Microsoft word - fellowship_in_medical_toxicology.doc

Fellowship in Medical
Internationally toxicology is a sub-speciality of emergency medicine with separate certification. In the western part of the world poisoning is mainly due to tablet overdose and industrial accidents. India being a developing country the incidence of poisoning , envenomation and chemical exposure is increasing. Apart from this an increased incidence of plant and chemical poisoning is unique to India, for which there is very little published research and inadequate guidelines for the management of these poisonings. A significant proportion of patients seeking emergency medical care in India come due to the manifestations of chemical and plant toxicity. Moreover the awareness of the need for Medical toxicologists is virtually non existent in India and hence, Medical toxicology as a separate specialty is long overdue. Medical toxicology encompasses the pathophysiology, diagnosis, and treatment of clinical problems related to poisoning and drug intoxication. Medical toxicologists treat patients with acute drug overdoses, as well as those poisoned by industrial chemicals, snakes, plants, herbs and alternative Medical toxicologists are emergency physicians, Intensivists, pediatricians, general physicians, Clinical Phamacologists and Forensic experts put together and no single speciality can fulfill this need intoto. Hence it is necessary to initiate Medical toxicology as a separate speciality with input from the various specialities. They direct poison control centers and advice The training program includes direct patient care, consultation to poison centers and evaluation of cases at the centers, rotations in critical care, Emergency medicine, preventive medicine; and course work in clinical pharmacology, pharmacokinetics, and the medical management of exposure to hazardous chemicals, plants and envenomation. The goal of the training program is to produce a Fellow in Medical Toxicology with the necessary knowledge, skill and attitude to diagnose and manage a wide range of clinical problems in Toxicology. The qualities to be absolutely necessary:
2.1 Sound knowledge and skills in the management of various
poisonings, drug overdose chemical exposures and 2.2 Competent in life saving emergency interventions and
appropriate use various diagnostic tests, and interpret their results 2.3 Be familiar with the fundamentals of research methodology.
2.4 Possess humanistic qualities, attitudes and behaviour necessary
for the development of appropriate patient-doctor relationship. 2.5 To assist and if necessary train juniors.
2.6 To keep up-to-date and be familiar with all recent advances in the
As a result of the training under this program, at the end of 1 year of postgraduate training, a resident must acquire the following 3.1.1 A thorough knowledge of pathological abnormalities, clinical manifestations, and principles of management of toxicological 3.1.2 Skill and competence to choose and interpret correctly the results of the various routine investigations necessary for proper management of the patient. While ordering these investigations, a resident must be able to understand the sensitivity, specificity and the predictive value of the proposed investigation, as well as its cost-effectiveness in the management of the patient. 3.1.3 Skill and competence in emergency interventions like endotracheal intubation, needle cricothyrotomy, defibrillation, mechanical ventilation, hemodialysis, ultrasonography, Echo etc. 3.1.4 Skill and competence in handling the appropriate antidotes 3.1.4 Skills and competence to perform commonly used diagnostic procedures, namely, blood and body fluids collections, 3.1.5 Skill and competence to choose and interpret correctly the results of specialized investigations including radiologic, ultra- sonographic, biochemical, hemodynamic, electro-cardio graphic, electrophysiological, pulmonary functional, hematological, immunological, nuclear isotope scanning and arterial blood gas 3.1.6 Skill and competence to provide consultation to other medical and surgical specialties and sub-specialties, whenever needed. 3.1.7 Skill and competence to function effectively in varied clinical settings, namely emergency/critical care, ambulatory care, out- Skill and competence to take sound decisions regarding hospitalization, or timely involvement of other consultants of various medical sub specialties recognizing his limitations in 3.1.9 Proficiency in selecting correct drug combinations for different clinical problems with thorough knowledge of their pharmacological effects, side-effects, interactions with the other drugs, alteration of their metabolism in different clinical situations, including that in the elderly. Skill and competence to advise on the preventive, restorative and rehabilitative aspects including those in the elderly, so as to be able to counsel the patient correctly after recovery from an acute or chronic illness. Skill and competence to undertake a critical appraisal of the literature published in various journals and be able to apply the same in the setting in which the resident is working. Skill and competence to work cohesively in Resuscitation teams along with paramedical personnel, maintain discipline and Skill and competence to communicate clearly and consciously, and teach other junior residents, medical students, nurses and other paramedical staff, the theory as well as the practical clinical skills required for the practice of Medical 3.2 INTEGRATION
The entire educational program will be conducted in an integrated and co-ordinated manner in association with various para-clinical and clinical departments . The senior staff members of these departments will be requested to give lectures on various topics in relation to Eligibility Requirements:
MBBS or diploma / PG degree in anaesthesia, paediatrics, Respiratory medicine and General medicine. Syllabus
1. Principles of Toxicology
Pharmacokinetics /Toxicokinetics – metabolism, absorption Biokinetics – elimination/Clearance models Pharmacodynamics/Toxicodynamics – dose relationship to effect, agonism/antagonism Pharmacogenomics/Toxicogenomics – Xenobiotic response, gene profiling Mutagenesis, carcinogenesis,teratogenesis 2. Airway
3. Cardiac Emergencies related to toxicology
Management of Shock and IV Fluid Therapy 5. Neurological Emergencies
6. Respiratory Emergencies
7. Surgical Emergencies
8. Paediatric toxicology
Approach to the poisoned Pediatric Patient 9. Wound Assessment and Management
10. Local Anesthetics and Anesthesia
11. Analgesia and sedation
12. Imaging
Emergency and Critical care Sonography, x-ray, CT scan and MRI. 13. Toxicology
Treatment of Hypotension Associated with Drug Poisoning Illicit Drugs and Controlled Substances of Abuse Organophosphate and Organocarbamate Poisoning 14. Endocrine Emergencies
15. Acid Base and Electrolytes
Acid Base Balance and Interpretation of Blood Gas Results 16. Burns
17. Emergency Department Anaphylaxis
18. Emergency Department Bites & Stings
19. Envenomations
Snake Bite Emergency First Aid Information 20. Environmental/ Industrial Emergencies
21. Mechanical Ventilation
22. Urogenital Emergencies in the poisoned patient
23. Transfusion Emergencies
24. Hepato- Biliary Emergencies related to toxicology
25. Psychiatric Emergency and counselling
26. Legal Aspect of Medical Toxicology
Paper I Theory (100 marks) -Minimum 50% Pass Paper II Theory (100 marks)- Minimum 50% Pass Clinical examination and Viva (150marks) – Minimum 50% pass Clinicals and viva to be conducted by a panel consisting of an internal examiner and an external examiner. Fee Structure
Total Course Fee:

Total Course Fee: Rs.75, 000/-
Application Procedure
Duly completed application form is to be submitted with necessary
documents along with fees in the form of a crossed Demand Draft drawn in
favour of "Vinayaka Missions University", payable at Salem. Write your
name and course name in the back of DD / Cheque
Application should send to:
The Registrar,
Vinayaka Missions University
Tel : +91427 -398 7000
Mobile: 9789660560,9362127345, 7305274550 E-MAIL :,,



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