Feasibility and evaluation of high-fidelity simulation education for acute clinical toxicology.

To prepare medical students appropriately for the management of toxicological emergencies, we have developed a simulation-based medical education (SBME) training in acute clinical toxicology. Our aim is to report on the feasibility, evaluation and lessons learned of this training. Since 2019, each year approximately 180 fifth-year medical students are invited to participate in the SBME training. The training consists of an interactive lecture and two SBME stations. For each station, a team of students had to perform the primary assessment and management of an intoxicated patient. After the training, the students completed a questionnaire about their experiences and confidence in clinical toxicology. Overall, the vast majority of students agreed that the training provided a fun, interactive and stimulating way to teach about clinical toxicology. Additionally, they felt more confident regarding their skills in this area. Our pilot study shows that SBME training was well-evaluated and feasible over a longer period.

[On the question of increasing the qualification of staff for the purposes of forensic-chemical and chemical-toxicological analysis: results of the questionnaire of expert chemists]. / K voprosu povysheniya kvalifikatsii kadrov dlya tselei sudebno-khimicheskogo i khimiko-toksikologicheskogo analiza: rezul'taty anketirovaniya khimikov-ekspertov.

Today, one of the most effective tools for high-quality training of specialists at the postgraduate level is continuous professional development (CPD). Additional professional education of specialists in the field of forensic chemical and chemical-toxicological analysis with higher non-medical education (pharmaceutical, chemical, biological) is carried out on the basis of pharmaceutical and medical higher educational institutions, autonomous non-profit organizations through the implementation of additional professional training programs. The timing, forms, content and technology of training by organizations implementing the corresponding educational program are of great importance. Analysis of the results of the questionnaire survey of expert chemists, carried out according to the original questionnaire in 2020-2021 in some regions of Russia, showed the main directions of development of the training system, forms and methods of teaching, the need to develop appropriate software.

A Brief Overview of the STP 35th Annual Symposium on the Basis and Relevance of Variation in Toxicologic Responses.

The title of the 2016 Society of Toxicologic Pathology (STP) Symposium was the "Basis and Relevance of Variation in Toxicologic Responses." Many factors may contribute to variation in toxicologic responses and can confound results, complicate interpretation of data, interfere with reproducibility, and make extrapolation to humans problematic. This brief overview summarizes speaker presentations from each session which describes important factors that may impact the interpretation of nonclinical discovery and developmental toxicity studies. In addition, summaries of the Continuing Education (CE) courses and other educational events that occurred during the Symposium are highlighted.

NTP/NIEHS Global Contributions to Toxicologic Pathology.

National Toxicology Program (NTP) pathologists are engaged in important initiatives that have significant global impact. These initiatives build on its leadership in pathology peer review and publications in the areas of toxicologic pathology, clinical pathology, and laboratory animal medicine. Over the past decade, NTP/National Institute of Environmental Health Sciences research initiatives have focused on cancer and noncancer hazard identification, with the goal of understanding cellular and molecular mechanisms of disease. New initiatives of significant global impact include the web-based nonneoplastic lesion atlas and an NTP partnership with international scientists to investigate molecular mechanisms at the whole genome level, which will be used to inform potential mechanisms of environmental exposures in human cancers. Also, we are dedicated to contributing to pathology and toxicology organizations through service on executive committees and editorial boards, participating in international projects and symposiums, and providing training for future leaders in toxicologic pathology. Herein, we provide highlights of our global contributions.

Teaching Tip: Improving Students' Email Communication through an Integrated Writing Assignment in a Third-Year Toxicology Course.

Client communication is important for success in veterinary practice, with written communication being an important means for veterinarian-client information sharing. Effective communication is adapted to clients' needs and wants, and presents information in a clear, understandable manner while accounting for varying degrees of client health literacy. This teaching tip describes the use of a mock electronic mail assignment as one way to integrate writing into a required veterinary toxicology course. As part of this project, we provide baseline data relating to students' written communication that will guide further development of writing modules in other curricula. Two independent raters analyzed students' writing using a coding scheme designed to assess adherence to the guidelines for effective written health communication. Results showed that the majority of students performed satisfactorily or required some development with respect to recommended guidelines for effective written health communication to facilitate client understanding. These findings suggest that additional instruction and practice should emphasize the importance of incorporating examples, metaphors, analogies, and pictures to create texts that are comprehensible and memorable to clients. Recommendations are provided for effective integration of writing assignments into the veterinary medicine curriculum.

Comparison of High-Fidelity Medical Simulation to Short-Answer Written Examination in the Assessment of Emergency Medicine Residents in Medical Toxicology.

