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Banner — University Medical Center Phoenix  
Resident Rotation
 

Medical Toxicology Rotation for House Staff

Goals
The resident will:
1.Develop clinical skills to assess a poisoning emergency
2.Develop problem-solving skills to manage clinical situations from poisoning and adverse drug reactions.
3.Understand the pharmacology and mechanism of toxicity of the more frequently encountered drugs and toxins.
4.Learn the appropriate applications of antidotes and specific therapies for common toxins.
5.Learn how to access, critically appraise, and apply the findings of the medical literature in clinical situations. In addition, learn how to access other toxicology specific resources, which assist in the management of poisoned patients.
6.Understand the functions of a poison center and how the public and medical community can access it.

Structure of the Rotation
The Medical Toxicology service can accept a maximum of five rotators per month. This is a one month rotation open to residents who will participate in a minimum of three weeks (one week vacation is allowed) assuming call requirements are met. The rotation is not available in December nor is it available to residents and students unable to make a minimum of three Friday morning “Weekly Toxicology Conference with Journal Club” due to clinic assignments or other absences.

Call:
Residents are expected to take 7 days of call during the month. If the resident has scheduled a one week vacation 5 days of call are required. The call days should include one Friday, Saturday and Sunday. Residents may establish their own call coverage assuming the above requirements are met. The on-call resident should be at the hospital and available for admissions until 5:00pm, after which time the resident may take call from home. The resident will be expected to come in for all admissions, consults or problems. For all admissions and consults, a fellow or staff member will always accompany the resident. The residents will NOT be expected to provide medical back-up for the Poison Center. Toxicology is a “front-loaded” specialty, in that patient’s are sickest in the first several hours; consequently, call offers early patient contact which provides the best learning experience for the resident.

Morning Rounds:
Residents are expected to participate in daily morning rounds which begin at 9:00 a.m. Residents will be expected to pre-round and write daily notes prior to 9:00 a.m. Residents will be expected to round on patients that are admitted while the resident was on call until the patient leaves the hospital. The resident should contact the post-call fellow or resident each day to see if they can assist in any patient care responsibilities prior to Morning Rounds.

Poison Center Call Monitoring:
Residents should spend at least 6 hours during the month monitoring calls at the Poison Center. Contact the Poison Center to schedule a time to monitor calls @ (602) 253-3334.

Conferences and Activities

Poison Center Case Review Conferences

The Poison Center gives recommendations and follows poisoning cases statewide. Every Monday at 11:15 a.m. residents, fellows, and staff gather to discuss interesting and educational patient cases. Cases are utilized to discuss diagnostic and treatment plans for envenomations, poisonings with pharmaceutical agents, and occupational/environmental exposures.

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. 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.

Clinical Toxicology Chapter Review

Every Monday at 10:30 a.m. a faculty member meets with the fellows and residents 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.

Occupational Toxicology Chapter Review

Every other Tuesday at 10:30 a.m., a faculty member meets with fellows and residents 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

Once 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.

Resident Presentations

During the month, each resident is expected to review and present 2 topics related to toxicology for the group during the Friday didactic. The subject should be discussed with and approved by staff prior to presentation. Topics should be researched, outlined and presented in a 10-15 minute presentation. A typewritten outline with a bibliography should be handed out at the time of presentation.

Core Lectures

Core lectures will be presented by staff or fellows each week and will cover the topics listed below. Each resident will receive a reading packet with pertinent articles and chapters reviewing the core content. The resident is expected to complete the reading prior to the core lecture.

General Management Plants/Mushrooms
Acetaminophen Snakes/Scorpions
Salicylates Carbon Monoxide
Cardiac Toxins Neurotransmitters
Tricyclic Anti-depressants Toxic Alcohols

Information Search and Retrieval

The residents will be assigned subjects during the week to be researched and articles retrieved from either the medical library. These searches will be in response to questions directed to the poison center by other health care providers or institutions. They will require rapid turn-around. The resident will be taught how to perform productive literature searches during this procedure.

Exit Examination

The exit examination helps evaluate what the resident has learned and identify areas where we should concentrate our efforts in teaching. Performance on the exit examination will be reflected on the resident’s evaluation for the rotation. Residents who leave the service early should arrange to take the examination before leaving.

  Monday Tuesday Wednesday Thursday Friday
8:00-9:00 Write Notes Write Notes Write Notes Write Notes Write Notes
9:00-10:00 Tox Rounds Tox Rounds Tox Rounds Tox Rounds Didactics/Journal Club
10:30-11:15 Goldfrank's Chapter review Occupational Ch. Review/ Board Review     Didactics/Journal Club
11:15-12:15 Poison Center Conf        

Contact Teri Glidewell at 602-839-6690 or via email [email protected] before the start of the rotation.

On the first day of your rotation please arrive at the Medical Toxicology offices at 925 E. McDowell, 2nd floor at approximately 8:30 a.m. so that Teri can initiate your orientation and direct you to academic rounds.

Teri Glidewell 839-6690 (Front Desk/Tox)

Poison Center (602) 253-3334 or 1-800-222-1222

Thank you and we look forward to your rotation.