Curriculum - Didactic Teaching Schedule
Core Toxicology Sessions
In July and August of every year, the Fellows participate in our "Core Toxicology" lectures. During this time, we have no residents or students taking our rotation and the time is reserved specifically with the fellows. In the morning, our fellows and faculty round on in-patient toxicology consultations. In the afternoon, our Faculty give interactive or didactic sessions on core toxicology topics. This serves as an introduction for junior fellows and allows senior fellows to solidify their core knowledge base.
Wednesday Conference Day
On Wednesday afternoons, our Fellows and Faculty participate in our weekly toxicology conference.
On the first Wednesday of the month, we delve deep into "Neurotransmitters and core tox principles" and review important receptor agonists/antagonists, receptors, and core toxicology chapters.
On the second Wednesday, we review an 'Core pharmaceutical/drug' chapter from Goldfrank's Toxicologic Emergencies . These topics are the core pharmaceuticals that clinical toxicologists encounter and are intended to cover all of the major pharmaceuticals in a 2 year period.
On the third Wednesday of the month (and the 5th Wednesday if there is one), we review a 'Core Occupational/Environmental Toxin' chapter from Sullivan and Krieger's Clinical Environmental Health and Toxic Exposures , Rom's Environmental and Occupational Medicine , and from Occupational, Industrial, and Environmental Toxicology (Greenberg, ed.) . This is intended to allow the Fellow to cover all of the major occupational and environmental disorders in depth through the 24 month Fellowship.
On the fourth Wednesday of the month, we review a "Toxicologic Principles" chapter from Goldfrank's Toxicologic Emergencies . This is intended to allow the Fellow to look in-depth into the core toxicology principles over the 24 month fellowship.
We have a monthly Journal Club on recent and important articles/topics. Articles are chosen by the faculty and reviewed by faculty, fellows, residents, and students. Our journal clubs are recorded and available on our tox podcast website.
On Mondays at 1pm, the fellows and faculty participate in a multi-state teleconference. Clinical toxicologists from several states and provinces, including Oregon, Washington, Calgary, and New Jersey, routinely participate and discuss cases from the week. This allows for in-depth discussions of common topics in clinical toxicology as well as laboratory toxicology. Our fellows present cases for this conference once per month.
National case conference
On the third Thursday of the month, our program participates on a national case conference where cases are discussed with toxicology programs throughout the country.
Twice a month, the fellows and faculty review recent and important published papers chosen by the Program Director. The purpose of this journal review is to keep all participants up to date on the literature and allow for discussion of topics not covered in the formal didactic curriculum.
Once per month, the fellows and faculty review papers on a piece of dogma in medical toxicology. Papers are chosen by the program director and reviewed by faculty and fellows. This allows us to review the original papers on dogmatic topics to truly understand the research that was done and its implications.
On every Wednesday morning, our faculty meet with our fellows without students, residents, or other learners. During this time, our faculty present on board review topics or we discuss topics that are specific to fellows. For example: How do you build a CV for a medical toxicology practice? What are the job opportunities after fellowship? How do you review manuscripts for journals? How do you become an expert for legal cases and how do you review these cases? How do you talk to the media in print, radio, and television (including live)?
In-patient Consultative Service
Our toxicology service sees patients in both the Oregon Health and Science University (OHSU) Hospital and the Doernbecher Children's Hospital (DCH). These hospitals, which see more than 400,000 annual patient visits and comprise over 700 total inpatient beds are all located within a short walking distance from the fellow's office in Poison Center. Doernbecher Children's Hospital is the largest children's hospital in Oregon and a Level-1 pediatric trauma center and frequently is the referral site for toxicology patients, including many followed by the Poison Center prior to transfer. OHSU is the only medical school in the state and a major tertiary care pediatric and adult referral center. OHSU and DCH receive transferred patients from Northern California, southern Washington, and the entire state of Oregon. The toxicology service has a congenial and respectful relationship with referral institutions as well as referring services on campus.
Toxicology fellows gain significant breadth and depth of knowledge while taking call for the Poison Center. The Oregon Poison Center handles about 70,000 phone consultations per year from a catchment area that covers Oregon, Alaska, Guam and the Northern Marianas Islands. Our faculty and fellows also handle poison center calls from the Utah Poison Center about 2 weeks out of the month.
This diverse catchment area allows our fellows to learn the entire spectrum of toxicology, from acute care toxicology in Portland, Oregon to marine envenomations (e.g. Lionfish, Stonefish) in Guam, shellfish poisoning on the Oregon Coast (e.g. paralytic shellfish poisoning, domoic acid poisoning) to snake bites from Eastern Oregon and mushroom toxicity in Western Oregon. Our fellows learn how to handle toxicology cases in large cities where laboratory testing and resources are readily available, as well as in remote frontier Alaska and in Guam, where testing is highly limited and transfers may take days.
Occupational / Environmental Toxicology
All occupational toxicology topics in the Core Curriculum are covered in the didactic curriculum. However it is important for toxicology fellows to have clinical experience with occupational and environmental toxicology patients in order to gain experience in obtaining a detailed exposure history, understanding the confounding factors which complicate occupational toxicology assessments, understanding the limitation of analytical tests in the occupational setting and gaining familiarity with the economic medico-legal aspects of the field. Our fellows gain this experience in several ways.
Our fellowship is privileged to be affiliated with a private practice Medical Toxicologist, Brent Burton, MD, who sees occupational toxicology cases full-time. Once a month, our fellows see patients with this toxicologist in his office.
In addition, though it is not a core part of the fellowship, our fellowship faculty occasionally see occupational and environmental toxicology outpatient consultations at OHSU. This is usually reserved for patients with known severe toxicity or unique cases and we see about a 10 patients per year. Examples of cases that we have seen include lead toxicity, thallium toxicity, manganese toxicity, solvent neurotoxicity, and snakebite follow-ups.
Dan Sudakin, MD, is a toxicology faculty member who has a thriving outpatient addiction medicine office practice. Our fellows spend time in his office where they gain experience with buprenorphine induction and maintenance.
Once a month, the OHSU medical toxicology program participates on a video teleconference to discuss topics in occupational toxicology. Our fellows and faculty video conference with multiple sites in Thailand. Thai participants are medical toxicologists, occupational physicians, and nurses and physicians who care for patients with occupational exposures to toxins. OHSU participants are toxicology fellows and faculty, as well as occupational physicians, and experts in occupational toxicology topics. Examples of topics that we have discussed include exposures to metals (e.g. arsenic, mercury, lead), solvents, and caustics as well as nanotoxicology, biological monitoring, reduction of worker exposures, the petroleum industry, and industrial chemical releases. This conference exposes our fellows to international occupational toxicology and toxicology exposures that are not commonly seen in the United States.