Meeting #8

Laguna Beach, Califoria

March 26 - 29, 2003



Present at the meeting were Drs. Marc Schuckit, Christina Delos Reyes, Karen Drexler, Katie McQueen, Gail Rose, Joe Thornton, Evaristo Akerele, Woody Levy, Steven Madonick, Margaret Rukstalis, Marianne Guschwan, Susan Tapert, and Ms. Marcy Gregg.



I. Wednesday, March 26th (The Introductory Session).

The group convened at the Surf and Sand Hotel. All scholars had the opportunity of informally meeting together and reviewing recent events. The group adjourned to a dinner at a local restaurant, French 75.



II. Thursday, March 27th

The major focus of this morning portion of the session was to review the lecture on “How to Give a Lecture,” with an emphasis on the optimal way to prepare new scholars for the first-year assignment of developing a lecture. Marc Schuckit presented the original lecture, in which he emphasized: the lecturer is not important – it’s the audience who matters both in terms of at-presentation flexibility and in developing the structure and content of the lecture; avoid presenting scientific data to medical students (no slides with p values, etc.); and as part of the research for a lecture, talk to practitioners, as the actual work may differ from the literature. He asked for additional input on how to best optimize the learning experience.

Among the comments offered by the scholars were: emphasize that Marc is teaching a technique or style each individual will eventually modify to meet their own needs; emphasize that a lecture is to give a clear message focusing on a limited number of major points — not to teach everything about all topics that might possibly be related; be sure that the senior scholars, while serving as mentors, are also emphasizing the basic technique of teaching; establish a clear guideline through which scholars know they are to make acceptable changes suggested by Marc and get the next draft back to him within 48 hours whenever possible; regularly remind the first-year scholars of the importance of the established deadlines; teach junior scholars that there are many fun aspects of AMSP (the meeting places, the low-key atmosphere of the meetings themselves, the opportunity to have teaching efforts focusing on their developments, the money available to them during their first year to develop career-related activities, and so on), but be certain they understand that the process of learning to give optimal lectures involves a lot of work; warn entering scholars that the first six months is the period that involves the largest amount of work — the actual development of a lecture; remind them that the learning process involved in developing a lecture is even more important than the lecture itself; remind the entire first-year group that everyone is going through a similar learning process at the same time; emphasize that the only expectation is that they will work hard at the learning process — they are not expected to develop a perfect product, but will have many opportunities in the future to further develop their lecture style; Marc’s lecture on lecturing should give more examples about things such as how to select the four central points, etc.; at the time of delivering the first lecture, Marc should hand out two outlines — one of the lecture on “lecturing”, and another of an actual lecture delivered someplace to show how the major points actually work in a real lecture; first-year scholars need to be reminded that they may have some preconceived notions of what their lecture will cover, but these ideas need to be approached with flexibility and modified as the literature review continues; and so on. The scholars noted that each time they hear a discussion of lecturing, or listen to the lecture on lecturing, they learn something new, and it is important that the lecture be repeated.

Our group next turned to a discussion of the optimal mentoring role for senior scholars. Their major emphasis needs to be on helping the junior scholar to understand the lecturing technique that is being offered as part of AMSP. In that light, it is important that they (the senior scholars) follow the lead of the information presented by Marc in the initial lecture. The senior scholars can also: help the junior scholar interpret the feedback given by Marc regarding drafts of the lecture; help them to adhere to the time schedule, and rapid revisions; offer reassurance; set a role model by responding quickly when given drafts; help the junior scholars to practice their lecture before delivering it; and so on. It will be important at all initial meetings in which first-year scholars participate to try to identify an appropriate senior scholar as early as possible, and to attempt to set at least a half hour aside to meet with them individually.

Gail Rose next presented her lecture on Mentoring. As was true of all five junior-scholar lectures, this was exceptionally well received. It will be very useful to both junior and senior scholars in the future, and will make a very important addition to our website.

Next, Karen Drexler presented her lecture on Craving. This was a high-powered, research-oriented lecture that was very effective. The level of audience most likely to gain the greatest amount from this lecture might be scientists and graduate students. Karen is revising the lecture to produce a second format that might be even more appropriate for medical students.

