Medical Toxicology Fellowship
The mission of the Medical Toxicology Fellowship in NYU Langone’s Ronald O. Perelman Department of Emergency Medicine is to train compassionate, thoughtful physicians to excel in caring for patients who have been poisoned.
Poisoning is now the leading cause of death from injury in the United States, and the need for well-trained medical toxicologists has never been greater. Our curriculum prepares fellows to succeed in diverse roles within the field.
The Medical Toxicology Fellowship was established in 1981 and is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Medical toxicology, an American Board of Medical Specialties–recognized medical subspecialty, focuses on the diagnosis, management, and prevention of poisoning and other adverse health effects caused by medications, occupational and environmental toxins, and biological agents.
In July 2000, the ACGME established criteria for the accreditation of residencies and fellowships in medical toxicology. These criteria are rigorous and aim to establish a baseline level of consistency in training.
Our fellowship is based at the NYC Poison Control Center and has full certification through the ACGME’s Residency Review Committee for Emergency Medicine. Participation in the Medical Toxicology Certification examination, administered by the American Board of Emergency Medicine, requires completion of an ACGME-certified residency in medical toxicology.
We aim to train physicians in the clinical and academic aspects of toxicology and pharmacology and prepare them for leadership roles in research, teaching, patient care, and poison control center management.
Fellows possess the following skill sets upon completion of training:
- the ability to manage acute toxicological emergencies by providing hands-on care and by effectively advising others, either in person or through distant interaction
- a comprehensive knowledge of core topics including the scientific principles of toxins and poisoning, clinical diagnosis and management of patients with toxic exposures, appropriate use of clinical and toxicology laboratories, rational pharmacotherapy, occupational toxicology and industrial hygiene, and environmental medicine and toxicology
- the competence to seek out, critically review, and synthesize the available literature
- the ability to identify important controversies within medical toxicology, and use appropriate investigational approaches to design and carry out research
- the ability to author clinical and scientific reports, case studies, review articles, and textbook chapters
- effective skills in teaching to small and large groups, the lay public, nurses, pharmacists, paramedics, medical students, house officers, and physicians with and without toxicological expertise
- the proficiency to pass the certification examination approved by the American Board of Medical Subspecialties, which oversees the American Board of Emergency Medicine
Fellowship Clinical Sites
As one of the largest medical toxicology programs in the country, we train our fellows in a variety of didactic, outpatient, and inpatient clinical settings.
NYU Langone maintains a high-fidelity simulation facility, the New York Simulation Center for the Health Sciences, and we use this world-class technology in our toxicology curriculum.
The diverse patient populations at NYC Health + Hospitals/Bellevue, NYU Langone’s Ronald O. Perelman Center for Emergency Services, and the VA NY Harbor Healthcare System provide a rich training environment. Our close relationship with New York City’s Department of Health and Mental Hygiene, where the NYC Poison Control Center is located, also provides an important perspective on population health.
Through the NYC Poison Control Center, our fellows have access to research facilities at New York City’s Public Health Laboratory. In addition, there are other extensive and accessible laboratory facilities within the Department of Health and Mental Hygiene and at Bellevue and NYU Langone locations.
Fellows play an integral role in medical student and resident training, and in the clinical practice of emergency medicine in all Department of Emergency Medicine facilities, including emergency departments at Bellevue, Tisch Hospital, and the VA NY Harbor Healthcare System.
Through the many teaching opportunities fellows have as part of their training, they excel as educators. As members of the Division of Medical Toxicology, our fellows are also active in multiple cross-disciplinary administrative, operational, and research projects.
Fellowship Clinical Training
Medical toxicology fellows gain hands-on experience at our busy clinical sites.
NYC Poison Control Center Medical Backup
Fellows provide physician backup for certified specialists in poison information (CSPIs). CSPIs are pharmacists, nurses, and other health professionals who have additional advanced training in poison management. CSPIs answer the majority of inquiries received by the NYC Poison Control Center and are primarily responsible for case management.
Fellows are expected to perform primary follow-up on approximately 10 to 20 cases per week (500 to 1,000 cases per year). They are responsible for advising CSPIs on poison management issues, advising the treating medical staff by phone or in person (when appropriate), and obtaining follow-up data on particular cases. Fellows also have the opportunity to provide continuing education to CSPIs.
Direct NYC Poison Control Center Duties
Periodically, fellows directly handle incoming calls at the NYC Poison Control Center. These brief periods help familiarize fellows with how a poison control center functions, as well as a variety of problem-solving tasks.
Hospital Clinical Duties
In conjunction with Department of Emergency Medicine faculty, fellows consult on all cases in which patients present with toxicologic problems to the Perelman Emergency Center, Bellevue, and the VA NY Harbor Healthcare System, providing comprehensive management advice and relevant literature to primary providers.
Medical Toxicology Clinic
The medical toxicology service maintains its own specialty clinic. Fellows and faculty identify patients to be seen at the clinic, which is by appointment only.
Fellowship Didactic Training
Fellows are encouraged to attend numerous conferences and other educational sessions. The didactic curriculum is based on a 24-month cycle.
Toxicology Conference Schedule
|Toxicology Case Review||Daily at 9:30AM|
|Toxicology Rounds||Daily at 12:30PM|
|Fellows’ Conference||Every other Tuesday|
|Occupational Toxicology||Every other Tuesday|
|Toxicology Journal Club||Thursdays at 8:30AM|
|Consultants’ Conference||First Thursday of each month at 2:00PM|
|Emergency Medicine Morning Rounds||Mondays, Tuesdays, Thursdays, and Fridays at 8:15AM|
|Emergency Medicine Educational Conference||Wednesdays from 8:00AM to 12:00PM|
|Metal||First Friday of each month at 10:00AM|
|Biochemistry||Second Friday of each month at 10:00AM|
|Classic Journal Club||Third Friday of each month at 10:00AM|
|Physiology||Fourth Friday of each month at 10:00AM|
|Flashcards||Fourth Wednesday of each month at 10:00AM|
|Structure/Disaster of the Week||Weekly|
Toxicology Case Review
Fellows present active toxicology cases to other fellows and faculty. An interactive discussion of patient care decisions in a nonjudgmental and informal educational format helps improve future care.
