Service Rotation for Residents and Students

We enjoy having health care providers rotate onto the Toxicology Service. The feedback from the “rotators” has been that we have an education-rich environment that gets the job done in a reasonable time-frame. Please contact us if you would like to learn more about possibly doing a rotation with the Service.

The toxicology rotation provides toxicology training to a wide variety of health care providers. These include emergency medicine residents, pediatric residents, pediatric emergency medicine fellows, medical students, and pharmacy students. Other health care providers are welcomed depending upon their needs and the timing of the requests.

Yes. We only offer a limited number of rotator slots at any given time. Too many rotators would dilute the educational experience. A student must be able to be credentialed within Parkland. There must be a command of the English language.

The goals will vary from provider to provider. For example, the pharmacist may have a different need than a medical student who may need something different than a senior emergency medicine resident.

In general, upon completion of this rotation, a health care provider will be able to:

Rotator Expectations

· Read Rotator Expectations prior to arrival

· Olson’s “Poisoning and Drug Overdose” is required for the rotation. It can be purchased through the poison center at cost or through Majors bookstore.

· You should bring a white clinical coat for visiting hospitalized patients. Appropriate attire is expected. Business casual is acceptable. For example, “ties” are not required. Conversely, Jeans, non-collared shirts, shirts with inappropriate sayings, etc are NOT acceptable.

· Typical Schedule

o       By 8:00 AM: Start Fellow rounds & data gathering

o       9:30 AM    Attending teaching rounds followed by bedside rounds

o       Lunch: free time except when told otherwise

o       1:00 PM Topic Review with Fellows and/or Faculty

o       2:00 – 4:00 PM Independent literature review
and study

· Fellow Rounds

o       Rotators will arrive by 8:00. You likely should arrive earlier on Mondays because the case loads are typically higher.

o       The case list is provided daily and the rotators are responsible for printing out cases and making follow up calls to acquire updated information. Rotators may occasionally need to obtain initial case details and even provide recommendations. Consult with the available Fellows for clarification as needed. A keycut is provided on the computer to facilitate information gathering.

o       Please respect work areas and equipment. Return work stations to original state and place head phones, headsets, etc in appropriate storage bins. All follow up calls must be made on the computer system and each call should be documented. Any personal calls can be made from conference room phone or fellow phones. The black cordless phone is designated as the Mary Kay line and is not to be used for making calls. The Kronos phone located on the wall as you enter the work area is strictly for staff to record working hours.

o       Ensure the Poison Center Computers have updated patient information.

§         Notes made on the computer while doing the follow-up calls

§         Notes after having seen Parkland and Children’s patients

o       Call and computer documentation format

· Vesta (phone) user name – ROTATOR (no password)

· Toxicall (cases) user name – MDROTATOR; password MD3

· Keycut – FOLLOWUP

· Close using File functions – NOT X

· Set next f/u time

· Attending Rounds

o       Rotators will only be responsible for presenting assigned cases during rounds; however, discussion is open to all.

o       You are expected to know the details of the case(s) you are presenting and to have read on the pertinent topics

o       Case presentation format

§         Age and gender of patient

§         Presenting symptoms (focus on toxidrome)

§         History of exposure

§         Pertinent medical history (chronic vs. acute exposure, additional meds available, etc)

§         Discussion of agent/s

· drug name (generic and brand), chemical ingredient, toxin

· mechanism of action (therapeutic and toxic)

· range of toxicity

· expected manifestations

· compare and contrast similar agents

§         Hospital course (timing of events is key)

§         Management dilemmas (compare what was done to guidelines)

§         ABCs/DON’T

§         Decontamination (indications, procedure, doses)

§         Treatment (mechanisms, doses)

§         Antidote (indications, mechanisms, doses)

· Special Questions

· During rounds, rotators and Fellows alike may be assign an issue to investigate; often a question that needs a best answer.

· Any investigation should include a copy of a pertinent article for other rotators and Fellows

· Wednesday Conferences

· See the monthly calendar for details.

· Thursday EM Conference

Rotator Presentations: These will be scheduled on the last Wednesday that you are on the service.

· Visual Stimuli & Question Review: Prepare pictures as described below in the Picture Project

· Core Content Reviews (Occupational and General): Extra textbooks are available in the conference room. You may use the texts to read the chapters before conference or you may make copies of pertinent chapters. You are expected to have read the chapters before the conference.

· Journal club: Get the articles from the Education Coordinator

· Core Competency Review: Get the articles from the Education Coordinator.

· Rotator Presentation

·        This will be presented during the final week of the rotation; generally at the Wednesday conference.

·        Presentation with PowerPoint

·        Topic must be approved by the Senior Fellow or the Program Director

·        Topic will NOT be a general review of a larger topic i.e. not “cyanide”, “beta-blockers”, “Ethylene Glycol.” The topic should address a specific question about a common condition or it can be about an uncommon agent.

·        Duration: ~ 30 minutes

·        References included

·        Copies of 1-3 key papers pertaining to the topic for Fellows, faculty, and rotators

·        The electronic version of the presentation will be given to the Fellowship program so it can be accessed by future rotators, Fellows, and faculty

· Resident on call procedures

Check in with the Poison Center when your on-call time begins. Carry the Poison Center from 8-5 during the weekdays (no night or weekend responsibilities)
Gather case details and then discuss with Fellow on call
Ensure appropriate follow up – this may include additional f/u calls from Poison Center, but should be determined on a case by case basis with guidance from Fellow on call

· Respond to a call within 10-15min

· Understand that Poison Center staff are not always able to gather much data before the consult, but do use the time as a teaching opportunity to review what you consider relevant data and probable recommendations. Elaborate on your thought process (“Think out loud”) to help them understand and enable them to assist you as well.

· After the consult, review information and recommendations with Poison Center staff and follow up with additional details/discussion.

· Give recommendations for follow up times and discuss anticipated problems, questions and solutions.

· Text Box: Rotators should not provide toxicologic recommendations to outside providers without having first discussed the case with a Toxicology Fellow. Call back and check on critical cases