Woody Levy next demonstrated how his 40-minute lecture on Substance Use and Problems among Athletes could be modified to a 20-minute format. He led a discussion on how to choose the major points to make when a lecture is shortened, and how to select among slides to focus on those most appropriate for the time allotted.

The day’s proceedings ended with several sessions discussing career developmental issues. These included discussions of how (and when) to apply for research grants or K awards, how to select specific organizations in which to participate, and assets and liabilities of working with pharmaceutical company-related research.



III. Friday, March 28th

The meeting convened promptly at 8:00 a.m. with a presentation by Evaristo Akerele of the modification of his 45-minute lecture on alcoholism and schizophrenia into a 20-minute format. The major emphasis in the discussion was the importance of selecting a limited number of points to be made, and of choosing the slides appropriate for that message. The series of shortened lectures demonstrated to be senior and junior scholars the importance of clearly focusing on the needs of the audience, while adjusting the lecture to be appropriate for the time allotted — avoiding the temptation to try to cover everything. The process can be most challenging.

Margaret Rukstalis from the University of Pennsylvania Medical School next reviewed her accomplishments during the prior year. These included a series of developments aimed at medical students: presenting how to give a lecture as part of the core doctoring course; a lecture on how to choose and take advantage of a mentor; participation in the Women and Substance Use Disorders discussion during the Brain and Behavior medical student course; supervision of medical students; meeting with representatives of pharmacology to discuss the optimal structure for the lecture on the Fetal Alcohol Syndrome; and working with other lecturers to be certain that optimal information about alcohol and drugs is included in medical student lectures. Margaret’s activities with psychiatry residents have included: working with a resident on substance use disorders clinical issues; offering lectures to the third-year residents approximately every eight weeks; helping to direct an Addiction Psychiatry Rotation Course for second-year residents; and working to optimize the selection of candidates for the Addiction Psychiatry Fellowship. At the same time, Margaret is working on an R01 grant application, is a counselor for the Philadelphia Psychiatric Society, hopes to become the Chair for the Alcohol Use Disorders section of the Annual Women’s Mental Health Forum, and is beginning to work on implementation of some of the AMSP teaching techniques with a medical school is Croatia.

Evaristo Akerele next reviewed his accomplishments at Columbia. These include increasing training for third-year residents as they rotate through a substance use disorders treatment program; delivering his lecture on Alcoholism and Schizophrenia at NYU; participating in posters at several meetings (including the American Psychiatric Association, and CPDD); helping to expand educational efforts on dual diagnosis; and working with other AMSP scholars on developing a fellowship in substance use disorders.

The next item on the agenda was the delivery of the lecture on the Effectiveness of Substance Use Disorders treatment by Christina Delos Reyes. This was a fine and enthusiastic lecture that was well received by all. With minimal changes, it will be added to the website.

Woody Levy next reviewed his accomplishments and plans at the University of South Florida. Woody serves on the Medical School Education Committee and has markedly expanded information on substance use disorders since joining the AMSP program. These include developing one of three two-hour seminar/workshops dedicated to substance use issues and delivered to first-year medical students, and the establishment of a series of half-day rotations over an eight-week period for third-year medical students. Woody has also developed a clinical case conference with an emphasis on substance use disorders for third-year students, and has produced a fourth-year elective in substance-related problems. Woody’s activities with residents include clinical rotations for first- and second-year residents, a two-month rotation on addictions for third-year residents, and a fourth-year elective. Furthermore, he has developed a new lecture for residents on pharmacological treatments in substance use disorders, and is working on a substance-related fellowship program. On a personal level, he is taking on more responsibility for educational efforts in the department, working on a paper regarding a series of case reports, serving as a co-investigator on a study on genetics of cocaine, and is working closely with the Chair of his Department.

