Traditional Track Didactics Electives

Year I
 
The toxicology fellow spends 12 months running the Clinical Toxicology Consulting Service at San Francisco General Hospital (SFGH) and the California Poison Control System - San Francisco Division (CPCS-SF) under the supervision of the medical toxicology program attending physicians. The fellow develops core knowledge content and confidence in assessing and treating poisoning and drug overdose through bedside consultations at SFGH and telephone consultations at the CPCS-SF.

Year II
 
The toxicology fellow focuses on her/his chosen research project, while continuing to attend weekly and bi-weekly required conferences and coursework in clinical study design (TICR course) and occupational medicine (Dr. Richard Cohen and OEM Clinic). Time is provided for electives in laboratory toxicology, forensic toxicology, occupational medcine, pediatric environmental health (PEHSU), childhood lead poisoning and prevention, or other areas of interest.

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Fellows partake in a number of regularly scheduled educational conferences.

Toxicology 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 San Francisco General Hospital. Daily rounds provide an opportunity for the faculty to answer questions and to provide general teaching points.

Fellows present interesting cases from the prior week for further discussion with all medical toxicology faculty members and members of the laboratory staff at SFGH. 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 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 6-8 interesting cases, and lively debate typically ensues.

Articles are selected from the current scientific literature. Fellows are assigned one article for presentation. Journal club offers the fellows an opportunity to critically evaluate the current literature, and to contemplate study design and execution for their own research projects.

Medical toxicology faculty, poison center staff, invited lecturers and senior fellows give ongoing lectures designed for the junior fellows. Lectures topics are selected based on the required core content of medical toxicology. A schedule is provided at the beginning of each academic year, and fellows are required to attend all lectures.

Fellows see patients referred to this clinic for toxicology related exposures. Cases include both occupational and environmental exposures. Some families and pediatric cases are seen as referrals from the Pediatric Environmental Health Specialty Unit. Industrial hygiene and nursing students also participate in patient evaluations, as does our faculty Industrial Hygienist. 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.

Organized and led by Dr. Neal Benowitz, this seminar introduces the fellows to important concepts of pharmacology, pharmacokinetics and pharmacogenomics.

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

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. Valerie Charlton and the DPH staff they gain a greater understanding of the diagnosis and management of patients with exposure to lead.

Fellows participate in meetings and lectures related to the functions of the San Francisco Medical Examiner's Office. Under the supervision of Amy Hart MD and the Medical Examiner's staff, fellows review results of toxicology test 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.

Fellows participate in lectures and meetings related to the function of the Toxicology Laboratory at San Francisco General Hospital. Under the supervision of Alan Wu, 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.

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 exposures, gas and heavy metal exposures among others.

During this rotation fellows develop a better understanding of the management of adult critical care patients. They participate in lectures, case conferences, work rounds and attending rounds. Fellows are expected to research topics of interest for the housestaff and provide a short series of lectures on poisonings.

Fellows participate in lectures and meetings related to functions of the PEHSU and will assist with telephone response and case investigations. Under the supervision of Dr. John Balmes, 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.

During this rotation, fellows develop a better understanding of the management of pediatric critical care patients. They participate in lectures, case conferences, work rounds and attending rounds. It is expected that they research topics of interest for the house staff and provide a short series of lectures on poisonings.

During this rotation fellows participate in the evaluation and treatment of patients with occupational and environmental illness and injury. Under the supervision of Dr. Richard Cohen, fellows develop their knowledge base in the area of occupational toxicology, including the diagnosis, management and treatment of these patients.