Meeting #7

London

October 23 - 26, 2002

Present at the meeting were First Year Scholars: Christina Delos Reyes, Karen Drexler, Katie McQueen, Gail Rose, and Joe Thornton, Second Year Scholars: Evaristo Akerele, Margaret Rukstalis, Woody Levy, and Steven Madonick; invited guests: Valger Dur (Iceland) and Roberta Agabio (Italy). Hosted by Marc A. Schuckit, M.D., with assistance by Susan Tapert, Ph.D., and Marianne Guschwan, M.D., along with Marcy Gregg.

I. Wednesday, October 23rd (The Introductory Session)

After arrival at the Montague hotel, our group convened at 6:45 p.m. Introductions were made all around, and we proceeded to a separate room in Vasco’s Restaurant for dinner and discussions. The agenda and goals for the following days were discussed, and Junior Scholars were reminded of their need to select a topic, outline potential activities at their university over the upcoming year, and to select a Senior Scholar as a mentor.

II. Thursday, October 24th

The meeting began at 8:00 a.m. with a review of the final itinerary for that day. The various topics were discussed including the importance of using an outline form for lectures and the fact that all participants had taken the opportunity to review the website.

The first formal presentation was an extended discussion of the lecture: How to Give a Lecture, by Marc Schuckit. This involved great detail relating to literature reviews, taking notes, sifting through information to that most relevant to the individual, and the use of an outline form. This session also gave the opportunity of demonstrating the production of slides, and more formal aspects of the presentation itself. These discussions occupied most of the morning.

A working lunch was accompanied by a discussion of career development issues. These included topics on how to choose a mentor, the steps usually required for promotion, and some of the assets and liabilities of various grant applications such as K Awards.

The final session of the day gave the opportunity for Woody Levy to demonstrate his lecture. This was presented as it would actually be given to medical students, and the full 45 minutes was used. The presentation was then discussed in the context of the morning’s first lecture on How to Give a Lecture.

Thursday’s work ended with a review of Friday’s schedule. All participants were on their own Thursday evening.

III. Friday, October 25th

The morning began with a review of the outline developed by Margaret Rukstalis regarding goals, methods, and details for the development of lectures.

Marc Schuckit then demonstrated how a 40-minute lecture can be cut back to 20 minutes. Both the long and short outline were handed out and discussed.

Continuing with the discussion of lecture style and organization, Susan Tapert demonstrated her lecture on The Effect of Alcohol Advertising among Youth.

Steven Madonick, a Senior Scholar, next reviewed his accomplishments to date at Yale as an AMSP scholar. These included: participation in the alcohol and drug-related issues for the Yale grant on the Importance of Geriatric Issues in the Medical School Curriculum; the incorporation of material related to substance use disorders in existing lectures, including those on schizophrenia; education of staff of the clozapine clinic regarding substance-related topics; and enhanced visibility of alcohol and drug-related education among his research and clinical groups at Yale. In the future, Steve hopes to incorporate more lectures including the presentation on How to Give a Lecture, and enhance the substance-related education in the residency.

Woody Levy next presented his update of accomplishments at the University of South Florida. Woody began a year ago with very little in alcohol education at USF, but has had excellent help from Dr. Odorica and Dr. Frances. His work these last 12 months has included: active participation in the substance-related disorders fellowship; development of a lecture series for that group; developing a substance-related inpatient component of the fellowship which now runs for six weeks full time; incorporation of substance-related material into the general psychiatry residency; having all psychiatric residents rotate through the outpatient substance use disorders treatment program; beginning a series of 12 two-hour lectures for psychiatric residents; running of three two-hour workshops each year for medical students on topics related to substance use disorders; and working to develop a psychiatry substance use disorder rotation for medical students. At the same time, Dr. Levy’s prominence in his Department has markedly expanded as he functions as Chief of the Inpatient Substance Use Disorders Unit, and Chief of the Emergency Psychiatric Service. He was recently named Assistant Chief of Psychiatry, is a member of the Medical School Education Committee, and developed a relationship with the Residency Education Committee. Woody also works with the Dual Diagnosis Program, and this last year became Board Certified in Addiction Psychiatry.

Steve Madonick next presented a brief version of his geriatric substance use disorder lecture developed for AMSP. He volunteered to demonstrate how a 30-minute version (originally developed from the full 45 minutes) could further be cut down to ten minutes—and to present how he would arrange such slides as the kick-off for the Saturday morning session.

