DURATION

The course duration will be one year for the Diploma and two years for the Masters degree.

The course is a distance learning programme based on an online platform using the MOODLE learning management system. In addition to course work, trainees are expected to formulate a case book by critically analyzing a designated number of toxicology-related cases, in a ward setting. Each ward setting must be prospectively approved by the Specialty Board.

Diploma trainees have to complete 4 modules designated as ‘core subjects’ in order to sit for the final PGDip (Med.Tox.) exam, while Masters trainees have to complete the 4 core modules and 4 other modules designated as ‘elective subjects’ in order to sit for the final M.Med. Tox exam.

Trainees are also encouraged to attend international/national face-to-face workshops in clinical toxicology, but these will not carry additional credits. Each module is assigned a credit weight, such that one credit is equivalent to 50 notional hours of learning. Notional learning hours include those spent on online learning activities on the MOODLE platform and on self-study off the MOODLE platform, as well as time spent on preparation for assignments, carrying out assignments and assessments.

Trainees are expected to spend at least 30 hours of learning each week on this study programme during the first year to cover the ‘core subjects’. This includes online learning activities equivalent to 15 hours per week on the MOODLE platform and 15 hours of self-study off the MOODLE platform using related learning material / references.

During the second year, trainees are expected to spend at least 25 hours of learning each week to cover the ‘elective subjects’. This includes online learning activities equivalent to 10 hours per week on MOODLE platform and 15 hours of self-study.

The overall structure of the study programme shall be as follows:

COURSE CONTENT

Overall organization of study programme is as follows

M-004-01- M-004-04 are core modules covered in the first year of the Programme
M-004-01: Core Toxicology 10 weeks / 6 credits

1. Benzodiazepines/ZZ
2. Aspirin
3. Opiates
4. TCA
5. Paracetamol
6. Citalopram
7. Lithium
8. Potassium
9. Mid-assignment
10. End Assignment

M-004-02: Clinical Toxidromes
12 weeks/ 7 credits

1. Antihistamine
2. SSRIs
3. Baclofen
4. Clonidine
5. Alcohol withdrawal
6. NMS
7. SNRI
8. MAOIs
9. Mid-assignment
10. End Assignment

M-004-03: Investigations and monitoring
12 weeks/ 7credits

1. Digoxin and yellow oleander
2. Propranolol (BBs)
3. Verapamil (CCBs)
4. Phenytoin
5. Carbamazepine
6. Valproate
7. Oral anticoagulants
8. Hypoglycemic agents
9. Iron
10. Mid-assignment
11. End Assignment

M-004-04: Regional Toxicology 1
12 weeks/ 7 credits

1. Organophosphates, Carbamates and Solvents
2. Glyphosate-surfactant and Paraquat
3. Plants 2
   • Cochicine
   • Strychine
4. Plants
5. Methanol
6. Alkali/acid
7. Carbon Monoxide
8. Other Snakes
   • Sri Lanka
   • Australia
9. Snakebite - VICC
   • Brown
   • Russels Viper
10. Snakebite - paralysis
    • Tiger
    • Krait
11. Mid-assignment
12. Envenomation
13. End Assignment
    • Pesticides

Elective Modules (Each 10 weeks and 5Credits) 2nd Year Students are expected to complete 4 selected modules

M-004-05: Regional Toxicology 2

1. New synthetic drugs - cathinones
2. Hg/As - Ayurvedic medicine
3. Lead
4. Industrial poisonings (HF chlorine gas)
5. Marine
   • ciguatera, scombroid, tetrodotoxin
   • Fish stings
6. Cyanide
7. latrodectus +? Big black spider/scorpion
8. Mushrooms
9. Mid-assignment
10. End Assignment
    Emerging poisons

M-004-06: Rare & Unusual Poisonings

1. Herbal (Aconitine/ Cardiac glycoside/ Other)
2. Alternative cancer therapy (cesium)
3. Antipsychotic
4. Flecainide - cardiac arrest
5. MCPA-bromoxinil
6. Ppost-mortem levels (orphenadrine, diflunisal?)
7. Copper cobalt THR
8. Internet (fenibutt)
9. Alcohol cannabis
10. Methotrexate (chronic)
11. Mid-assignment
12. End Assignment