We compared high-fidelity medical simulation to short-answer written examination in the assessment of emergency medicine residents (EMR) on a month-long medical toxicology rotation. Knowledge-based assessment tools using cases of an aspirin overdose and a tricyclic antidepressant overdose were used to assess all consecutive rotating EMR (n=53). Assessment by simulation had similar accuracy and precision but higher satisfaction rates when compared to written examination. Incorporating simulation into the ABEM certifying examination warrants further study.

A practice analysis of toxicology.

In 2015, the American Board of Toxicology (ABT), with collaboration from the Society of Toxicology (SOT), in consultation with Professional Examination Service, performed a practice analysis study of the knowledge required for general toxicology. The purpose of this study is to help assure that the examination and requirements for attainment of Diplomate status are relevant to modern toxicology and based upon an empirical foundation of knowledge. A profile of the domains and tasks used in toxicology practice was developed by subject-matter experts representing a broad range of experiences and perspectives. An on-line survey of toxicologists, including Diplomates of the ABT and SOT members, confirmed the delineation. Results of the study can be used to improve understanding of toxicology practice, to better serve all toxicologists, and to present the role of toxicologists to those outside the profession. Survey results may also be used by the ABT Board of Directors to develop test specifications for the certifying examination and will be useful for evaluating and updating the content of professional preparation, development, and continuing education programs.

Commentary: the role of the toxicologic pathologist in academia.

Veterinary pathologists working as toxicologic pathologists in academic settings fill many vital roles, such as diagnosticians, educators, and/or researchers. These individuals have spent years investigating pathology problems that mainly or exclusively focus on the reactions of cells, organs, or systems to toxic materials. Thus, academic toxicologic pathologists are uniquely suited both to help trainees understand toxicity as a cause of pathology responses and also to provide expert consultation on toxicologic pathology. Most toxicologic pathologists in academia are employed at colleges of medicine or veterinary medicine, even though specific toxicologic pathology faculty appointments are uncommon in Europe and North America. Academic toxicologic pathologists typically receive lower financial compensation than do toxicologic pathologists in industry, but academic positions generally provide alternative rewards, such as higher workplace autonomy and scheduling flexibility, professional enrichment through student interactions, and enhanced opportunities for collaborative research and advanced diagnostic investigations. Regular participation by academic toxicologic pathologists in professional training opportunities (eg, as pathology and toxicology instructors in medical and veterinary medical courses, graduate programs, and residencies) offers an important means of engendering interest and inspiring veterinarians to select toxicologic pathology and toxicology as their own areas of future expertise.

How Can Newborn Toxicology Testing Be More Equitable? An Interactive Ethics Workshop.

Introduction: Practice variation in newborn toxicology testing during the birth hospitalization exists across institutions and legal jurisdictions. While testing can provide benefits, indiscriminate testing has been shown to perpetuate health care inequities. In the backdrop of an opioid epidemic and a charged medicolegal landscape, this workshop guides participants to reexamine newborn toxicology testing through a shared ethical lens. Methods: We conducted a live, 90-minute workshop in English at an international pediatric conference. Physicians, residents, and fellows participated in large- and small-group breakout sessions to learn relevant clinical and bioethical frameworks, share their own local context and expertise, and explore ethical applications through case-based discussions. We administered two anonymous online follow-up surveys to assess self-perceived impact on participant knowledge, behavior, and clinical practice. Results: Seven facilitators and 45 individuals participated in the workshop. Eighteen participants completed survey 1 immediately following workshop conclusion, and six participants completed survey 2 after 3 months had elapsed. Immediately following the workshop, 94% of respondents reported that they had been introduced to a new idea, and 82% were considering practice change. A low response rate to survey 2 limited interpretation, but some respondents reported self-perceived change following workshop attendance. Discussion: This workshop facilitated conversation between physician participants on a complex pediatric health care inequity issue using an ethical framework.

Importance of clinical toxicology teaching and its impact in improving knowledge: sharing experience from a workshop.

OBJECTIVE: To assess the impact of a one-day clinical toxicology workshop in improving knowledge. METHODS: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was ued for statistical analysis of the data. RESULT: There were 22 participants in the course. The pre-test mean score was 31.6 +/- 15.1% (95% CI; 24-40; n = 19) compared to the post-test the mean score of 56.0 +/- 10.8% (95% CI; 47- 61; n = 17). The positive difference was also statistically significant (p < 0.001). The overall workshop was evaluated as excellent by 08 (47.46%) and very good by 10 (52.63%) participants. CONCLUSION: Short training in clinical toxicology improved knowledge of the participants.

