Clinical Pharmacology & Toxicology

Overview

The University of Toronto’s Division of Clinical Pharmacology and Toxicology is one of only a handful of such programs in North America. Division members, many of them cross-appointed with other divisions, are actively engaged in research, teaching, and the provision of clinical care, principally in the fields of adverse drug reactions/drug safety and acute-care toxicology. At present, these activities are concentrated at Sunnybrook Health Sciences Centre and the Hospital for Sick Children, but the division is committed to growing its presence at other sites in the years ahead.

The Clinical Pharmacology and Toxicology training program is a two-year program accredited by the Royal College of Physicians and Surgeons of Canada. We generally accept two trainees each year, with most applicants from either internal medicine, emergency medicine, paediatrics, psychiatry, occupational medicine or anaesthesia. A major strength of our training program is its flexibility: trainees can focus their educational and research efforts in the field of their choosing (for example, acute-care toxicology, quality improvement, or drug safety), and some elect to combine their clinical training with an MSc or PhD in a related field. In some instances, trainees have been able to complete dual training in clinical pharmacology and toxicology and another subspecialty program. In the years ahead, our division seeks to expand its clinical and teaching activities to other university-affiliated hospitals, develop a focus on quality improvement, and encourage the growth of the speciality by attracting trainees who appreciate the diversity of career options created by training in clinical pharmacology and toxicology.

Objectives

The training program follows the Royal College of Physicians and Surgeons of Canada objectives of training, which are updated regularly. Each resident is expected to do a six-month block of his or her primary speciality along with two three-month blocks of two other specialities. A full year of elective experiences constitutes the second year of training. A mandatory lecture series and examination are expected to be completed within two years. Trainees are expected to participate in research, and a variety of options are available to this end.

Opportunities for trainees are numerous, with many partners across the University, in industry, and in regulatory medicine. These include epidemiologic research in drug safety, occupational and environmental exposures, quality and safety, therapeutics, addiction medicine, administration, critical care, public health, emergency medicine, geriatrics, drug development, laboratory toxicology, and pharmacogenetics.

Training Sites

The Clinical Pharmacology and Toxicology Fellowship Program is based at three major sites: Sunnybrook Health Sciences Centre, the Hospital for Sick Children, and the Ontario Poison Centre, located at the Hospital for Sick Children in Toronto.

Program Content

Trainees will acquire in-depth knowledge of human pharmacology, therapeutics, and toxicology tailored to different age groups (paediatric and adult), and diverse populations, addressing aspects of gender, ethnicity, and ethics. Over the course of training, fellows must demonstrate competence in the foundations of pharmacokinetics, pharmacodynamics, pharmacogenetics, pharmacoeconomics and pharmacoepidemiology. Fellows will also acquire knowledge in drug development and regulation, clinical aspects such as adverse drug reactions and interactions and therapeutic drug monitoring with an objective of improving the levels of health within communities, unique population groups, and individuals. They will also conduct research, utilizing statistical analytic methodology, and critically appraise publications. The program requires the trainee and the supervisor to identify individual future career goals and settings according to the Competence by Design framework. The program integrates the CanMEDS Roles in the training and encourages trainees to undertake advanced level training in related areas.

Research Experience

Research in our division focuses on clinical epidemiology and health services research, with the bulk of it conducted at the Institute for Clinical Evaluative Sciences. Most of this research focuses on the safety of drugs in real-world clinical practice, the consequences of drug-drug interactions, and the health status of individuals after an episode of self-harm. The paediatric research programs focus on drug-metabolizing enzymes and its regulation, drug transporters, mammary gland drug transport and metabolism, and reproductive toxicology teratology.

Shinya Ito, Head - Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children (SickKids), University of Toronto.

