Our two-year fellowship in Medical Toxicology is available to
physicians who have completed residency training in occupational medicine,
pediatrics, or emergency medicine, and are board certified or board
eligible in their respective specialties.
Because fellow and attending toxicologists act as primary
physicians for poisoned patients, competence in critical care is required.
The goals of the fellowship are the following:
To develop expertise in the diagnosis and treatment of acutely and
chronically poisoned patients. This
encompasses intentional and accidental poisoning from pharmaceutical
agents, plants and venomous animals, household products and from
To become familiar with industrial hygiene procedures for
environmental monitoring, OSHA regulations, NIOSH criteria documents,
NIOSH proposed standards, documentation used by ACGIH for determining TLVs,
and general industrial toxicology.
To become familiar with the medical effects of hazardous materials,
and to become competent in managing the medical complications seen after
hazardous material incidents.
To actively engage in both animal and human research that produces
relevant information which can be used in the treatment of poisoned
To actively disseminate information gathered in research by
publishing results in medical journals and by making presentations at
national and local medical meetings.
To participate in the training of medical personnel ranging from
paramedics to physicians in training.
To become knowledgeable in basic pharmacology, drug interactions
and pharmacokinetics, and to provide these services to physicians in the
To spend time in the toxicology laboratory and become familiar with
To promote expertise in the operation of a regional
poison center and in the public services provided by such a center.
To become competent in the prevention of poisonings in the home and
work place through public education programs and through direct
involvement with industry.
To become knowledgeable in the practice of hyperbaric medicine as
it pertains to toxicology.
12. To prepare physicians for certification by The American College of Medical Toxicology, and the certifying primary boards of
Emergency Medicine, Pediatrics, and Preventive Medicine.
FACILITIES AND PATIENT POPULATION
toxicology consulting is also provided to Scripps Mercy Hospital, the San
Medical Center, Balboa Naval Medical Center and Children’s Hospital all of
which are major medical centers in the metropolitan San Diego area. UCSD Medical Center is the only tertiary referral center for
poisoned patients in southern California, accepting patients from Los
Angeles, Orange, Riverside, San Bernardino, and Imperial counties and
occasionally from western Arizona.
spectrum of poisoned patients encountered by fellows is wide and includes
accidental adult and childhood drug ingestions, recreational drug abuse,
suicide attempts, adverse drug effects, plant and mushroom poisoning,
envenomations by venomous creatures, and industrial toxicology problems.
The Medical Toxicology service also manages carbon monoxide poisonings through our
California Poison Control System (CPCS) is comprised of centers from four
regional areas in California. The San Diego Division of the CPCS is
located at UCSD Medical Center and currently receives over 80,000 calls
per year, serving San Diego, Imperial, Orange, Riverside and San
Bernardino counties, the fastest growing metropolitan area of its size in
the United States.
Other sites are located in San Francisco, Sacramento, and
theFresno/Madera area. The Division is part of the largest integrated poison control system in the world serving over 32 million people. The CPCS is linked together by an integrated data collection and communications system. The management and medical staff work cooperatively to provide uniform treatment protocols for the entire state. Pharmacists, nurses, and specialists who have received training in the diagnosis and management of poisonings and have been certified as specialists in poison information (SPI) by the American Association of Poison Control Centers staff our Division.
The fellow is on call for 24 hours
approximately every third day. The
faculty provides full-time medical backup for fellows.
The responsibility of taking call under supervision of faculty
Handling phone and patient consultations from physicians.
2. Round with the attending daily on poisoned patients at all facilities where inpatient consultation is provided
Acting as medical backup for the staff of the Poison Center.
Providing bedside consultations on poisoned patients at UCSD,
Thornton Medical Center, Children’s Hospital, VA Medical Center, Scripps
Mercy Hospital, and Balboa Naval Medical Center.
Participating in medical toxicology outpatient care, including
seeing new outpatients and seeing discharged patients in follow-up, and
staffing the VA outpatient toxicology clinic.
Acting as medical authority for hazardous material incidents in the
Greater San Diego area.
Consulting and providing care on patients requiring hyperbaric
oxygen therapy for carbon monoxide poisonings.
8. Personally consulting by telephone on inpatients with poisoning-related illnesses at other community hospitals.
AND PREVENTIVE TOXICOLOGY
Programs are established at the Department of Preventive Medicine
for incorporation of medical toxicology into the services available to
patients. Patients will be
scheduled appointments to be seen in a medical toxicology clinic.
Drs. Fred Fung and Steve Munday are specialists in the field of
occupational medicine with subspecialty certifications in medical
toxicology. Both are closely affiliated with our Division.
Dr. Fung is the Director of Occupational Toxicology at Sharp
Hospital in San Diego, and is active in teaching the residents and fellows
occupational toxicology at Journal Club, occupational toxicology
consultations, occupational toxicology lectures, and conducting field
A Medical Toxicology clinic is presently held on an “as
scheduled” basis through the Urgent Care Center at UCSDMC.
