Meeting #6

Del Mar, Califoria

April 24 - 27, 2002



Present at the meeting, which was chaired by Marc Schuckit, M.D. (Director), Marianne Guschwan, M.D. and Susan Tapert, Ph.D. (Director’s Assistants); Donna Londino, M.D., Jean-Joel Villier, M.D., Lauren Williams, M.D. and Chris Welsh, M.D. (Senior Scholars); Evaristo Akerele, M.D., Woody Levy, M.D., Steven Madonick, M.D., Laura Pieri, M.D. and Margaret Rukstalis, M.D. (Junior Scholars); Mimy Eng (guest); Bob Niculescu, M.D., Ph.D. (guest), Marcy Gregg (Administrator).



I. Wednesday, April 24th.

The group convened our meeting at 7:00 p.m. on Wednesday, April 24th at the L’Auberge, Del Mar north of San Diego. Following a brief get-together greeting of all participants, the group proceeded to dinner. At that time, the agenda for the following days was discussed, and the guests were introduced.



II. Thursday, April 25th.

The group convened at 8:00 a.m. to begin the meeting over breakfast. Marc Schuckit discussed the agenda, and asked for any additions or deletions.

The group turned to a discussion of the poster on AMSP at the upcoming Research Society on Alcoholism meeting. The poster itself was presented, and the following suggestions were made. The poster should be available as a handout on an 8 ½" x 11" sheet of paper; we need to develop cards for AMSP for people to refer to (Marcy will develop this); we need to hand out a brochure. This led to a discussion of the fact that we might use the AMSP poster as an additional handout to describe in more detail what we have accomplished.

Marc then demonstrated a lecture from the AMSP website. The goal was to demonstrate how the original outline published on the website could be modified and focused, and how a very sparse outline can serve as a guide for presentation of material. Following the demonstration, the group discussed issues related to lecture outlines and delivery style.

Woody Levy then presented his lecture on Substance Use in Athletes. This was full of information that might be of interest to a variety of audiences, and the lecture was well delivered and received. The group offered a series of suggestions of things that might help to make a good lecture even better. The thought was emphasized that the material of most direct interest (i.e., eye catching to medical students) were the data regarding various ways of taking drugs in an attempt to enhance performance; the group very much appreciated the way that problems and dangers were emphasized by being placed into another color; and it was felt a bit more emphasis should be placed on anecdotes and perhaps a couple of pictures of some athletes for whom drugs have been a problem. Perhaps less emphasis might be placed on illicit drug use.

The next topic was a discussion led by Marc Schuckit and Susan Tapert regarding how to optimally prepare Junior Scholars for the development of a lecture. It was felt the excellent lecture on the website as originally developed by Jean-Joel Villier and Susan Tapert, dealing with the steps taken in developing an outline and carrying out a literature review, etc. was an excellent base. The following suggestions were made regarding steps that can be taken to enhance the existing lecture:

1) Clear due dates must be established has to be emphasized. The first draft of material (not necessarily including slide copy) must be sent to Marc on December 15th at the latest, and the final draft with all final slides (following multiple drafts carried out with Marc Schuckit) are due on March 1st at the very latest;

2) it will be important to emphasize that we are developing a style that allows consistency across lectures on the website, and that participants are expected to master this approach and then modify and develop their own lecture style for additional lectures. However, it is important that everyone conform to the basic style for this assignment;

3) it will be important to advise new scholars to have studied the website and selected a potential lecture topic before they come to their first meeting;

4) the expanded lecture by Marc will discuss the importance of using abuse and dependence as outlined in DSM-IV, and will give some examples;

5) examples of text will also be given to show the difference between the outline style we use versus writing full sentences and paragraphs;

6) some slides will also demonstrate the difference between busy slides and those that are most appropriate for AMSP;

7) participants will be told to use numerals rather than writing out numbers, remove prepositions, etc. to prepare a lecture;

8) a specific slide will be developed regarding how to use and list references;

9) the Junior Scholars will be reminded that (unless they state otherwise) they are to assume this is for a medical school audience and they are limited to less than one hour;

10) Junior Scholars who are not very comfortable with computers can be encouraged to send rough-typed or handwritten drafts and slides by fax if they are having trouble formatting; a clear guideline will be established demonstrating that the rough number of slides should be between 15 and 30/ the length of the usual outline is between 5 and 10 pages/ and that the appropriate number of references is probably somewhere between 15 and 30.

