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25 Anniversary Article: Transitions

TRANSITIONS

By J. Ward Donovan, Past President of ACMT

In this series of articles about the history of ACMT, other past presidents have reviewed the history of ACMT and their own entertaining and informative remembrances. By comparing the organization and activities of the American Board of Medical Toxicology (ABMT) and the early ACMT with those of ACMT today, we can see the dramatic evolution and growth of our College and specialty. I will recount my own recollections of those early years, and how the efforts of many then and now placed medical toxicology solidly in the mainstream of medical practice.

The ABMT was formed in 1974 from within the American Academy of Clinical Toxicology (AACT) to provide recognition of physicians practicing in this new specialty. The very challenging certifying exam was the primary and almost sole function of this non-ABMS, specialty society board. The by-laws of ABMT stated its purpose to be “the advancement of medical toxicology by evaluating the training programs and credentials of physicians applying for certification as medical toxicologists; fostering the development of medical toxicology; and striving to advance and elevate the science, study, and practice of medical toxicology”. Members of ABMT were limited to those “diplomate physicians certified by the board as qualified to render care in medical toxicology”.

In order to sit for the examination to achieve certification, the candidate had to complete a 2-year fellowship in medical toxicology, clinical pharmacology, occupational medicine, forensic pathology, or laboratory medicine, or a one-year fellowship followed by 2 years of subsequent clinical practice in medical toxicology. Absent these formal training requirements, prior to 1991 candidates could be eligible if they had 3 years of clinical practice with significant emphasis on medical toxicology and at least 150 hours of supervised preceptor experience with an ABMT Diplomate or someone with equivalent credentials. In the 1970’s and 1980’s, many, if not most, qualified for the exam through these latter criteria. I was fortunate enough in 1985-86 to spend a one-year sabbatical with Professors Prescott and Proudfoot at the Royal Infirmary of Edinburgh in Scotland, as had Barry Rumack before me, thus qualifying me for the exam. Fellowships in medical toxicology were being developed at that time, but were not recognized by the American College of Graduate Medical Education (ACGME).

The other significant activity of ABMT was to present a scientific symposium at the annual meeting of the AACT/AAPCC/ABMT, now known as the NACCT. Committees of ABMT were only the Executive, Nominating, and Certification Committees. An informal ad hoc group would be responsible for preparing the symposium, and all administrative activities were performed by the officers and the board of directors. Administrative support was also provided through the good graces of the administrative assistants and secretaries of each officer at their institutions. The by-laws stated that “the office of ABMT will be in the city of the residence of the Secretary/Treasurer”, and in practice this meant that every 2 years, with the change of officers, all of the ABMT files and records were shipped to the newly elected Secretary. With my election in 1992 to this office, an honor largely bestowed on those foolish enough to volunteer, I was challenged by the idea of administering a national society. I therefore lobbied the board to establish a fixed location with a dedicated professional support staff, and they thankfully agreed.  Consistent with the by-laws, the first office was contracted to the Pennsylvania Medical Society in Harrisburg, reasonably close to my “city of residence”. A permanent national office was a practical and significant advance for ABMT, and it was spared the uncertainty of depending on my secretarial oversight.

In those early years of medical toxicology, a distinguished group of physicians nurtured and advanced the specialty by preparing and administering the exam, by their clinical practice, directing poison centers, teaching, and by publishing cases and literature on focused toxicology topics, as well as research. This august first generation of modern toxicologists included such luminaries as Lew Goldfrank, Helmut Redetzki, Matt Ellenhorn, Don Kunkel, Fred Lovejoy, Chuck Becker, Alan Done, Howard Mofenson, Bill Robertson, Tony Temple, Barry Rumack, and Carol Angle. A second generation of medical toxicologists, too numerous to mention, began to assume roles in ABMT and the specialty. As medical toxicology began the transition to an ABMS recognized specialty, Bill Banner and Paul Pentel assumed the reins of ABMT, and I was thrilled to be able to mingle with all of these founders. Meanwhile, the elder statesmen were masterfully navigating the complexities of medical politics within the American Board of Medical Specialties to gain recognition of medical toxicology as a sub board of the American Boards of Emergency Medicine, Pediatrics, and Preventive Medicine. When this was approved in 1993, the need for the ABMT’s primary purpose was eliminated. However, there still remained the other goals of ABMT as stated in its by-laws. While there was some discussion about the way forward, it was probably inevitable that the functions, board of directors, membership, and national office would continue under another logo to provide a specialty society for board certified medical toxicologists.

Thus, on August 19, 1993, following a vote by the membership, articles of incorporation were signed by the incumbent ABMT officers to establish ACMT. Unburdened from the time -consuming responsibility of preparing and administering a board exam, ACMT was able to focus on advancing toxicology education, the further development of the medical toxicology specialty, and representing its members. In its early years, ACMT continued its sponsorship of a scientific symposium within NACCT and added pre-meeting and practice symposia, offered a board review course (complete with copies of the old ABMT questions), established criteria for ACMT Fellowship, created the Ellenhorn Award, partnered with ATSDR to provide environmental toxicology education, founded an ACMT website and an internet journal, and began to offer research awards.

Today, ACMT has grown from its 210 members in 1993 to over 800, has a national office with a full-time executive director and 12 associate staff, and has 3 affiliated programs: the Toxicology Investigators Consortium, the Pediatric Environmental Health Specialty Units, and the Medical Toxicology Foundation. It has 7 membership categories, 12 standing committees, and 10 special interest sections. Educational activities include not just the previous symposia at the NACCT, but its own annual meeting, a Forensic conference and a board review course, along with online grand rounds, journal club, webinars, case conferences, and podcasts. Finally, ACMT now has its own peer-reviewed journal, the Journal of Medical Toxicology. All of these remarkable achievements resulted from the dedicated efforts of those who succeeded the original core of medical toxicologists who founded ACMT. The transition from the ABMT to the fledgling ACMT, to the large and successful organization we belong to today, could not have been foreseen by those of us who signed those articles of incorporation in 1993.