Microsoft word - fellowship_in_medical_toxicology.doc
Fellowship in Medical Toxicology INTRODUCTION:
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 OBJECTIVES 3.1 KNOWLEDGE
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
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
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
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.
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 Assessment
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 : firstname.lastname@example.org, email@example.com, firstname.lastname@example.org.
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