The group next turned to some thought on how to review an article. The emphasis was on the types of literature reviews that one might use in trying to prepare a lecture. Marc set forth (and might add to the lecture discussed immediately above) that for the type of material most appropriate for a medical student audience an emphasis is usually not placed on details of methodology. Therefore, most of the relevant information can be obtained for articles very quickly by reading the abstract, taking a look at material that stands out from the tables, and only going to methodological details or great details of tables when there are specific items relevant to the lecture. A number of examples were given.

The optimal role of Senior Scholars was discussed. Timing of selection of Senior Scholar/ Junior Scholar pairing is probably best done on the second day of the fall meeting. That gives a little bit of time for people to get a feel for each other, and then some time for them to make plans. The Senior Scholars also need to recognize that they must respond very quickly to drafts sent to them so that the deadlines set can be met.

The next topic involved career development issues surrounding the optimal use of free time. Most of the discussion focused on the absolute need for free time and for additional interests. Various ways of trying to accomplish this in the context of a demanding academic atmosphere were discussed. Along with this came the question about how best to be able to say no when asked to take something on.

The final section of Thursday’s meeting was the presentation by Laura Pieri of the lecture on The Therapeutic Community as Treatment in Substance Use Disorders. This went very well, with effective slides and demonstration of mastery of information. The discussion included the fact this was the type of lecture (as is true for spirituality) that could have developed into relatively “soft” material that would not be well accepted by (and thus, not much used by) medical students. The lecture Laura delivered gave useful information that was well organized with an emphasis on data from controlled trials. It was effective and the AMSP scholars offered suggestions on highlighting some of the slides and optimizing the delivery of information.

The meeting adjourned at 2:00 p.m.



III. Friday, April 26th.

The group reconvened at 8:00 a.m. Our first order of business was the lecture on Substance Use Disorders among Schizophrenics by Evaristo Akerele. This lecture offered many unique opportunities to discuss issues relevant to material that might be developed to be presented to department faculty as this was Avaristo’s focus. The material was a good blending of appropriate use of references, a fine demonstration of a detailed understanding of the work in the field, and an effective demonstration of many of the lecture techniques discussed. Several issues arose that were useful to the group in general, and resulted in a detailed discussion. All scholars were impressed with the lecture and look forward to adding this to the website after some modest modifications.

We next progressed to a series of presentations of accomplishments made at their medical schools by Senior Scholars. The first report came from Lauren Williams at Miami. A great deal has been accomplished these last two years at Miami, including incorporation of information into all four years of medical school. In addition, a DOC-like program based on a template from the Department of Family Practice will be used to generate funding from the medical school for a program for which students will get credit. Addiction fellows help teach, and Lauren looks forward to enthusiastic student participation. An additional development grew out of the success of last year’s Addiction Day, where Lauren will now participate in a Spirituality Day, during which she will be using some of the lectures developed from AMSP, including that put forth by Marianne Guschwan.

Jean-Joel Villier at Howard University gave his report. This included the use of an AMSP lecture as part of the introduction to alcoholism for first-year students, as well as the lecture he offers approximately every six weeks to third-year medical students — focusing on his lecture developed for AMSP. He is also working with Dr. Galati on a DOC-like program for medical students; participated in the National Alcohol Screening Day using the AUDIT; and has helped Dr. Taylor to use a lecture from the AMSP website. He is working with OB-Gyn and has given the AMSP lecture on the fetal alcohol syndrome.

Donna Londino of Medical College of Georgia presented a series of accomplishments during her recent tenure with AMSP. She now serves on the Family Committee of the American Academy of Child and Adolescent Psychiatry where she is helping them to develop diagnostic guidelines and serves as a consultant for greater understanding of the role of alcohol in family issues. Recently she passed her Child Psychiatry Boards (for which we all offered hearty congratulations). Dr. Londino’s student elective on Alcohol and Drug Use Disorders was accepted, and the group discussed a number of approaches that she might use to optimize the number of students who participate (e.g., sending out flyers to students just prior to the time they are eligible to sign up for electives; e-mailing medical students about that time about the wonderful course she is offering; trying to find several medical students who might be able to serve as endorsements for the program and speak up the issues with other medical students, etc.). Donna also serves on the Curriculum Oversight Committee for the medical school where she is attempting to optimize the efficient offering of information related to alcohol and drug use disorders. She participates in a Psychiatry Interest Group for 12 medical students where she is emphasizing the importance of alcohol and drugs as this group gets together for dinners, to view movies, and so on. Dr. Londino also serves as an advisor for the Students for Community Involvement, where she gives a lecture on alcohol and drugs. Furthermore, as her Adolescent Psychiatric Unit has increased to 14 beds, she is increasing the number of patients with alcohol and drug use disorders, and is also able to report that six students participated in electives on the unit. Finally, Dr. Londino is now in charge of a board review course for residents and interns where she emphasizes the importance of substance use disorders in children and on family violence, and she will be giving Grand Rounds.