Margaret Rukstalis reviewed her accomplishments at the University of Pennsylvania, emphasizing that her relationship with AMSP has helped give her visibility in a department where substance use disorders issues were already relatively prominent. Specifically, she has: added new alcohol and drug-related cases to the first-year case discussion series; presented her lecture on Substance Use Disorders in Women to first-year students; offered a lecture to a subgroup of first-year students regarding how to give a lecture; worked with two separate groups of between 10 and 20 minority medical students on a similar topic, as well as teaching about her alcohol and nicotine lecture; and is now working on the development of an elective for first-year students. For psychiatry residents, Margaret helps coordinate the substance use disorder lecture series, has helped develop a three-month block for third-year residents where substance use disorder material is discussed, and she is involved with individual supervision of two hours per week with a fourth year resident, with much of the material dealing with substance-related issues. For fellows, she serves on the Executive Committee, is a mentor for substance use disorders fellows, and is a teacher in the program. Next year, Margaret hopes to expand this work, as well as establishing a liaison with the treatment program at the VA Hospital as a potential venue for teaching psychiatry residents and third-year medical students.

The informal lunch time discussion of career development issues focused on problems in career development for women, steps that can be taken to balance personal life and professional life, finding appropriate mentors, appropriate use of free time, and ways of limiting activities by knowing how and when to say no.

In the final session of the day, Evaristo Akerele gave a brief version of the manner in which his lecture on Substance Use Disorders among Schizophrenics might be presented. Plans were made for him to actually present a subsection of this material directly the next morning.

IV. Friday, October 25th evening get-together

The group reconvened in the lobby of the hotel and proceeded to Le Deuxieme restaurant for our discussion of issues and celebration of accomplishments. The Junior Scholars were reminded that the Saturday session would focus primarily on their announcements regarding their lecture topics, senior supervisor, and goals.

V. Saturday, October 26th.

We began with a 15-minute section of Evaristo Akerele’s lecture on Schizophrenia and Substance Use Disorders. A number of issues related to slides and his excellent presentation style were discussed.

Susan Tapert then gave an update of accomplishments at UCSD. These included her work with the DOC Program; the excellent manner in which the medical student elective is progressing; both her work, as well as that of Marc Schuckit with medical students individual study projects; Marc’s lecture about How to Give a Lecture; the input that both Susan and Marc give to the Psychology Training Program; consulting with the Child Psychiatry Fellowship on integrating substance use disorder information into the curriculum; as well as the development of a new substance use disorders psychology fellowship through both UCSD and SDSU.

Susan next reviewed the website. In the nine and a half months between January 1, 2002 and approximately October 15th, the website had over 56,000 hits and about 17,000 visits. In September this included 75 unique visits per day from approximately 2400 different sites. She reviewed the search strings that were used, the referral source, and the specific components of the site most often visited.

Marianne Guschwan next gave her update from NYU. She has successfully implemented a club (similar to an elective) on substance use disorders, developed a new rotation for third-year medical students, and is reaching out to the internal medicine residency regarding substance-related problems. Marianne continues to develop workshops on How to Give a Lecture, where she prominently cites AMSP. She is also teaching medical residents in the Physicians in Residence Program at Hazelden New York, and developed a Lunch with the Experts on education in addiction at the American Academy of Addiction Psychiatry. Marianne published a paper on AMSP for the Association for Academic Psychiatry, and continues to work with medical students as well as fellows.

Margaret Rukstalis then presented her lecture on Nicotine and Alcohol. This was done as a 30-minute version, and she was able to demonstrate how well a lecture can work even when shortened.

Evaristo Akerele then presented his accomplishments at Columbia. He has been very active in teaching second-year residents about substance use disorders, reaching out to PGY3 residents, teaching fellows, and working with other prominent substance use disorder experts at his university. Evaristo is the Assistant Medical Director for the program headed by Dr. Herb Kleber, and is working with his department regarding the relevance of slides and lectures using a format somewhat similar to AMSP. In the future, he hopes to continue to teach at major meetings, and is part of a proposed workshop and symposium at CPDD.

Our two guests, Valger Dur (Iceland) and Roberta Agabio (Italy), next reviewed their impressions of AMSP, what it is they gained from the meeting, and suggestions regarding additional such participants in the future.

