During years I and II, fellows will partake in both clinical service and didactics. Below, you will see how the curriculum is designed over a 24-month period.
Multi-Hospital Clinical Service
(*In the month of August Fellows will perform clinical service consults in Phoenix, AZ at BannerHealth Good Samaritan Medical Center)
|Research & Poison Center Operations||Medical ICU||Pediatric ICU||Elective||Vacation|
Multi-Hospital Clinical Service
(*In the month of July, Fellows will perform clinical service consults in Phoenix, AZ at BannerHealth Good Samaritan Medical Center)
|Research & Poison Center Operations||Elective||Vacation|
|Clinical Service Rounds||1 hour||Daily|
|Case and Morbidity/Mortality Conferences||1 hour||Weekly|
|Core Content Lectures and Literature Review||2 hours||Weekly|
|Forensics Conferences||1 hour||Bi-Weekly|
|Occupational and Environmental Toxicology Conferences||1 hour||Bi-Weekly|
|Research Conference||1 hour||Monthly|
|Journal Club||2 hours||Monthly|
Fellows will spend approximately 6 months of each year assigned to multi-hospital medical toxicology consults and 1-2 months each year assigned to research and poison center operations. In addition to providing consultations in the Emergency Department, fellows will serve as attending Emergency Medicine faculty 12 hours per week. The fellow will direct the management of multiple patients of varying complexity and degrees of illness presenting simultaneously and over time, as well as supervising residents and students. During the research and poison center operations rotation, fellows will monitor telephone calls from the public and from health care professionals.
Toxicology Core Content Lectures and Literature Review
As the core content will be covered over two years, the set of core content lectures will necessarily include both basic and advanced subject matter. The schedule of lectures will, thus, be arranged to provide an even blend of basic and advanced topics. Specifically covered topics include:
- Clinical manifestations, differential diagnosis and management of poisoning
- Biochemistry of metabolic processes, pharmacology, pharmacokinetics, toxicity and interactions of therapeutic drugs
- Biochemistry of toxins, kinetics, metabolism, mechanisms of acute and chronic injury and carcinogenesis
- Experimental design and statistical analysis of data as related to laboratory, clinical, and epidemiologic research
- Laboratory techniques in toxicology
- Occupational toxicology, including acute and chronic workplace exposure to intoxicants and basic concepts of the workplace and industrial hygiene
- Prevention of poisoning, including prevention of occupational exposures by intervention methodologies; that take into account the epidemiology, environmental factors and the role of regulation and legislation in prevention
- Environmental toxicology, including identification of hazardous materials and the basic principles of management of large-scale environmental contamination and mass exposures
- Function, management and financing of poison control centers
- Oral and written communication skills and teaching techniques
- Principles of epidemiology and risk communication, analytical laboratory techniques and research methodologies in toxicology
Fellows will be required to present toxicology lectures at a rate of approximately 1-2 per month. Some of these lectures will comprise the medical toxicology core content lectures offered to the other fellows and members of the poison center staff. Others will be provided to emergency medicine faculty and residents, including residents performing medical toxicology rotations.
Morbidity and Mortality Conference
Fellows will focus on elements of the evaluation and treatment that we correctly implemented, missed opportunities for prevention of patient deterioration and lessons learned. The fellows will also be tasked with identifying how errors incurred, might be avoided in the future and to establish learning and improvement goals related to the case and condition being discussed.
Occupational and Environmental/Forensics Conference
Fellows will assist in identifying pertinent cases for the occupational and environmental toxicology lecture/case series and will serve as discussants for forensic cases.
Research will be required for all fellows, with a requirement that a manuscript of publishable quality be submitted to a peer-reviewed journal or peer-reviewed electronic reference prior to completion of the program. Fellows will discuss the progress of their research projects at the research conference.
Fellows will be assigned articles to review and present for journal club.
Unique Program Attributes
The Department of Emergency Medicine is developing a state of the art simulation center which will offer fellows and residents challenging, realistic simulations of patients affected by a variety of chemical, biological or nuclear exposures, helping them to manage multiple casualties (triage), to broaden their differential diagnoses and to hone their treatment skills in these areas.
In addition to simulation exercises, fellows will learn about disaster preparedness through didactic triage, hospital incident command system (HICS) and tabletop scenario planning. Fellows will generate a table-top scenario involving hazardous materials in which EM Residents will act as decision makers.
Industrial Hygiene and Safety
Fellows will receive instruction in industrial hygiene basics, in order to be familiar with the scope of practice of the industrial hygienist and to be able to perform assessments of workplace health and safety.