M-004-07: Telephone Toxicology

1. Olanzapine oxazepam (aggressive delirous patient)
2. Colchicine (early presentation refusing treatment
3. Barbiturate OD (terminal cancer)
4. With ingestion of plants in the garden (abrus, ricin, glory lily, fox-glove?
5. Foreign body (lead sinker? lithium battery?)
6. Unknown - coma ?stroke (clozapine)
7. Unknown - acidosis (ethylene glycol)
8. Snakebite:non-envenomed
9. Cardiac arrest (hydroxychloroquine)
10. Grandma's tablets (glibenclamide amlodipine paracetamol SR)
11. Mid-assignment
12. End Assignment

M-004-08: Mixed Overdoses

1. Mirtazapine moclobemide, alprazolam, zopiclone, topiramate
2. Webster pack OD - rivastigmine, SR paracetamol, theophylline ??????
3. Metformin NSAIDs acute renal failure
4. Warfarin late paracetamol
5. MDMA and amyl nitrite
6. Amlodipine valsartan hydrochlorothiazide
7. Lithium benztropine
8. Digoxin atenolol diltiazem
9. Fluvoxamine quetiapine bupropion
10. Ibuprofen paracetamol codeine caffeine pseudoephedrine mefenamic acid doxylamine
11. Mid-assignment
12. End Assignment

M-004-09: Addiction

1. Overview Clinical Skills/ Neurobiology of Addiction
2. Comorbidity
3. Prescription and OTC Drug Misuse
4. Alcohol - Part 1
5. Alcohol - Part 2
6. Smoking and Tobacco 1 and 2
7. Opioids - Part 1
8. Opioids - Part 2
9. Cannabis
10. Stimulants
11. Mid assessment
12. Final Assessment

M-004-10: Hazmat Chemical Disaster

1. Toxicology of some Major industrial Chemicals
2. Combustion Toxicology
3. Major Chemical Incidents
4. Management of Hazmat incidents Roles of Different Agencies
5. Public health response to Chemical emergencies
6. UN GHS system classification and labeling of Chemicals
7. Safety Data Sheets (SDS)
8. Chemical Principles – Fire and Explosions
9. Legislation pertaining to Chemical Control
10. ALOHA

M-004-11: Regulatory Sciences

1. Epidemiology of Poisoning and Principles of Forensic Toxicology
2. Principles of Occupational Toxicology and Classification of Chemicals
3. Mode of Entry of Chemicals and Hazards, Risks and Risk Management
4. Exposure Limits, Regulatory Frame work and Poisoning Prevention
5. Issues Related to Control of Poisoning and Psychiatric and Social Determinants
6. Food Toxicology

M-004-12: Community Health and Environmental Toxicology

1. Community Health
   • Basic Concepts of Epidemiology, Measures in Epidemiology and Epidemiological Study designs.
   • Global Epidemiology of Poisoning
   • Epidemiology of Poisoning in Developing Countries and Sri Lanka
   • Prevention of Poisoning
2. Environmental Toxicology

TEACHING-LEARNING ACTIVITIES

The online training would make use of reading materials, video demonstrations, pod casts, online presentations, discussion boards, assignments and quizzes. Each module will have several topics of designated duration (one week, in most cases) that require the trainees to actively participate and contribute. During the programme, trainees will be grouped for each topic.

Tutorial Group Structure and Function

Trainee will be allocated into a tutorial group. As each module consists of a series of topics, trainees will be rotated through differing roles for each topic as follows:  Discussion leader: Initiates the discussion by attempting to provide answers or thoughts to a presented clinical scenario and related questions  Group members: Comment and add to the discussion leader’s post. In addition, each are trainee may post additional questions or discussion points.  Discussion rapporteur: Collate the group views towards the end of the tutorial session

