Toxicology Fellowship 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, then discuss active cases. 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.
Tuesday Conference Day
On Tuesdays, our Fellows participate in our weekly toxicology conference.
Tuesday mornings, fellows and the Program Director or other Toxicology faculty discuss a fellow didactic topic. The topics range from professional development to occupational/industrial processes and toxicity to environmental, forensic, and addiction toxicology. All topics can be viewed here.
Fellows also review “minor toxicology topics” which include chemicals with significant toxicity that are not typically encountered commonly in clinical practice.
On Tuesday afternoons, fellows and faculty discuss a core topic by doing a textbook chapter review. Chapter reviews include core topics from Goldfrank's Toxicologic Emergencies , 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.)
Journal Club
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.
Teleconference
On Mondays at 1pm, the fellows and faculty participate in a multi-state teleconference. Clinical toxicologists from several states and provinces, including Oregon, Washington, Alabama, Utah, and Calgary, 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 quarterly.
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.
Journal Review
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.
Dogma Review
Once per month, the fellows and faculty review papers on a piece of dogma in medical toxicology. Papers are chosen by toxicology faculty 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.
Fellow Didactics
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.
Poison Center
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.
Addiction Medicine/Toxicology
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.