Medical Toxicology is officially recognized as a medical subspecialty by the American Board of Medical Specialties. The American College of Medical Toxicology (ACMT) describes medical toxicology as a medical subspecialty focusing on the diagnosis, management and prevention of poisoning and other adverse health effects due to medications, occupational and environmental toxins, and biological agents. Examples of exposures commonly evaluated and managed by Medical Toxicologist include drug overdoses, either intentional or unintentional, of therapeutic pharmaceutical drugs or drugs of abuse, envenomations, ingestions of food borne or plant and mushroom toxins, hazardous exposures to chemical products, particularly those in industry, either acutely or chronically such as pesticides, heavy metals, toxic gases, and toxic alcohols and solvents. In addition Medical Toxicology training provides expertise in drug abuse management particularly drug withdrawal as well as skills used to assess injury and disability resulting from a wide variety of potentially toxic exposures.

This diverse and broad training prepares physicians who are board certified in Medical Toxicology to practice in a variety of professional settings. The most common practice is to provide direct treatment and consultation of acutely poisoned patients in an emergency department or intensive care setting. This is often based in a teaching hospital practice integrating patient care with teaching, administrative and research opportunities. However vast arrays of other opportunities are available as well including poison control center management where one can provide 24 hour consultation services to health care providers and the general public as well as integration into the public health network for the community particularly for mass casualty exposures or unusual clusters of potential toxin related illness. Industry and commerce has numerous opportunities for Medical Toxicology including in drug discovery and pharmaceutical research, product safety, and regulatory drafting. There are opportunities in various agencies particularly those focused on public safety and regulation such as the U.S. Food and Drug Administration, the Occupational Safety Health Administration, and the U.S. Environmental Protection Agency as well as nongovernmental advocacy and industrial groups.

Medical Toxicology training lasts a minimum of 24 months and the training program must be associated with an ACGME-accredited residency in emergency medicine, pediatrics or preventative medicine and board eligibility requires successful completion of an ACGME-accredited residency in one of these medical specialties.

During this training a fellow will be exposed to a broad and detailed curriculum, as defined by the ACGME, including:

1. The clinical manifestations, differential diagnosis and management of various poisoning.
2. The pharmacology, pharmacokinetics, potential teratogenesis, and toxic effects of various therapeutic drugs.
3. The biochemistry, metabolism, mechanisms of acute and chronic injury and carcinogensis of various compounds.
4. Research skills include experimental design, statistical analysis, and the principles of epidemiologic study as well as skills to critically read, reviewing and interpret the scientific literature.
5. Interpretation and methodology of analytical toxicology laboratory results and techniques.
6. Occupational toxicology, including acute and chronic exposure in the workplace.
7. Poisoning prevention and the role of regulation and legislation as effective tools to promote this, particularly in the workplace.
8. Environmental toxicology particularly the basic principles of mass incidents including logistics of resource management and decontamination.
9. The role of poison control centers as well as their financing and management.
10. Educational skills particularly oral, visual, and written communication.

This training may be based at a poison control center or an academic medical center. Practically speaking the bulk of your clinical training will include phone consultation to emergency physicians and intensive care specialists who are at the bedside of poisoned patients or by providing that care directly either in an emergency department or an inpatient setting as the primary care provider in an intensive care setting or as a consultation service. In addition, daily teaching and case discussion with medical students and residents helps solidify concepts and improve teaching skills. Occupational medicine training may include regular didactic sessions about unique occupational exposures or diseases, a medical assessment clinic examining and counseling patients for possible toxin exposures.

1. Who are the teaching and supervising faculty of medical toxicologists and what their areas of interest and research are?
2. Is there opportunity to continue to work in your area of specialty training Emergency Medicine, Pediatrics, Preventative medicine) and is it required? If so what is the clinical obligation?
3. How is the occupational medicine training structured?
4. What types of positions have the graduates from the fellowship program obtained after training?
5. What is the relationship between the residents of the associated ACGME residency program and the Medical Toxicology fellows? (This is typically the emergency medicine residency) Also what is your role in the training of these residents?
6. What are the research opportunities and requirements?
7. Will you have adequate protected time for research, study time, and development of lectures and other educational tools?
8. How is the fellowship funded? Is this position funded through GME dollars, from departmental or poison center funds, or from grant money?
9. Is the fellowship accredited?