Distribution by internet

All core learning materials would be delivered by internet

Discussion forums

A clinical scenario and related questions will be presented at the start of each new topic. The trainees will be expected to consider this information, and then read and critically consider the references and other resources that are provided and contribute their opinions to the discussion forum. Trainee’s contributions are expected to add or build upon the discussion, not repeat previously posted responses, facts or principles. The educational model is based around a high level of interaction within the groups, whereby trainees will learn from each other. Participation is measured against the quality of their contribution in group discussions, including delegation as leader or rapporteur. The discussion leader’s post should address all the aspects of the clinical scenario and related questions. It should also highlight some areas of controversy or uncertainty. A group member’s posts should not repeat the contents of the lead post, but instead it should offer further comment and insights, highlighting areas of difference of opinion, and/or ask further questions of the group on unclear or unknown topics. The rapporteur’s post should summarise the week’s discussion effectively highlighting the take home messages for the topic and any areas of controversy. However, it is not acceptable to simply state an area of controversy; instead, the various opinions and reasons for and references that support such opinions should be presented. As such, to enable a useful summary to be produced at the end of each topic, all members of the group including the leader and rapporteur should contribute to the discussion In the discussion forum it is necessary to contribute to the group discussion but it is not necessary to be correct in order to receive good grades. Tutors are looking for quality posts when they grade a post for purposes of assessment. What is a "Quality" Post? A quality post should be at least one paragraph but less than 300 words, and should add value to the discussion. It should also reference and critically discuss the course and other material, and not simply be an unsupported statement of opinion. It should not be a simple "that is a good point - I agree". You may agree with a colleague's post, provided you say WHY you agree with appropriate references. Areas that add value include, a critical appraisal of the literature, highlighting a seminal article, reorienting discussion that had strayed from the original clinical scenario and questions, answering a clinical or mechanistic dilemma (e.g. pathophysiology of this condition, or validity of extrapolating from known mechanism of another better described toxic substances), a clinical pearl or introduction of content leading to relevant or related discussion or questions. Making an initial and quality post in the case that the leader is slow to initiate discussion can also be considered valuable.

Tutors will be allocated to oversee the web-based discussion boards within a module. The major input of the online tutor is after the discussion has been summarized by the rapporteur. Prior to that, they may offer guidance or supplementary questions to enhance learning

All academic material submitted for online activities (e.g. discussion forums, assignments) will be perused using sophisticated software for acts of plagiarism. In the event of detecting plagiarism, action will be taken according to the degree of the violation and can amount to:  Instructing on re-submitting the work with appropriate changes  Reporting to the other relevant bodies dealing with disciplinary matters at the PGIM  Failing the assessment in which the plagiarized content was intended  Suspension from the course of study after a disciplinary inquiry according to the PGIM regulations.  Or any other disciplinary action according to the PGIM regulations as decided by the relevant authorized body.

All the reference articles and book chapters will be provided with links on the MOODLE platform.

COURSE ASSESSMENT

This requires successful completion of course work and stipulated number of credits. The course evaluation will be done in 2 parts: First Year Assessment during the 1 st Year and Second Year Assessment during the second year.

The First Year Assessment comprises of two components. (a) Continuous Assessment of the Core Modules (b) Part I Examination

The total mark given for continuous assessments will be 150 (50 marks for forum discussions, 50 marks for mid-module assignments and 50 marks for end module assignments) and that will be scaled down to 100. The following factors will be considered when marking these assessments

Trainees need to attend a minimum of 80% of the online discussions to have satisfactory attendance and be eligible to receive marks for this component. Participation is measured against the quality of their contribution in group discussions, including delegation as leader or rapporteur. Grading of Forum Posts A trainee needs to make a post in order to be considered to have attended that topic and the post must occur while that topic is active (prior to submission of the summary by the rapporteur). In addition, each trainee at the end of each module will be asked to nominate their 5 highest quality posts, and justify the selection. The trainee should consider their nomination in the context of the entire discussion thread e.g. a post which is comprehensive but effectively repeats something already posted is unlikely to score highly (see quality post below). Those 5 posts will be assessed by a designated tutor and an average mark (out of 100) will be given per each trainee which will be considered as the forum marks for that particular course unit.

Each mid-module assignment will be marked out of 100. The assignments should be submitted through the online platform before the stipulated deadline.