Steven Madonick at Yale next offered his report. He announced that he has been given a position at the Institute of Living where he will head a clinical unit dedicated to teaching residents — a position that will give him ample opportunity to emphasize substance-related problems. He continues to work on the Geriatric Education Grant by supplying information on substance use disorders, and uses clozapine clinic as an opportunity to teach medical students about substance use problems among psychotic patients. At the same time, Steven tutors students on interviewing (using examples of substance use disorders whenever possible), and is working to develop an elective for medical students regarding his new position at the Institute of Living.

Joe Thornton, a first-year scholar, next delivered his lecture on Substance Use Disorders and PTSD. This also proved to be a very effective lecture, and the group had additional suggestions regarding some easily corrected problems with optimal clarity on slides, and a few minor suggestions regarding the lecture content.

The lunchtime discussion on career development issues focused on criteria for promotion, the meaning and way to achieve tenure, and other topics focusing on development of careers at a variety of institutions.

The days’ work ended with two demonstrations by the Associate Directors of AMSP. Marianne Guschwan demonstrated the 20-minute version of her AMSP lecture on Spirituality, and Susan Tapert led a discussion of the use of animation (along with pros and cons) on PowerPoint.



IV. Saturday, March 29th

The first order of business was the discussion by Katie McQueen of her accomplishments at Baylor. These include her application for an adjunct appointment in the Department of Psychiatry (in addition to the functioning in the Department of Medicine); adding an hour on substance use disorders to the core medicine clinical rotation, contributing to a test for core medicine — giving an opportunity to emphasize substance use disorders; developing a chapter on Alcoholism for Conn’s Current Therapy; delivering a Grand Rounds for Family Medicine on Intoxication and Withdrawal; becoming the Chair of the committee reviewing abstracts for AMERSA; writing and revising a Career Development Award focusing on substance related issues; further developing her own opportunities in research, participating in Alcohol Screening Month by training supervisors at a variety of hospitals; creating an application to the Robert Wood Johnson Foundation regarding the assets of mandatory screening for substance use disorders on general medical patients; and producing a list of important topics needed to be added to the core curriculum; while also working as a supervisor of the Chief Resident. In the future, Katie hopes to implement a substance use disorders-related journal club, work to increase the medical student hours related to substance use disorders, submit three papers on important related topics, recruit and train an addiction fellow from pediatrics, develop and deliver an opioid replacement lecture for residents, serve as a reviewer for the Journal of Studies on Alcohol, develop a talk for a national meeting on the interface between traditional medicine and affiliated treatment communities, and interact more closely with medical students.

Karen Drexler at Emory University in Atlanta presented her activities. These include participation in the Substance Use Disorders Teaching Day; being nominated for a teaching award for medical students; participating in the Physicians Wellness Committee; helping to develop a journal club; developing a chapter for a text in Oxford University Press regarding craving; submitting a paper on the neural circuits of craving; offering a lecture at the Medical School of Georgia; participating in a discussion of substance-related problems on CNN News; developing an R01 grant application; teaching third-year students on substance use disorders; mentoring students; and directing the resident course on substance use disorders.

Gail Rose of the University of Vermont reviewed her accomplishments. These include participation in an interviewing skills class where she is able to use substance use disorders topics while teaching medical students; participating in regular sessions of a resident-related journal club; developing brief intervention training for non-psychiatric physicians; presenting substance-related problem issues at a local CME Conference; expanding research collaborations throughout the University of Vermont and with the State Department of Health; serving as a consultant to the Residency Training Committee in Psychiatry; and serving as a medical student learning group facilitator. Gail hopes to continue to increase her interactions with medical students and residents by developing an elective, looking to implement the DOC program at the University of Vermont, trying to develop a substance-related issues discussion group for medical students, and producing a rotation for medical students in her research laboratory.