Patients are scheduled by appointment through referrals in the
community or directly by patients desiring to be seen by a medical
toxicologist. The fellow will
participate in the staffing of this clinic.
v TOXICOLOGY JOURNAL CLUBEvery month, fellows are expected to review the table of contents of all publications received at UCSDMC library to search for articles dealing with toxicology (medical, industrial, forensic, analytical), adverse drug reactions, and pharmacology. In addition, the fellow will review selected bibliographies to search for similar articles. The references in all new and updated managements in PoisindexR will be reviewed to search for articles of interest. At the Medical Toxicology conference every Monday, two hours are devoted to journal club. It is the fellow's responsibility to organize and distribute articles to all conference attendees.
Every Monday the Division of Medical Toxicology holds a teaching
conference for toxicologists, fellows, pharmacists, house staff and
students rotating on toxicology or pharmacology services.
The fellow will present a 10 to 15 minute presentation on a major
topic pertaining to toxicology every week, in addition to participating in
case reviews and journal club.
Emergency department teaching and
Morbidity and Mortality conferences are held every Tuesday morning.
A toxicology related topic is presented monthly (or as interesting
cases occur). Fellows may be
responsible for presenting and discussing such cases.
Emergency Medicine Grand Rounds are the second Tuesday of every
month with Morbidity and Mortality conferences every Tuesday.
Internal Medicine Grand Rounds are every Wednesday with Morbidity
and Mortality conferences every Friday.
Toxicology-related cases or issues are frequently presented at
these gatherings and the fellow will be expected to attend and
Medicine Morning Report is held several times a week and may be attended
by the fellow and toxicology staff as time permits for discussion and
teaching of pertinent toxicology cases.
Medical toxicology fellows are expected to participate in
presenting didactic material at these conferences.
The CPCS has a twice-monthly educational teleconference with all
statewide sites participating. The
format of these teleconferences is case presentation and discussion. New and ongoing system-wide studies are discussed in
this setting. System policies concerning treatments are also reviewed.
The Division of Medical Toxicology at UCSDMC is frequently asked to
provide speakers for conferences at the Veterans' Administration Medical
Center, UCSD Medical Center, Children's Hospital, and other miscellaneous meetings.
Fellows are expected to share in the responsibility of making these
The fellow will spend some time during the first two months of the
fellowship in the Poison Center working with the nursing and pharmacist
personnel. Activities will
include answering phones, using poison center resources, and making
follow-up telephone calls. This
will allow integration into the system and facilitate communications among
Fellows will also be involved in poison center Continuous Quality Improvement (CQI) by reviewing selected cases being managed by poison center staff. These cases will serve as a springboard for educational discussion with students, residents and attendings. Treatment recommendations will be provided to the requesting party by phone and documented into the poison center database by the fellows.
Fellows are requested to participate in at least one animal
research project and one clinical research project during the medical
toxicology fellowship. Seed
money is available for research endeavors through the Division of Medical
Toxicology research fund. The
fellow will be responsible for designing the project, obtaining grants and
moving the projects through various committees, including the
Institutional Review Board, with the assistance of the attending
physicians. In conducting the
research projects, the fellow is expected to gather experience in biostatistics, medical epidemiology, and preparation of manuscripts for
publication. The Division of
Medical Toxicology and the VA Medical Center provide computer support,
office space and supplies to the fellow.
Animal research can be conducted at UCSDMC or other affiliated
veterinarians and veterinary technicians staff these centers.
Fully equipped operating rooms and facilities for invasive
monitoring, general anesthesia, radiology, and long and short-term animal
care are available. Many
projects are currently underway by the Division of Medical Toxicology,
including several large multi-center trials of new therapies for poisoned
patients. Other smaller
studies are ongoing as well. All the listed and unlisted projects are immediately
available for fellow participation.
Formal didactic courses in medical epidemiology and biostatistics
are offered at the Medical Center and on the UCSD Campus.
Time will be provided for the Fellow to attend at least one of
these courses during the program.
The fellow is expected to submit at least two manuscripts for
publication to medical journals or as book chapters.
At least one of these will deal with results obtained from research
projects alluded to above. Others
may include reviews, clinical series or case reports.
PUBLIC HEALTHAn affiliation has been established with the School of Public Health at San Diego State University (SDSU). Fellows will have the opportunity to obtain a degree in public health from SDSU while completing the Medical Toxicology fellowship at UCSD.
Funding for the fellowship is provided by the Veteran’s
Administration through an educational fund. Fellow’s salaries are in
accordance with other physicians completing postgraduate training at UCSD.
There are no requirements of the fellow to provide patient care outside of
the direct responsibilities of the fellowship. Fellows may elect to
supplement their incomes by moonlighting. These opportunities may be available at UCSD or other
hospitals in the San Diego area. Total monthly moonlighting commitments
are not to exceed 32 hours and may not conflict with any fellowship
Information about the following items can be found on the UCSD Graduate Medical Education website at the following address: http://ogme.ucsd.edu
Terms and Conditions of Appointment to UCSD GME Training Programs
Officer Policy and Procedure Document
- This document
contains information regarding:
eligibility, selection and nondiscrimination criteria
and working conditions policy
regarding Evaluation, Promotion, Corrective Action, and Dismissal