Susan Tapert then presented her overview of PowerPoint.

The meeting then turned to the presentation by the new scholars regarding their topics and goals.

Joe Thornton selected the topic of “PTSD and Substance Use Disorders” and will work with Woody Levy as the Senior Scholar. His goals include documenting what already exists regarding alcohol and drugs at the University of Texas Health Science Center, working with the Chair of his Department regarding expanding substance use disorder materials in the residency, and reaching out to house staff regarding education on substance use problems. He is considering the possible development of an elective based on the AMSP material developed by Susan Tapert, and of beginning to work with a DOC program.

Katie McQueen of Baylor College of Medicine, will develop a lecture on “Alcohol and Cocaine,” working with Evaristo Akerele as a Senior Scholar. Her goals will include seeking to expand her work at the University through a joint appointment with psychiatry, establishing collaborations on substance use disorders education and research, potentially developing an elective for first- and second-year medical students, possibly developing a fourth-year clinical elective on substance use disorders for medical students, working on developing a lecture on the genetics of alcoholism that might be appropriate for the Department of Medicine, and participating in the skills-based half-day sessions on screening and intervention—being sure that substance use disorders are represented.

Gail Rose from the University of Vermont has selected as her topic the “Process of Mentoring,” and will work with Margaret Rukstalis. Her goals at her University include developing a lecture on How to Give a Lecture, work toward an elective rotation through the research laboratory, and continuing to expand her efforts in her medical school regarding a variety of medical school and resident education projects. Since being selected as an AMSP scholar this summer, Gail has already worked to impact on psychiatric resident education in alcohol and drugs, and is working toward getting on the Residency Training Committee. She is also working to develop up to six session to be incorporated into the Journal Club relating to reading and understanding papers, and is attempting to make substance use-related issues prominent. Gail now serves on a group looking at the optimization of the medical school curriculum, and hopes to be able to incorporate alcohol and drug-related issues into the first year series that relates to medical skill development. Furthermore, she is working on using alcohol and drug-related subjects for the medical school course on interviewing skills. In the future she hopes to expand her work with a DOC-like program while considering development of an elective course.

Karen Drexler, from Emory University, will work to develop an AMSP lecture on “Craving,” selecting Steve Madonick as her Senior Scholar. The goals for her first AMSP year take advantage of the fact that she already occupies a relatively prominent role in her school. Therefore, she hopes to: expand her work in training junior faculty to help her teach in the addiction fellowship, implement some of the skills learned from AMSP for use in her roles as Director of the Substance Use Disorders Treatment Program at the VA Hospital, and Director of the General Psychiatric Course on Addiction Psychiatry. She also hopes to be able to lobby for incorporation of medical students in a clinical rotation on the substance use disorder unit at the VA Hospital, improve the five-week block in addiction psychiatry for second year medical students, and she is planning to join the Impaired Physician Committee.

Chris Delos Reyes from Case Western Reserve University has chosen the topic of “Presenting Physicians with Evidence that Treatment for Substance Use Disorders is Effective.” For this, Marianne Guschwan has agreed to serve as the immediate supervisor. As Chris also occupies a relatively prominent role in her medical school, she hopes to use the skills gained from AMSP to help her with her 90-minute lecture on Impaired Physicians, and her activities in teaching general psychiatry. She will also implement some of her skills for enhancing her three hours of lecture on substance use disorders to the PGY1 residents, and for an elective series for PGY3's. Chris currently functions as the Addiction Psychiatry Fellowship Assistant Director, and as a liaison to the Medical School Physician Wellness Program. Her goals will also include obtaining a position on the Medical School Education Committee, working with fellows on how to give lectures, and optimizing the curriculum in the Addiction Fellowship. On a longer-term basis, Chris hopes to work to expand the clinical experience in substance use disorders of PGY2 residents.

We next turned to a discussion of the time and place for the spring, 2003 AMSP meeting. The meeting is to take place from 5:00 p.m. on Wednesday, March 26th through noon on Saturday, March 29th. The specific place and activities will depend upon the determination of costs for the current London meeting as we try to stay within our yearly budget. We had considered San Francisco, but this is not appropriate because the American Psychiatric Association will be there the following month. It’s also possible that we may choose to meet in San Diego, Laguna Beach near San Diego, and, although not directly discussed at the meeting, we hope to consider a potential meeting in New York sometime over the next year or so. If money permits, and considering the fact that several of our scholars live in Texas, it might be cost effective to hold the meeting someplace in Mexico, and Marc’s office will look into this.