The full-time and adjunct faculty of the Division of Medical Toxicology have considerable experience and formal training in Occupational and Environmental Medicine and will impart this knowledge through didactic sessions designed to instill understanding of environmental hygiene technology, evaluation and control of hazards, industrial hygiene practice, occupational dermatology, pulmonary function testing, evaluation and control of hazards, industrial hygiene practice, occupational dermatology, pulmonary function testing, evaluation of occupational lung disease, epidemiology and health and safety law.
El Paso is home to two schools of public health. The medical toxicology fellowship program will call on faculty from these two schools, as well as Texas Tech's own Biostatistics and Epidemiology Consulting Lab to provide educational opportunities in public health.
In addition, fellows will be afforded the opportunity to obtain a Certificate in Public Health at the University of Texas School of Public Health or the University of Texas at El Paso. The fellowship will allocate adequate time for the fellow to dedicate towards certification coursework, however, the fellow will be responsible for financing the certificate.
For more information regarding the Certificates of Public Health offered by local universities, please visit the following sites:
University of Texas School of Public Health: http://www.sph.uth.tmc.edu/elpaso
University of Texas at El Paso: http://academics.utep.edu/Default.aspx?tabid=45611
Regional Toxicology Issues
El Paso and West Texas are home to a number of venomous animals and poisonous plants. Fellows will gain experience in the management of rattlesnake bites and black widow (Latrodectus spp.) bites. During the rotation at BannerHealth in Phoenix, fellows may have the opportunity to treat bark scorpion (Centruroides spp.) stings and the bite of the Gila monster (Heloderma spp.).
In addition to its poisonous flora and fauna, West Texas is home to the petrochemical industry and its attendant chemical risks. Exposures to hydrocarbon derivatives, hydrogen sulfide, nickel carbonyl, strong mineral acids and hydrofluoric acid are fortunately rare, but do provide important experience to fellows when they occur.
It is our intention that all fellows become comfortable in spoken and written Spanish. We will encourage this through Spanish language lessons taught in association with the emergency medicine residency curriculum, through packaged training courses, and occasional presentations of medical lectures in Spanish. One of the most unique opportunities afforded to our fellows in provided by the West Texas Regional Poison Center. Fellows will have the opportunity to practice Spanish daily in talking with patients and interacting with fellow professionals and to field poison center calls in Spanish. Beyond simply learning Spanish, fellows will learn of the challenges involved in providing poison center services to a multicultural population.
Substance Abuse Treatment
Significant progress has been made in recent years in the realm of substance abuse treatment, particularly in the area of substitution therapy. Fellows will learn about Buprenorphine Maintenance Therapy and may become certified to provide this therapy for opiate-dependent patients. In addition, fellows may learn about naltrexone implant therapy, used for narcotic as well as alcohol addiction.
Transnational/Border Occupational and Environmental Health Issues
West Texas and Southeastern New Mexico are the seasonal home to many migrant farm workers who cross the US/Mexico border annually to work in the fields and orchards of the region. Among these workers, occur significant exposures to pesticides and other agrichemicals, which may affect not only the workers, but their families when contamination is spread to home from the workplace. The Division of Medical Toxicology is working to develop a system of health surveillance and longitudinal research on migrant worker health issues.
El Paso's geographic location places it at the crossroads for substantial illegal importation of illicit drugs and other chemical and biological hazards. Fellows will learn about the methods of concealing these hazards, including the use of bodypackers and other living vectors, and methods for detecting them.
In addition to the intentional illegal shipment of hazardous substances, environmental releases of hazardous substances from the many maquilas in Northern Mexico as well as industrial installations in Texas and New Mexico may result in cross border pollution of air and water. Fellows will learn of the activities of the Border 2012 initiative and future projects to protect environmental and occupational health in the transborder region.
Medical Toxicology Clinic
The Division of Medical Toxicology is establishing a Medical Toxicology Clinic for the evaluation of occupational and environmental toxicant-related illness and for follow-up of patients seen during inpatient and outpatient consultations. This clinic will afford fellows the opportunity to evaluate acute, subacute, and chronic toxicological illnesses and to differentiate them from illnesses not caused by toxic substances.
Medical Toxicology Research
The Division of Medical Toxicology is constantly expanding its research activities. Research will be required for all fellows, with a requirement that a manuscript of publishable quality be submitted to a peer-reviewed journal or peer-reviewed electronic reference prior to completion of the program. Original research is preferred. Current medical toxicology division projects include multi-center clinical trials of crotaline antivenoms, black widow spider antivenoms, two forms of n-acetylcysteine and the use of intraosseous access for rapid delivery of lifesaving drug and fluid therapy. Fellows will have the opportunity to participate in ongoing studies and/or initiate new projects.