Medical Toxicology Fellowship Training Is Available to Applicants from Many Specialties

At a recent national toxicology meeting, fellowship directors were asked whether non-Emergency Medicine residency graduates were eligible for Medical Toxicology fellowship training. Specifically, an applicant from Pediatrics relayed some difficulty determining which programs would accept her application.

Medical Toxicology is a clinical specialty focused on prevention, monitoring, and care of injury and illness due to exposures and poisonings. Since 2000, Medical Toxicology fellowship programs have been credentialed in the USA by the Accreditation Council for Graduate Medical Education (ACGME). Medical Toxicology fellows undergo a 2-year training program following completion of their residency training program. Previous studies have examined the positive career impact and practice characteristics of physicians following training in Medical Toxicology [1, 2].

Medical Toxicology fellowship training is available for graduates of any accredited US (ACGME) or Canadian (RCPSC/CFPC) residency program, or at the discretion of the program director and institutional review committee [3]. The certification examination for Medical Toxicology is offered by the American Board of Pediatrics (ABP), the American Board of Preventive Medicine (ABPM), and the American Board of Emergency Medicine (ABEM).

Despite this wide eligibility, most Medical Toxicology fellowship programs are housed under Emergency Medicine departments and train primarily Emergency Medicine residency graduates. Medical Toxicology fellows are encouraged to maintain their primary specialty board skills during fellowship [3], and many programs have a shift or service requirement built into the fellowship curriculum. Due to the structure and funding of individual programs, not all programs are able to consider applications from all eligible residency training backgrounds. Currently, about 90% of Medical Toxicology fellows in the US are from Emergency Medicine residency background [4].

The American College of Medical Toxicology (ACMT) and Medical Toxicology fellowship directors desire to encourage applicants from EM and non-EM specialties. To that end, we have determined the current application acceptance across all 28 ACGME-accredited training programs in the USA.

Of the 28 ACGME Medical Toxicology Fellowship programs, 100% (28/28) accept EM applications, 79% (22/28) accept Pediatric applications, 68% (19/28) accept Internal Medicine applications, 61% (17/28) accept Occupational/Preventive Medicine applications, 57% (16/28) accept Other applications, and 61% (17/28) accept International applications. The most frequently cited Other specialty was Family Medicine.

Of the 28 programs, 75% (21/28) had a shift or service requirement built into the program curriculum. Some programs did note their fellows receive additional reimbursement for their service.

Individual program information is available at: https://www.acmt.net/_Library/Fellowship_Programs/MT_Fellowship_Programs_Grid_2018.pdf

NRMP Update

Recently, the specialty of Medical Toxicology joined the NRMP (National Resident Matching Program) with the first Match Day held on November 20, 2013 for the 2014 appointment year [5]. The ACMT Fellowship Directors Committee recognized that participating in NRMP conferred several advantages. Having a specific timeline allows programs to interview applicants in a uniform fashion, and applicants are given the opportunity to complete all desired interviews before contemplating offers. Furthermore, having an early match date (the third Wednesday in November) allows ample time for additional recruitment activities after the Match.

Since the inception of the Medical Toxicology Fellowship Match, we have had excellent program participation, with the most recent years seeing all programs participating. The number of positions offered has increased, from 37 in 2014 to 40 in 2015, 41 in 2016, and 47 in both 2017 and 2018. The number of matched applicants has also increased, from 20 in 2014 to 35 in both 2017 and 2018 [6].

Medical Toxicology is a specialty encompassing a wide variety of training backgrounds; however, recently it has evolved into a primarily Emergency Medicine-based subspecialty. We have concern that due to this predominance, potential applicants from non-EM specialties may erroneously believe they are not eligible for training in Medical Toxicology.

We find it encouraging that the majority of programs accept applications from Pediatrics, Internal Medicine, Occupational Medicine, and other residency training backgrounds. We hope this finding will assist with increased recruitment of interested applicants from specialties outside of EM.

Most programs have a shift or service requirement, although some provide additional reimbursement for this activity. With candidates outside of EM, the type of requirement varies per individual program and per specialty background of the candidate. For example, a fellow with Pediatrics primary training may staff a pediatric urgent care center, or a fellow from Internal Medicine primary training may cover an inpatient hospitalist service.

The NRMP data shows a trend toward more offered and filled positions, although with only a few years of data the significance of these trends is difficult to interpret. Currently, all ACGME Medical Toxicology Fellowship programs participated in the NRMP and we anticipate this participation will continue.

Abbreviations

ACGME

Accreditation Council for Graduate Medical Education

ACMT

American College of Medical Toxicology

EM

Emergency Medicine

RCPSC

Royal College of Physicians and Surgeons of Canada

CFPC

College of Family Physicians Canada

NRMP

National Resident Matching Program

US

United States

Sources of Funding

None

Compliance with Ethical Standards

Conflicts of Interest

None