Each end module assignment will be marked out of 100. The assignments should be submitted through the online platform before a stipulated deadline.

 A candidate should obtain a minimum of 80% participation for online discussion forums of core modules.  A candidate who is deemed ineligible to sit the Part I Examination due to less than 80% participation in online discussion forums would have to submit one or more assignment(s) designated by the Specialty Board and obtain ‘pass’ grade(s) (50 marks or more for each assignment) in order to be considered as eligible for sitting the exam.

The Part I Examination will consist of a Multiple Choice Question paper, based on 4 core modules. This can be attempted in any PGIM-approved centre, one of which will be in Colombo. The location of other examination centres will be provided 3 months prior to the exam and it may be necessary for the trainee to travel internationally to complete this exam. The duration of the paper would be 2½ hours. There would be 30 questions of the single best response type and 30 of the true/ false type questions. Each true/ false type question will carry a mark out of 5 and each single best response will carry 3 marks and the total marks available for the MCQ would be scaled to obtain a mark out of 50.

Successful Candidate: First Year Assessment

In order to pass the First Year Assessment, a candidate should obtain 1. 50% or more for the continuous assessments and 2. 50% or more for the Part I Examination

Unsuccessful candidate: First Year Assessment

1. A candidate who has obtained 50% or more for the continuous assessments but has failed to achieve 50% or more in the Part I Examination is eligible to sit for the next exam. 2. A candidate who has obtained 50% or more for the Part I Examination but has failed to achieve 50% or more for the continuous assessments but would have to follow (repeat) the relevant modules as designated by the Specialty Board and attain the stipulated minimum requirements within a given period decided by the Specialty Board (The candidates would have to incur the expenses in repeating an online module as designated by the PGIM). 3. A candidate who has failed to obtain 50% or more for both the continuous assessments and the Part I Examination would have to repeat the relevant modules as designated by the Specialty Board and sit for the next examination. A candidate would be given a maximum of six attempts over a period of 8 years, whichever comes first, to complete the Part I Examination from the date of commencing the course.

A trainee who has not passed the First Year Assessment may be permitted to follow the ‘Elective Subjects’ provided that the trainee has made the appropriate payments. However such a trainee is not eligible to sit the Part II Examination until he / she has passed the First Year Assessment.

9.2 Second Year Assessment

The Second Year Assessment comprises three components. 1. Continuous Assessment of Elective Modules 2. Case Book 3. Part II Examination

9.2.1 Continuous Assessment of the Elective Modules (50% of the final mark):

The total mark given for continuous assessments will be 150 (50 for forum discussions, 50 for Mid Module assignments and 50 for end module assignments) and that will be scaled down to 100. Discussion forums will be marked and graded according to the criteria given in Section 9.1.1 above

9.2.2 Case Book

During the course, each trainee is expected to compile a case book consisting of 8 different clinical cases in toxicology and toxicology according to the following criteria: 1. Each case to be written using a format given in the guideline (See the Annexure 2): 2. Trainees are expected to visit a medical facility of choice and witness and get involved in the management of each patient. 3. The medical facility should be prospectively approved by the PGIM. 4. The trainees should inform the PGIM at the beginning of the second year the name of the consultant and the hospital in which they intend to observe clinical cases, to facilitate the PGIM to prepare supporting documents. 5. The consultant-in-charge of the patient should supervise the case report. 6. An internal supervisor will be nominated by the specialty board for each trainee and the written case reports will be supervised by the internal supervisor. It is the duty of the trainees to send all the case reports at least 1 month before the Case Book submission date to the internal supervisor for review. Case Book Structure: Please see the annex 2

Case Book Submission

Trainees are required to submit the case book approximately 3 months before the date of the final exam.

Case Book Assessment:

The case book will be assessed at a face-to-face viva examination when the trainee will defend the cases, using a structured marking scheme (Annex 3). Candidates are expected to obtain 50% or more out of 100 marks to receive a ‘pass’ grade in order to become eligible to sit the final exam.

Re-submission of the Case Book

Trainees who obtain less than 50% for the case book are expected to re-submit the case book, according to examiner recommendations, 1 month before the exam for re-evaluation.