating poisoning in a variety of clinical settings. The fellow supervises a team of medical students, pharmacy students, and resident physicians, and attends weekly didactics (grand rounds, journal clubs, fellow lecture series). Time is also provided for one month of research and one month of elective.

Year II 

The medical toxicology fellow focuses on a research project, 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.

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 both cases called into the Poison Control Center as well as those seen directly at the bedside at ZSFGH, the UCSF Parnassus campus, and the UCSF Mission Bay campus. 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 a diverse group comprised of colleagues from different specialties with involvement or interest in medical toxicology. 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 3-4 interesting cases, and lively debate typically ensues.

 Journal Club

Articles are selected from the current and classic scientific literature. Fellows are assigned one article for presentation. Journal Club offers the fellows an opportunity to critically evaluate the literature, review the literature which forms the foundation of our practice, 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 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. 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 a controlled and safe environment.

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

Childhood Lead Poisoning and Prevention (CLPPB)

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. Jean Woo 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, Luke Rodda, PhD and the Medical Examiner's staff, fellows review results of toxicology tests 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 Kara Lynch, 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, gas, and heavy metal exposures among others.

 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. 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.

Please submit the following application material via the Electronic Residency Application Service (ERAS). If you have any questions, please contact Fellowship Director Dr. Zhanna Livshits or Fellowship Administrator Dawnee Wong. The application deadline is September 15, 2024.

• A personal statement explaining your interest in Medical Toxicology
• Curriculum Vitae
• Three letters of recommendation (one of which must be from your program director and another from your institution'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 on the NRMP website.

Eligibility Requirements:

• Graduate of an ACGME approved U.S. 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
• Visas: Our department can sponsor J-1 visas but cannot sponsor H-1B visas.