Toxicology, Career Planning, Practice Environments, Medical Students, Advising

Toxicology: A Unique EM Subspecialty

Toxicology is a field many medical students don’t know much about. There just isn’t much exposure. In fact, many toxicology fellows didn’t realize they were interested in the field until residency. So, what exactly is toxicology and what do toxicologists do?

Toxicology is a clinical subspecialty field of Emergency Medicine. It deals with “acute drug poisoning; adverse drug events; drug abuse, addiction and withdrawal; chemicals and hazardous materials; terrorism preparedness; venomous bites and stings; and environmental and workplace exposures.” As a subject, toxicology has very strong clinical foundations and requires interest and dedication to areas such as pharmacology, pathophysiology, organic chemistry, and research.

The Pathway into Toxicology
During the second-to-last year of an EM residency, residents will apply to one of 30 toxicology fellowship programs in the U.S. The schedule during the 2-year fellowship is different from the block schedule regularly found in EM residencies. Toxicology fellows generally work “regular business hours” performing clinical work in the hospital, conducting and publishing research, attending conferences and didactic lectures, and being on-call for Certified Specialists in Poison Information (CSPIs) in the poison control center, in addition to call covering the toxicology service at night. The “on-call” schedule will vary between programs.

Once board-certified, toxicologists can be found working in EDs or in academic, governmental, and public health settings, as well as in poison control center leadership. In EDs and ICUs, they provide bedside consultation and treatment of acutely poisoned adults and children. On the national and regional level, toxicologists are often found within the leadership of a poison control center. There they provide information and guidance to physicians, first responders, public health officials, safety personnel, and the generation public on hazard identification, decontamination protocols, emergency management, and critical care of poisoned patients. Toxicologists are also hired by medical schools, universities with residencies, and other clinical training sites where they teach, conduct research, and guide advanced evidence-based patient care.

Outside of the medical field, toxicologists contribute to pharmaceutical research and development, occupational health services, product safety, regulatory compliance and governmental agencies such as the U.S. Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) in addition to state health departments.

For more information on toxicology fellowships, check out the EMRA Fellowship Guide.

Want to learn more and get involved? Join the EMRA Toxicology Committee!


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