Although the focus of toxicology rounds is on educating visiting students and physicians, the depth and comprehensiveness of this conference ensures that fellows are continually challenged. Rounds have a periodically repetitive format, which reinforces core concepts and allows fellows to observe effective teaching techniques. As fellows advance within the program, they eventually lead rounds.
The fellows’ conference is based on readings that cover topics important to the greater understanding of medical toxicology. This may include basic science topics, toxin-specific discussions, statistics, research design, and more. The focus of the readings alternates on a four-week cycle: The first week is metals; the second week is biochemistry; the third week is classic journal article review (journal club); and the fourth week is physiology. Textbook materials and original literature are used, and appropriate specialists may be invited.
For the occupational toxicology conference, fellows prepare a discussion based on textbook materials and original literature that focuses on either an occupational exposure or an occupation itself.
Toxicology Journal Club
Fellows select articles from recent literature for discussion in an interactive forum with rotating residents and faculty.
In this conference, medical toxicologists from the mid-Atlantic states convene to discuss cases managed by participating poison control centers during the preceding month. Our fellows present cases from the NYC Poison Control Center.
Emergency Medicine Conferences
Fellows provide didactic education to NYU Langone and Bellevue emergency medicine residents through case discussions and lectures.
Rotating Resident Supervision
The NYC Poison Control Center receives visiting residents in emergency medicine, internal medicine, pediatrics, anesthesia, and critical care from throughout the United States and Canada. A number of medical and pharmacy students also rotate through the NYC Poison Control Center. On-call fellows maintain daily office hours and assist with resident teaching and supervision during this rotation.
Medical toxicology fellows are employed at an appropriate postgraduate year level in the emergency medicine residency.
Research Opportunities for Fellows
In addition to meeting clinical responsibilities, fellows are expected to pursue an original research project under the guidance of departmental faculty.
Starting in the middle of the first year, fellows are encouraged to develop an area of interest under the mentorship of a medical toxicology faculty member. Although not required, this allows fellows to develop expertise in areas beyond those provided by the educational and clinical curriculum. Fellows work closely with one or more faculty members, who teach skills needed in study design, institutional review board application, statistical analysis, and scholarly writing.
All fellows are required to complete one scholarly project during training. This may include clinical or basic science research, a substantial writing project, a teaching curriculum, a community-based initiative, or another sustainable project. Throughout the fellowship, fellows gain an understanding of statistics and research methodologies through our journal clubs, research lectures, and monthly intradepartmental research meetings.
Clinical research opportunities are available through our clinical sites, including the NYC Poison Control Center. Fellows are encouraged to present their work at a national or regional scientific meeting. Assistance with obtaining research grants is available.
From the 94,000 annual NYC Poison Control Center and Bellevue cases, including clinical cases at our clinical sites, fellows are expected to prepare at least one case report or case series for publication.
Book Chapters and Review Articles
Fellows are typically given the opportunity to write at least one review article or text chapter during their fellowship.
Fellows have extensive opportunities to present cases, lectures, and original data at events including the consultants’ conference, our medical toxicology course, and the North American Congress of Clinical Toxicology. Additional lectureships, such as those at local and regional residency programs and conferences, are distributed according to fellows’ areas of interest.
Fellowship Eligibility and Length of Training
Our fellowship is open to physicians who are board-eligible or board-certified in emergency medicine, pediatrics, internal medicine, or preventive medicine. We especially welcome graduates from ACGME-accredited emergency residencies in these specialties. Such diversity allows for a richness of discussion.
Candidates must meet the requirements to obtain a license to practice medicine in New York state.
Medical toxicology fellows are appointed for two years.
How to Apply
Applicants email a cover letter, CV, and personal statement outlining their interests and discussing any experience in medical toxicology to Rana Biary, MD, fellowship director, at firstname.lastname@example.org. At least three confidential letters of recommendation are also required and should be emailed to Dr. Biary by the letter writers.
Select candidates are invited for an in-person interview at NYU Langone.
For inquiries about the fellowship and how to apply, please contact Dr. Biary at email@example.com or 212-562-6561.
Medical Toxicology Fellowship Faculty
Rana Biary, MD
Director, Medical Toxicology Fellowship
Assistant Professor, Ronald O. Perelman Department of Emergency Medicine
Silas W. Smith, MD
Associate Director, Medical Toxicology Fellowship
Director, Division of Emergency Medicine Quality, Safety, and Practice Innovation
Clinical Associate Professor, Ronald O. Perelman Department of Emergency Medicine
Emily Taub Cohen, MD
Clinical Assistant Professor, Ronald O. Perelman Department of Emergency Medicine
Mark K. Su, MD, MPH
Director, NYC Poison Control Center
Clinical Associate Professor, Ronald O. Perelman Department of Emergency Medicine
Medical Toxicology Fellows
Here are our current medical toxicology fellows:
Timothy Backus, DO, Class of 2021
Philip DiSalvo, MD, Class of 2021
Emma Furlano, MD, Class of 2021
Sarah Mahonski, MD, Class of 2022
Sanjay Mohan, MD, Class of 2022
Joshua Trebach, MD, Class of 2022