Chris Welsh from the University of Maryland next brought us up to date on his progress. He is a member of the Interdisciplinary Alcohol and Drug Presentations program which attempts to integrate information on this important topic across nursing/law/medicine/etc. schools; he works with the Students for Prevention of Addictions, and facilitates their attendance at the University of Utah Summer School of Alcohol and Drug Studies; Chris serves as liaison for medical students regarding substance use disorders where he receives perhaps one to two e-mails a week regarding issues on which they are concerned; he has helped organize a series of movies related to substance use disorders; Chris has given two lunch time lectures on impaired physicians and designer drugs; he is part of the Substance Abuse Outreach program which is a Doc-like endeavor reaching out to patients in substance use disorders programs; Dr. Welsh is in charge of the Medical School Education on Addictions and coordinates efforts across the school; and he recently functioned as part of a documentary on the life of medical students where he talked about addictions as well as other actions. The accomplishments listed by Chris also extend to his role as the coordinator for the Alcoholism Screening Day at the University of Maryland at Baltimore; his work in educating individuals involved in the consult service; his role as officially serving as the Chair of the Medical Student Education Committee of the American Academy of Addiction Psychiatry; his efforts for a proposed workshop of this group (AAAP) dealing with medical student education; his role of the coordinator of Grand Rounds for the Department of Psychiatry; as well as two American Psychiatric Association workshops on medical student education regarding substance abuse (during which he will highlight AMSP); and his participation in a workshop on How to Give a Lecture.

Marianne Guschwan then brought us up to date on her continuing efforts at New York University Medical School. Marianne has instituted a club on substance use disorders (similar to an elective) which currently involves eight students. The goal is to give them experience with interviewing individuals with substance use disorders and introducing them to the importance of these problems as emphasized through the rich educational programs at NYU. She has also increased her outreach to students as part of the Psychiatric Clerkship; she is working with fellows on giving lectures; she is working with a DOC-like program in the community; Dr. Guschwan is teaching social workers about the most appropriate use of motivational enhancement therapy for dual diagnosis patients (an activity that might expand into a research study); she is working on submitting an article on AMSP to the Association for Academic Psychiatry; and is one of the leaders of the American Psychiatric Association workshop (along with Donna Londino, Chris Welsh, and Susan Tapert) on How to Give a Lecture.

Finally, regarding senior members’ reports, Susan Tapert reviewed some of the activities at UCSD. Susan related the lectures which are given in each year of the medical school. The elective she teaches with Marc Schuckit has been successful this year due to contacting the electives coordinator (just prior to the time students sign up), to send an e-mail to all MS-1 and MS-2 students, and posting flyers around the medical school. She told us of her enhanced activity with the UCSD-San Diego State University Joint Doctoral Program in Clinical Psychology, and contacts with the residency and fellowship programs. She is also presenting information on substance use disorders as part of Grand Rounds. She has continued to serve as the advisor for the Doctors Ought to Care (DOC) Alcohol program, providing ideas to first and second-year medical students on how to deliver alcohol-related information to elementary through high school students.

Susan’s report was a logical segue into a discussion of the activities involving the AMSP website. We now get between 75 and 100 hits per day, translating to more than 2000 visits per month. Most people come directly to our website, with a substantial minority finding their way to us through Google or other search engines, or through connections related to NIDA, NIAAA, Gallo, and other websites. We have been visited by people from many countries, including Bangladesh, Saudi Arabia, Japan, Canada, Lithuania, Poland, Italy, the Czech Republic, Columbia, and so on.

The next item on our agenda was to demonstrate how a lecture originally developed for a one-hour presentation can be modified for a 15-minute delivery. Donna Londino demonstrated this process with her lecture regarding Substance Use Disorders and the Family. This was an excellent demonstration of (with almost no advanced warning) an ability to delete about a third of the slides, focus on the information Donna felt most comfortable with, and decrease the number of goals one hopes to accomplish in a particular lecture format. Her delivery was almost to the minute on time, and was highly effective.

As we began to prepare for lunch Susan Tapert next gave an update on the use of PowerPoint in presentations. Susan took all participants through various stages of developing slides, reviewing some of the material she had discussed before, but now having the opportunity to interact with scholars each of whom have had some PowerPoint experience. This was a highly successful interaction, and we hope to make this a regular part of all AMSP meetings.