Subject matter expert and public evaluations of a veterinary toxicology course brochure-writing assignment.

Veterinary schools are increasingly developing students' communication skills, with an emphasis placed on practice conveying medical and scientific knowledge to different audiences. We describe how patient-centered written communication has been integrated into the training of veterinary students using toxicology-related preventive materials. Third-year veterinary students were given an assignment to prepare a client-focused brochure related to veterinary toxicology. Since 2010, 148 students have completed this assignment, with an average score of 93.4%. Use of a grading rubric was instituted in 2011 and resulted in a more rigorous assessment of the brochures by the course instructors. In this study, we evaluated a sample (n=6) selected from 10 brochures volunteered for further public and expert assessment. Each brochure was measured for readability and assessed with a rubric for perceived usefulness and acceptability by 12 veterinary toxicologists and 10 or 11 adult members of the public attending a college of veterinary medicine open house. Veterinary toxicologist review anticipated that the brochures would be useful for most clients, and the public reviewers confirmed this assessment. Evaluation of the brochures using set marking criteria and readability indexes showed that students had successfully targeted the chosen audiences. Feedback showed that the general public rated the sample brochures highly in terms of quality, usefulness, and interest. Completion of this study has resulted in revision of the grading rubric, an increased use of brochure examples, and additional instruction in readability assessment and brochure development, thereby improving the assignment as a learning exercise.

[Establishment and activities of scientific school of industrial toxicology in institute].

The article deals with stages of establishment and development of toxicologic studies in the Institute over 90 years. The authors stress the role of professor N.S. Pravdin and RAMSc Corresponding Member I.V. Sanotsky in formulation and solving major problems of toxicology, in specifying its methodologic background. Priority directions in theoretic and applied research are presented, main results are given.

[Clinical toxicology of the Academy: yesterday, today and tomorrow].

National toxicology school of the Kirov Military Medical Academy, demonstrates the unity of clinical and experimental approaches related to one purpose throughout its history--saving human life and health from exposure to toxic substances of chemical nature. For more than three centuries the russian science of toxicology has been steadily developing, often ahead of the world science. It helped to create the means of protection and develop methods of treatment for chemical lesions. Currently, toxicology departments of military field therapy and military toxicology and medical protection are actively involved in the current study of military medicine, restructuring policy to provide toxicological aid in the Armed Forces, the development and introduction of Innovative methods of diagnosis and treatment of victims of toxicological etiology.

Developing and delivering clinical toxicology in the UK National Health Service.

Clinical toxicology concerns the investigation, diagnosis and management of suspected poisoning. It is an important discipline because of the frequency of suspected poisoning, including drug overdose. In the UK, most episodes are managed by nonspecialists, with support provided online or by telephone from the National Poisons Information Service. Leadership and clinical support for this is provided by a small number of clinical toxicologists, who are almost invariably accredited specialists in clinical pharmacology and therapeutics. Priorities for maintaining and enhancing clinical toxicology as a subspeciality in the UK include: 1 Maintaining funding for poisons centres. This is essential in spite of current budgetary pressures. 2 Formal training in the discipline. The 1 year optional training module in clinical toxicology approved in 2011 as part of the clinical pharmacology and therapeutics curriculum represents important progress, but funding for appropriate programmes and accreditation for trainees from other relevant disciplines is needed. Arrangements for registration and revalidation are also required. 3 An improved evidence base for management of poisoning. Priority areas include continued surveillance of the epidemiology and outcomes of poisoning, including syndromic surveillance, more rapid characterization of the human toxicity of newly introduced medicines and better clinical evidence on use of antidotes and other treatments; for example, acetylcysteine and lipid emulsion therapy.

Emergency medicine Joint Fellowship Curriculum.

BACKGROUND: The authors describe a Joint Fellowship Curriculum instituted for emergency medicine fellows in diverse fellowships. The curriculum is based on commonalities established among the varying fellowships offered within their Department of Emergency Medicine. Fellowships included in the curriculum development include Disaster/Emergency Medical Services, International Emergency Medicine, Health Policy, Ultrasonography, and Medical Toxicology. OBJECTIVES: The focus of this educational activity is to promote the development of the fellow into an expert within their field of specialization. DISCUSSION: Recognizing that topics such as scholarly activities, career development, clinical practice of medicine, business of medicine, and personal development are universally applicable to a variety of emergency medicine fellowships, the curriculum attempts to provide uniform instruction. The quality and applicability of this instruction was assessed and found to have been very well received by the participating fellows. CONCLUSION: The authors encourage academic emergency medicine departments with a number of fellowship training opportunities to consider providing such a uniform curriculum of instruction as well.