Christina Delos Reyes reviewed her activities at Case Western Reserve. Chris is serving on the Psychiatric Core Curriculum as a small group leader; she is working with addiction fellows; teaches first-year psychiatric residents in a four-hour seminar on substance use disorders; has developed a three-hour workshop for the All Ohio Institute on Community Psychiatry; and is working to try to help train counselors in the dormitories for her University to improve their knowledge on substance use disorders. In the future she will talk with the Director of the Core Curriculum regarding enhancing information substance use disorders, will be speaking to child and adolescent fellows regarding physician wellness, is hoping to work with other AMSP scholars to develop a lecture or poster for the annual ASAM meeting, will be lecturing to PGY1 residents, will participate in an internal fellowship review regarding the Addiction Psychiatry Fellowship, will work with the Editor of the Women’s Encyclopedia of Health regarding a short piece on the Fetal Alcohol Syndrome, and hopes to work with Dr. Lucille Fleming from the State of Ohio regarding enhancing education on alcohol and drugs for medical schools throughout the State of Ohio — hoping to build upon her experience with AMSP.

Joe Thornton of the University of Texas Health Sciences Center in San Antonio then offered his report. Joe is enhancing his work on teaching substance use disorders to medical students; developing a quality assurance topic related to substance use disorders; is working with third-year psychiatric residents; has developed a lecture on alcohol and violence to second-year medical students; is working on developing clinical pathways related to substance use disorders; has produced a lecture on Geriatric Substance Use Disorders which he delivers several times a year; is a consultant to the Community Disasters Program regarding the dangers of substances in such crises; and is working with various agencies to increase substance use treatment in his area. This next year he will be considering a number of new projects including an elective, a DOC-like program, and other activities.

While not directly presented to the scholars, an AMSP Associate Director, Marianne Guschwan, also reviewed some of the relevant teaching activities at NYU. She is currently working to re-start the five to 10-hours-per-week rotation for medical students on the detoxification unit and helps facilitate a substance-related issues club for medical students (Club S.O.D.A.) that has hosted dinners for various speakers including addiction psychiatrists, Petros Levounis, M.D. and Nora Volkow, M.D. (to be scheduled this spring). Marianne delivers a lecture on Psychopharmacology of Substance Use Disorders; presents four one-hour lectures on giving lectures aimed at psychiatry fellows; and has produced several lectures on dual diagnosis and substance use disorders for neurology residents. At the same time, Marianne remains very active in both New York and on a national and international level regarding a variety of activities focusing on substance use disorders. She is planning to continue these in upcoming years, will develop workshops for the American Psychiatric Association and other organizations, hopes to produce an AMSP-related poster at several national meetings, and will look to expand her activities at NYU.

Katie McQueen next delivered her lecture on Alcohol and Cocaine. This was a very effective lecture, well received, and (after a few modifications) will be loaded on our website.

Margaret Rukstalis next demonstrated how her 50-minute lecture on The Relationships between Alcohol and Nicotine Use Disorders could effectively be cut back to a 20-minute presentation.

The next item on the agenda was a discussion of recruitment for 2003. The scholars already selected to start August 1, 2003 were discussed. One position is being held open for a very appropriate candidate, pending his decision to transfer from a national institute (where teaching is not a major issue), to a medical school (where teaching is a central activity). The criteria for selection were reviewed, and the scholars were asked to begin to think about individuals who might be appropriate to select in 2004.

Susan Tapert, the second Associate Director, offered a brief overview of the success demonstrated by our website. The highlight of her discussion was the knowledge that we continue to have over 2000 visits per month, with almost two-thirds of these reflecting individuals who have directly and deliberately sought out AMSP, presumably to gather information on education on substance use disorders relevant to medical schools. The remainder found AMSP through a search engine. All of the lectures are well represented by visits, and our ties with additional websites appear to be working very well.

The next AMSP meeting will take place in October 2003, most likely on October 8th through 11th, or 22nd through 25th. A specific date will be chosen soon, but the scholars are asked to please reserve both dates until contacted again.

The next AMSP Conference Call for all current first- and second-year scholars will be July 14, 2003 (a Monday, at noon San Diego time - 3:00 p.m. East Coast time). Marcy will contact the scholars to remind them.

The senior scholars participated in their graduation ceremony. Marc was also given a signed papaya. Lots of pictures were taken, and all scholars were reminded of how much we hope they will continue to maintain contact with us, consider attending future meetings, and perhaps developing an alumni group.

The meeting adjourned Saturday noon.

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