During lunch, our group returned to issues related to career development. This included a discussion of what various academic rankings mean in different places; various tracks (e.g., academic research vs. clinical), and their assets and liabilities; how clinician teachers might be able to optimize their CV regarding publications; how to find mentors who can advise on academic promotion issues; and so on.

The final business on Friday was the presentation of a lecture by Margaret Rukstalis on The Relationships between Alcohol Use Disorders and Nicotine Dependence. This was a fine presentation with a very effective use of slides and an excellent level of organization. Suggestions were made regarding steps that might be taken to expand the amount of information a bit, along with the possibility of revising some of the slides. Minor issues relating to definitions and the use of jargon were presented. This is very close to a form that will be an effective addition to the website.

The group then reviewed the agenda for Saturday morning along with the directions for the dinner get-together Friday night.



IV. Saturday, April 27th

The group reconvened for our final session at 8:00 a.m. on Saturday. We began with Steve Madonick’s presentation of Substance Use Disorders in Geriatric Patients. This was a very effective talk with excellent slides. There was room to increase some information; the need to more clearly define jargon; and a variety of other suggestions to help make this fine lecture even better.

We next progressed to a series of presentations from Junior Scholars outlining their AMSP-related accomplishments at their universities.

The first such report came from Woody Levy at the University of South Florida. Woody has joined the Medical Education Student Committee for his school where he hopes to be able to highlight the need for education regarding substance use disorders, and he is monitoring the ongoing changes in the medical school curriculum and hopes to be able to implement additional courses and educational opportunities. Currently, he has a number of activities regarding medical students: in the first year he is monitoring a course on alcohol and drugs run by another staff member; for third-year students he is working to optimize the amount of information on alcohol and drugs during the one-month inpatient and one-month consult liaison rotation in Psychiatry; for fourth-year students, he is working toward developing a substance use disorders-related elective — although this cannot be established until the curriculum changes are instituted. Regarding medical students in general, Woody has been able to increase the amount of information offered as part of the didactic series from one hour to currently two hours — making sure that one of these two is now devoted to alcohol-related problems. Woody has a series of opportunities to improve the level of education of psychiatric residents, and is working with an additional new staff member. He also works closely with fellows, and has assisted in putting together a course for the fellows consisting of a series of 22 one-hour lectures presented by various faculty and staff, in which he previously gave two lectures and now delivers three of the lectures for the SUD fellows, basing some of this material on AMSP lectures. A wonderful new development is a six-week part-time rotation that was expanded to full time on the Adult Intensive Inpatient Unit in which the fellows now participate. Finally, he is working to use some of the AMSP lectures as additional teaching materials, including some that might be offered over the noon hour.

The next report is from Evaristo Akerele from Columbia University. Evaristo works in a university with a great deal going on regarding substance use disorders, but he has been able to take his AMSP experience to expand and improve these efforts. He is the Assistant Medical Director of the Outpatient Substance Treatment and Research Service (STARS), where he is able to increase the efficiency and focus of medical education to medical students regarding substance use disorders. In this light, he has restructured the teaching responsibilities so that fellows supervise residents who then supervise medical students. He is also incorporating the clinical psychologist in these teaching efforts. Evaristo has recently met with the Director of Residency Training who has agreed to increase the number of relevant people participating in training at STARS, and has enhanced the supervision of fellows by multiple faculty members. He is planning to begin a new general lecture on the treatment issues to be incorporated into STARS, and expanding his personal meeting with fellows to one time per week. At the same time, Dr. Akerele works as the Associate Fellowship Director for substance use disorders fellows where he is organizing a once per week meeting and working to develop an adolescent substance use disorders clinic as part of their education. Evaristo has increased the number of lectures given to appropriate students, residents, and fellows, including a number that were developed from AMSP, such as How to Give a Lecture. These efforts have combined with others at his university to result in an 87% average score on the Board Preparation Exam (the PRITE), and his efforts have been recognized as he has gained greater visibility with the overall Director of the program, Dr. Kleber.

