College of Pharmacy launches unique interdisciplinary toxicology fellowship

The UA College of Pharmacy has announced a new two-year toxicology fellowship believed to be the first of its kind in the country.

Under the new program, which began July 1, a recent UA PharmD graduate and a UA MD graduate will work side-by-side for two years, sharing knowledge and skills for the benefit of patients. It is an extension of a medical toxicology fellowship that was already in place.

“This is a unique program and the product of an interdisciplinary collaboration between the College of Pharmacy’s poison center and the College of Medicine’s Department of Emergency Medicine’s medical toxicology program,” says Mazda Shirazi, medical director of the Arizona Poison and Drug Information Center and a medical toxicologist.

“This program is only possible because of the long-standing interdisciplinary relationship between pharmacists, physicians and nurses at the poison center.”

Stephen Karpen, PharmD 2014, and Nicholas Hurst, MD 2011, will pioneer the new fellowship through the Arizona Poison and Drug Information Center, which is housed at the college. Karpen has worked at the poison center as a pharmacy intern since his first year of pharmacy school. Hurst, who completed his three-year residency in emergency medicine at UAMC on June 30, rotated through the poison center a few times during his education.

Together, Karpen and Hurst will form an interprofessional team that will respond to calls to the poison center about toxicology patients at UA Health Network hospitals, visiting the patients’ bedsides together.


Want to know more? View this short video about the fellowship.


“This is the only program we know of that pairs a medical toxicologist with a pharmacy toxicologist,” says Shirazi, who is also director of UA’s medical toxicology training program. “The power of this fellowship will be in the interdisciplinary sharing of knowledge. We’re putting a pharmacist through a physician’s toxicology program, and we’re exposing a physician to the in-depth knowledge of pharmacology and pharmaceutical science that a pharmacist has.”

Specialists in the field of medical toxicology can diagnose and treat many conditions involving harmful substances, including drug-drug interactions, lead and arsenic poisoning, and biocompatibility issues such as those that can occur as a result of implants in the body.

Keith Boesen, director of the Arizona Poison and Drug Information Center, says Karpen and Hurst were ideal candidates for the innovative program because they share interests in toxicology, research and teaching.

“I can’t think of a better candidate to be the first pharmacist in this type of interdisciplinary fellowship than Stephen Karpen,” says Boesen, who is also director of clinical toxicology fellowship training for the College of Pharmacy. “He is bright, energetic, creative and well educated. He will take a leadership role in developing a strong curriculum for this fellowship.”

“I’m excited to be the first pharmacist in this collaborative fellowship,” says Karpen, “because I’ll be evaluating patients in the emergency department (ED) side by side with a physician, which will give me the opportunity to expand on my pharmacy background.”

“I’ve always been interested in research and teaching,” he adds. “Through this program, I will be able to help build the toxicology curriculum and help teach students coming through the poison center on rotations. I’ll also have the chance to do clinical research. I have a big interest in venom research, and it helps to be in Tucson, where there is a large venomous creature population.”

What’s good for the pharmacist will be good for the physician, too, Hurst believes.

“Before med school, I had the wrong idea that physicians should know everything about all drugs,” says Hurst. “I quickly learned that is not possible. Especially in the ED, physicians rely heavily on pharmacists. They have more pharmaceutical knowledge and are up on the latest research.”

While Hurst learns about drugs from Karpen, the pharmacist will learn about clinical diagnoses from the physician.

“We really will build on each other’s strengths,” says Hurst. “For example, Stephen knows what drugs to give to someone who is intoxicated, but he may not have had training in how to examine a patient for signs of intoxication, such as nystagmus, or involuntary eye movements.”

The results of the fellowship will be measured at the end of the program, in 2016, when both professionals will sit for exams. Hurst will sit for his certification in medical toxicology by the American Board of Emergency Medicine and Karpen will take the exam to become certified by the American Board of Applied Toxicology.

Why hasn’t an interdisciplinary approach to a toxicology fellowship been tried before?

“Because it’s hard,” says Boesen, who, together with Shirazi, came up with the idea of the two-year physician/pharmacist toxicology fellowship. “There is no accredited pharmacy toxicology residency. We really are breaking new ground here. We will build the curriculum from scratch.”

“Did you know,” adds Shirazi, “that there are only about 400 medical toxicologists in the U.S.? We have four or five here at the UA, many more than most institutions. For example, the medical community of Houston has only one, and he came from here. So we have the staff and expertise to develop this new program and fill the medical toxicologist gap for the betterment of health care.”

The pharmacy fellowship in clinical toxicology is in collaboration with the medical toxicology training program from the UA Medical Center – South Campus, which is certified by the Accreditation Council for Graduate Medical Education.