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A Descriptive Cross Sectional Survey of Medical Toxicology Rotations at US Allopathic and Osteopathic Emergency Medicine Residency Programs

Nahar Alruwaili, Ziad N Kazzi and Brent Morgan

Background: Medical Toxicology (MT) is a core content area of the Emergency Medicine (EM) curriculum and a recognized subspecialty by the American Board of Medical Specialties and the American Osteopathic Board of Emergency Medicine. Since there is not a uniform presence of MT faculty in all EM residency programs, we attempted to describe the current methods and delivery of MT education at U.S. EM residency programs. Methods: A survey was sent to the program director of Allopathic and Osteopathic EM programs. Results of the survey were entered in a secure electronic database. This study was deemed exempt by the IRB at our institution. Results: The survey was completed by 57% (113/197) of the programs that we identified. Eighty four programs were allopathic while 25 and 4 were osteopathic and combined respectively. The length of the emergency medicine training was 3 years in the majority of respondents (62%) while it was 4 and 2 years in 37% and 1% of respondents respectively. A MT rotation was mandatory in 67%, offered as an elective in 12% and not offered in 21% of responding programs. When offered, the duration of the MT rotation was 1 month or 4 weeks in 85% and 3 weeks or less in 15% of programs. The rotation was offered onsite in 40% of programs and offsite at 60% of programs which had a MT rotation. When offered as an elective, 71% of respondents reported that less than 50% of their residents took advantage of that offer. 88% of programs which did not offer a MT rotation, allowed their residents to pursue it as an away rotation. When examining the structure of the MT rotation, 92% of programs had a poison center component while 71% had a bedside consult service and 57% had home call duties. Medical toxicology lectures were given by programaffiliated toxicologists in 63%, visiting medical toxicologists in 36%, EM physicians in 59%, online lectures in 11.5% and other methods in 5% of respondents. Ninety four percent of respondents were amenable to using online education. Thirty seven percent of respondents had no affiliated toxicologists while 39, 20 and 4% had 1-2, 3-5 and greater than 5 respectively. Conclusion: MT training is heterogeneous in US EM programs. Elective and offsite rotations provide the training when not available at the primary institution. Alternative methods such as online education need to be further evaluated.