Dr. Ito's research has focused on Clinical Pharmacology, Drug Transport and Kinetics, and Human Milk. Research Endeavours

(1) Breastfeeding pharmacology

This research focus is closely tied to clinical activities. Studies include prospective cohort studies on drug safety during lactation. With many new medications introduced in the market, or about to be introduced in the market, clinical data on safety and information on drug concentration in milk provide previous evidence for rationale therapeutics. Under the support from the Canadian Institutes of Health Research, the “Drug in Lactation” Analysis Consortium (DLAC) has been developed as an infrastructure for milk sample collection. With an updated list of target drugs, DLAC collects milk samples and the drug levels are used to estimate infant exposure levels through physiologically-based pharmacokinetic modelling analyses. Recently, we have been selected as one of the NIH-funded multicentre studies on drugs in breastfeeding.

(2) Pediatric pharmacogenomics

The field of pharmacogenetics is expanding, but data remain relatively scarce for infants and children. In addition to the nation-wide network for pharmacogenomics, we have been running a clinical implementation pilot study of paediatric pharmacogenomics service. This is to characterize practical hurdles in the implementation and explore clinical values of the service.

(3) Mammary drug transport

The research group in the division revealed a dual nature of mammary drug transport, which is opportunistic occupancy of nutrient transporters by xenobiotics. This further led to the discovery of the mechanism of lactation-associated upregulation of drug/vitamin B2 transporter, Breast Cancer Resistance Protein (BCRP/ABCG2), in the mammary gland. Most recently, another vitamin B2 transporter, SLC52A2, was found to be highly induced in the lactation mammary gland in a tissue-specific manner, creating an efficient vitamin B2 excretion system with BCRP/ABCG2. This has raised the possibility of using vitamin B2 to reduce transporter of BCRP substrate drugs into milk, which includes methotrexate cimetidine and acyclovir.

Evaluation

Our fellowship program is integrated with our subspecialty residency program. Evaluation of fellows and residents is done through the end of rotation In-Training Evaluation Reports (ITERs). In training, examinations are also organized to provide formative assessment and feedback to suggest areas for further study.

Additional Educational Opportunities

Fellows attend the same academic half-day seminars as residents, as well as educational rounds and journal club. Opportunities frequently exist to attend or present at local, national, and international conferences as well.

Applying To The Program

Clinical Fellowship

Clinical fellowships are an opportunity for a physician to obtain advanced training and/or to acquire more specialized expertise that complements their residency training. Clinical fellows must be recognized as specialists or family physicians. Training may involve both clinical and research activities.

Research Fellowship

Research fellows are engaged solely in research and have no patient contact whatsoever. Because research fellows do not have patient contact, licensure by the College of Physicians and Surgeons of Ontario (CPSO) is not required. The minimum qualification for research fellowship training is a medical degree; however, requirements for admission may vary from one research fellowship program to another.

Note

If you are considering applying to one of the Department of Medicine's Clinical or Research Fellowships, and you have also applied to the U.S. match through the National Residency Matching Program (NRMP), please be advised that the University of Toronto is a participating institution and adheres to the match policy. The policy states that "Applicants who have matched to a program or have accepted a position during the Supplemental Offer and Acceptance Program (SOAP), shall not apply for, discuss, interview for, or accept a concurrent year position in another program prior to the NRMP granting the requested waiver."

More information is accessible on the NRMP Specialty Matching Services Match Participation Agreement

Contact

Training Program Director

Dr. Chris Lazongas

Phone: 416 813 5900 (Sickkids) or 416 438 2911 ext. 3315 (Scarborough)

Email: chris.lazongas@utoronto.ca

Education Administrative Coordinator (SickKids)

Jacqueline Carillo

Phone: 416-813-7654 ext. 224586

Email: jacqueline.carillo@sickkids.ca or cpt.trainingprogram@sickkids.ca

Administrative Coordinator (SickKids)

Hila Halshtok

Phone: 416-813-7413 ext. 207413

Email: hila.halshtok@sickkids.ca or cpt.trainingprogram@sickkids.ca

Administrative Coordinator (SickKids – Ontario Poison Centre)

Donna Tedesco

Phone: 416-813-6437 ext. 206437

Email: donna.tedesco@sickkids.ca

Administrative Coordinator (Sunnybrook)

Peggy Kee

Phone: 416 480 6100 ext. 3505

Email: peggy.kee@sunnybrook.ca