The meeting adjourned shortly after noon on Saturday, October 26th. All participants returned home with a full agenda of tasks. We will next get together on a conference call for one hour approximately three months from the October meeting, tentatively scheduled for a noon time (San Diego time) in mid-January. Marcy will work toward potential dates by contacting everyone in December.

Marc A. Schuckit, M.D.

Potential Activities for Enhancing Education on Alcohol and Drugs at Medical Schools

November 18, 2002

I. Actions relevant to medical students:

A. Add new lectures and improve upon existing lecture formats regarding substance use and disorders in courses offered to year 1 and 2 students. These can include lectures on liver disease, neurology, AIDS and other immunodeficiencies, psychiatry, introductions to clinical medicine, and so on.

B. Offer an elective one session noontime discussion for first and second year students dealing with the nature of substance use disorders, how to identify them among patients/school mates, relatives, and approaches for intervention.

C. Develop an elective for first or second year students, including the ten-session, one hour each, patient description-oriented elective listed on the AMSP website.

D. Join with an ongoing Doctors Ought To Care (DOC) program, or help develop a new group if one does not exist. DOC offers medical students the opportunity to visit local schools to discuss issues related to alcohol and drugs.

E. Develop independent study programs for medical students where clinical or basic research issues focus on alcohol or drug use disorders.

F. Carry out a survey of existing medical school courses to document what is currently being offered on alcohol and drugs as a starting point for what needs to be done.

G. Work with the faculty responsible for the third or fourth year psychiatry clinical rotation to explore how lectures on alcohol and drugs can be fit into the curriculum, and how a rotation to an inpatient or outpatient substance use disorders treatment program might be instituted.

H. Work to become a member of your department’s Medical School Education Committee.

I. Meet with the Chair of your department and/or the Director of clinical services to determine how alcohol and drug-related education might be better incorporated. This will both provide information on AMSP, and enhance your visibility in the program.

J. Offer a special presentation to medical students on “How to Give a Lecture.”

K. Develop a film series (or one session) to discuss alcohol and drug issues in the media.

L. Offer a program where students attend an AA meeting, with a faculty led back-up discussion.

II. Efforts to consider in reaching out to residents in psychiatry, internal medicine, family practice, etc., masters and Ph.D. level psychology students, and other educational groups at your university:

A. Explore whether you can be appointed to the Residency Education Committee, which will give you the opportunity of enhancing alcohol and drug education.

B. See whether you can become part of the Residency Selection Committee to enhance choosing individuals with an interest in alcohol and drug-related problems.

C. Work to incorporate alcohol and drug education into the lecture series on medical/psychiatric emergencies, and courses offered to introduce residents to issues related to major psychiatric disorders.

D. Offer residents a lecture on “How to Give a Lecture.”

E. Create an inventory of current alcohol and drug education within the residency, as a basis for future expansion.

III. Educational efforts appropriate for fellows:

A. Develop and/or enhance a lecture series on substance use disorders.

B. Explore whether any of the AMSP lectures can and should be offered to the fellows.

C. Offer to supervise fellows to enhance their education on substance use disorders.

D. Consider offering lectures to fellows, borrowing from those already developed on the AMSP website.

E. Consider working with other faculty to start up a fellowship in substance use disorders, clinical issues, or research, if one does not exist.

IV. Other potential activities:

A. Look toward developing in-service lectures on an alcohol or drug-related topic for nursing, social work, emergency room personnel, and so on.

B. Explore the possibility of establishing a liaison with a relevant teaching service to enhance education on alcohol and drugs.

C. Determine whether any medical school continuing medical education program would be open to incorporating lectures on alcohol and drugs, or if a symposium on this topic can be developed.

D. Consider working with Medical Student organizations like AMSA, AMWA to present a lecture, hold a forum and/or organize activities for alcohol awareness week.

E. Before/after attending the next AMSP meeting when you arrange for coverage and notify colleagues and staff that you will be away, use the opportunity to describe AMSP and your role AND put in a plug for them to use and view www.alcoholmedicalscholars.org.

F. Notify your university public relations that you are an AMSP Scholar and give them the information that you would be happy to serve as a contact person for any alcohol/drug media-related questions.