Evidence-based reconstruction of medical toxicology fellowship orientation curriculum using a modified Delphi...

Currently, there are no evidence-based studies on orientation curriculum development for medical toxicology fellows. Fellows come from diverse training backgrounds yet are expected to manage a broad spectrum of toxicologic presentations in various practice environments. Standardized orientation curricula in other specialties have demonstrated improved comfort and knowledge of trainees. Our objective was to conduct an evidence-based reconstruction of orientation and study its impact on new fellows.

We utilized a modified Delphi approach at a single toxicology fellowship. Participants were considered experts if they had graduated fellowship training or worked in fellowship administration. Second-year fellows were also included. A panel was convened to identify areas for improvement, followed by a survey to assess consensus using a Likert scale. The survey had four sections: core content, logistics, expectations, and wellness. Consensus was categorized as strong (≥75%), weak (50-74%), or non-consensus (<50%). A second panel resolved non-consensus items. After orientation was reconstructed, new fellows' knowledge and comfort was assessed with pre- and post-tests before and after orientation.

Twelve experts participated in the panel process, followed by eight in the second panel. Thirty toxins and toxicology concepts met consensus as important to cover during orientation. There was strong consensus to cover most logistical, expectation, and wellness topics. After reconstruction, the three new fellows showed improved medical knowledge, comfort, and policy familiarity.

The modified Delphi process highlighted topics most important to cover at the beginning of fellowship. Important toxins fell into two main categories: common exposures and rare exposures requiring emergent action. Adding logistic, expectation, and wellness topics improved fellow experience. This intervention employed concepts central to adult learning theory.

Our study suggests there is consensus amongst expert toxicologists regarding essential topics during medical toxicology fellow orientation. This pilot data is a framework for developing an evidence-based, specialty-specific orientation curriculum.