Great, we just joined the club, now what? (please help the new guy)

[D.O.nysus]

Hi friends,
For those of us that will be starting the "advanced" phase of GME and jumping into a Tox fellowship next year, is there any advice you senior fellows or new grads can offer us wannabes?

For example:

-Here is the best text, online review, pocket guide, etc to use...

-The Tox board 1st time pass rate is so abysmal I would start preparing as early as....
And here is the best resource for board prep: ....

-I couldn't have survived a night of Tox call without: ...(e.g. Micromedex/poisindex, such-and-such Tox app, etc)

-Best practices for writing consults (e.g. I've heard of folks bringing laptop or tablet [plus/minus voice recognition software like DragonSpeak] to the bed side and typing/dictating consults)

-How long into your fellowship did it take before you felt like you actually could offer meaningful advice while on call?

Thank you from all of us who want to be like all of you!

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[BADMD]

-Here is the best text, online review, pocket guide, etc to use...

-The Tox board 1st time pass rate is so abysmal I would start preparing as early as....
And here is the best resource for board prep: Toxicology Pearls and the Board Review Course. Try to take the course twice if you can.

-I couldn't have survived a night of Tox call without: Olson's book

-Best practices for writing consults: Actually say something the primary team can use. Too often I find that consult documentation is a place holder and doesn't really say much. Also make it a point to include some education for the primary team in each one so that they can understand your thinking.

-How long into your fellowship did it take before you felt like you actually could offer meaningful advice while on call?
Within a few months, especially once you've seen the same ingestion a few times. I completely dazzled some medicine people once when I did a consult for an obscure and rare poisoning. I gave them very in depth recommendations without any lead or notice. What they didn't see was me puzzling the same thing out for 4 hours, 1 month prior when I got a similar call from a different hospital.

 

[Daiphon]

-Here is the best text, online review, pocket guide, etc to use...

-The Tox board 1st time pass rate is so abysmal I would start preparing as early as....
And here is the best resource for board prep: Toxicology Pearls and the Board Review Course. Try to take the course twice if you can.

-I couldn't have survived a night of Tox call without: Olson's book

-Best practices for writing consults: Actually say something the primary team can use. Too often I find that consult documentation is a place holder and doesn't really say much. Also make it a point to include some education for the primary team in each one so that they can understand your thinking.

-How long into your fellowship did it take before you felt like you actually could offer meaningful advice while on call?
Within a few months, especially once you've seen the same ingestion a few times. I completely dazzled some medicine people once when I did a consult for an obscure and rare poisoning. I gave them very in depth recommendations without any lead or notice. What they didn't see was me puzzling the same thing out for 4 hours, 1 month prior when I got a similar call from a different hospital.

Couldn't say it better myself. Think about your cases from the perspective of what *you* want out of a consultant - clear recs, a little teaching, and be sure to follow up.

As for the "best text," Goldfrank's is the primary source. But it's weak in occupational/environmental. I liked Sullivan & Krieger 'Clinical Environmental Health.'

Brent's 'Critical Care Toxicology' is also quite good.

Welcome to the club!!!

-d

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[BADMD]

Just to add more things as I think about them regarding the boards.

While I won't say "Start studying from day one," part of fellowship is board prep. If you start making a habit of doing some board pre-prep from day one, the prep part will be easier.

What do I mean? When you are reading the chapters, start making flash cards or other memory aid device that has high yield stuff on it. The Tox Boards are very buzzword heavy, especially in the occupational/industrial areas. Taking note of the buzzwords as you do your reading is very high yield. Other things to note is that you will need to be able to recognize notable plants and you will have to be able to recognize the chemical structures of some compounds. So taking note, early, of plants and salient chemical features is important. You don't want to try and cram that stuff.

I ended up making powerpoint slide of stuff while I was studying. The slide were basically meant to be electronic flash cards, which I then downloaded as jpegs to my iPhone. I did this during the 6 months before I took the boards. At the Tox Board review course, they included various high yield power points that were designed to be flash card like. Between the review course and my own stuff, I had around 800 complete cards that I could flip through at any moment. If you do this while you are reading throughout your fellowship, you will have more, higher quality stuff than I had.

I can't stress enough trying to go to the board review course while you are a fellow. I didn't and wish I did. I would definitely have done things a little differently, earlier. The next one will be in Sept of 2014, I believe.