The next report came from Laura Pieri from Temple University. Laura has accomplished a wide range of things at her university, reaching out to all years of medical students. She now teaches the Introduction to Alcohol and Drugs to medical students during the first year; she has become the person to whom students turn when they have questions regarding substance use disorders; she has an advanced lecture on substance use disorders for second-year medical students, during which time she also reaches out to the Department of Psychopharmacology to teach clinical applications of substance use disorders treatments; second-year medical students are offered a new elective on Spirituality which involves exposure to a therapeutic community; third-year students receive a number of additional lectures, most from other faculty members, but as monitored by Laura; and a fourth-year elective on Spirituality has been developed for students. Dr. Pieri now serves on the Impaired Physicians and Students Committee and has used the AMSP lecture on impaired physicians to help this group focus on their most relevant activities. Alcohol and drug issues were highlighted during a recent visit from the Medical School Accreditation Board, which also emphasized to the Dean of the Medical School the importance of AMSP efforts (in which he was quite interested). Additional activities have included a CME program for family practitioners, and a Grand Rounds presentation on the therapeutic community using her AMSP material. Due to a number of personal issues, Laura will be leaving Temple University to begin to work in Prescott, Arizona. She has found that the AMSP lectures have served as an important basis for her in training her replacement at Temple. While her job in Prescott is not in an academic institution (and, thus, she will not participate in the second year as a Senior Scholar), she plans to develop a medical school affiliation and we hope she might be able to return to us sometime in the future. In the meantime, her transition has demonstrated how AMSP materials can be not only useful to the individual scholar, but can serve as a basis for training a replacement.

Steven Madonick from Yale University brought us up to date on the experiences he has had at his medical school. Steve met with the Head of Medical School Education in Psychiatry and related faculty which has resulted in his ability to give input on a number of different levels. One of the most interesting development is that the medical school recently received a grant from the Reynolds Foundation dealing with geriatric medical problems, and his preparation of the lecture for AMSP has placed him in an excellent position to become part of that teaching effort. This, along with clinical-based teaching in which he is participating, have markedly increased Dr. Madonick’s visibility in the medical school and enhanced his career development. Steve believes that the AMSP website will be particularly useful to his department in general, as well as to the Reynolds Grant. Additional developments are the steps being taken to increase substance use disorders-related lectures as part of a case series; the possibility of developing an elective; and Steve’s ability to use AMSP-related material to reach out to residents and fellows. Finally, he is planning to develop a lecture or a series of presentations dealing with the optimal way of delivering a lecture.

The final of the Junior Scholar reports came from Margaret Rukstalis from the University of Pennsylvania. Margaret has been very active, including developing a medical student luncheon series relating to substance use disorders, and incorporating the AMSP lecture developed by Chris Welsh about impaired physicians as part of a medical school course that teaches healthy living to physicians. Furthermore, Margaret has received permission to begin an elective on substance use disorders for medical students and nonclinical fellows; she is a member of the Advisory Committee for the Substance Use Disorders Fellowship where she is working to enhance the level of mentoring; and her use of the AMSP lecture on How to Give a Lecture to teach fellows how to teach — with the requirement that they use our material (or others) to develop two talks. Margaret participates in the introduction of residents and interns to substance use disorders, and is considering developing a seminar on teaching approaches for the Research Society on Alcoholism.

Then Chris Welsh delivered his 45-minute to one-hour lecture condensed to 15 minute on Substance Use Disorders in Physicians. (Chris, do you something you could add here?)

Our meeting concluded with the discussion of a variety of important topics. These include:

1. The conference call for the existing Junior and Senior Scholars will be on Wednesday, July 17th at 3:00 p.m. EST (noon San Diego time). Marcy will arrange this call an will notify each scholar on how to sign in or to determine where they will be for us to be able to connect them.

2. The final versions of all lectures developed for AMSP by Junior Scholars must be forwarded to Marc Schuckit (lecture material and slides) no later than May 15, 2002. Our plan will be to load these on the website no later than May 31st.

3. Marc gave a brief background on the four scholars who have been selected for next year. A discussion was carried out regarding a number of candidates for the remaining position, including two new suggestions from Chris and Evaristo — both of whom will send CV’s to Marc. Marc hopes to make a final decision on the last position soon.

4. The Junior Scholars are encouraged to buy their tickets for the AMSP meeting in London as soon as possible. Remarkably low airfares are currently available. Once the ticket is purchased, Marcy will work with the scholar to get an advance on the cost from UCSD. Marcy will also send this same type of information on to the new scholars. Also, an additional letter with suggestions for how the funds provided by AMSP to the new scholars’ institutions could be utilized will be sent along with the monies for their first year of participation in AMSP.

5. Several of us will be at the RSA meeting. Our get together at RSA will be on Tuesday at 8:15 a.m. at the AMSP poster. People are encouraged to grab their breakfast and bring it so we can sit together and eat.

The meeting ended a little after noon with everyone wishing nothing but the best to everyone else. It was a wonderfully productive meeting, and we are all looking forward to the next get together and greeting the new scholars. The Senior Scholars are encouraged to help perpetuate an alumnus group for continued networking, and are invited to attend any future AMSP meetings (although, unfortunately, that will have to be at their own expense).

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