Clinical Service
Fellows are responsible for admitting and consulting on patients at both Banner — University Medical Center Phoenix and Phoenix Children's Hospital. Fellows lead daily teaching rounds with rotating residents and staff. Fellows take call along with staff every fourth night, caring for the acutely poisoned patient and offering medical back-up to the poison center. Fellows also obtain valuable teaching skills by providing presentations for Internal Medicine Morning Report and Noon Conference, Emergency Medicine Grand Rounds and Pediatric Noon Conference.
Core Lecture Series
(July and August of each year)
All first and second year toxicology fellows receive a series of core lectures at the beginning of each academic year. This lecture series begins with pharmacokinetics, drug metabolism, and receptor physiology and then moves on to basic toxicologic mechanisms, basic biochemical mechanisms, and common poisonings. Household products, envenomations, natural toxins and occupational toxins are covered in this overview. These lectures take place two to four hours each day for the first two months of the fellowship. All full-time faculty members participate in the lecture series.
Regular Conferences
Occupational Toxicology
Chapter Review
Every other week, a faculty member meets with fellows to discuss an assigned chapter in Sullivan's Clinical Environmental Health and Toxic Exposures. The chapter assignments are designed to cover the core content in industrial and environmental toxicology for medical toxicology over a 24-month period. The conference begins with a short written quiz and each chapter is discussed in detail; this includes a prepared summary or lecture by a faculty member.
Drug Interactions Conference
Twice a month interesting cases, drug interactions, and adverse drug effects are discussed. The format varies from bedside chart review to conference room discussions to formal lectures.
Poison Center Conference
Cases from the Banner Poison and Drug Information Center are reviewed on a weekly basis. This conference emphasizes skills directly related to the assessment and management of toxic exposures that are called to the poison center from the lay public as well as health care professionals. Cases are utilized to discuss diagnostic and treatment plans for envenomations, poisonings with pharmaceutical agents, and occupational/environmental exposures. The poison center staff and the medical toxicology faculty provide input.
Clinical Toxicology Chapter Review
Every week a faculty member meets with the fellows to discuss an assigned chapter in one of the standard medical toxicology references including Goldfrank's Toxicologic Emergencies and Critical Care Toxicology. The chapter assignments are designed to cover the core content for medical toxicology over a 24-month period. Conferences begin with a short written quiz. The chapter is then discussed in detail; this includes a prepared summary or lecture by a faculty member.
Research Conference
During the first year of fellowship, each fellow is encouraged to develop a research project that focuses on an area of particular interest. Generally, during the second year of fellowship, this project is initiated. Smaller projects are also encouraged. This conference facilitates the discussion of ongoing research projects as well as the "brain storming" of future ideas. Current research goals are discussed and solutions to research hurdles are developed. New ideas for ongoing projects and for possible future research projects are discussed. All fellows participate in ongoing research and the development of new research projects. The faculty review ongoing research projects and assist in the development of research ideas and the initiation of projects with the fellows. During this conference book chapters and review articles that are being collaborated on are also discussed. All research projects are generally submitted for poster or platform presentation at the North American Congress of Clinical Toxicology Conference in abstract form, and then in manuscript form to various journals. Funding for travel, board, and meeting attendance are provided for the fellows.
Examples of recent research projects include:
Participation in multicenter clinical trial of scorpion antivenom |
Participation in multicenter clinical trial of rattlesnake antivenom |
Participation in multicenter clinical trial of black widow antivenom |
Determination of plasma and urine DMPS levels following application of TD-DMPS |
Examining the influence of seafood diets on blood and urinary mercury excretion |
Examining myocardial depression produced by verapamil toxicity |
Examining the role of mitochondrial membrane transition antagonists in the treatment of salicylate toxicity |
Evaluating influence of tramadol on oxycodone elimination kinetics |
Weekly Toxicology Conference with Journal Club
Every Friday, at 9:00 a.m., all faculty members, fellows, and rotating residents and medical students meet for the Weekly Toxicology Conference, which generally lasts 2 hours. Each week two to four fellows give didactic lectures (10 to 20 minutes), and provide handouts ("outlines"), on topics pertaining to acute and chronic poisoning from industrial chemicals, household agents, pharmaceutical preparations, and natural toxins/venoms. These didactic lectures with handouts allow the fellows to develop and demonstrate oral and written communication skills. Journal articles are also presented and discussed during this session. Faculty, fellows, residents, and students review articles from the recent literature (encompassing the preceding two months and the current month). All journals received by the medical center library are examined for toxicology-related articles every month. These articles are distributed to attendees of the conference so that the literature from many specialties, with reference to toxicology, is reviewed every month. All inpatient and outpatient cases from the previous week are also reviewed at this conference.