Meeting #12
New York, New York
March 30 - April 2, 2005
Present at the meeting were AMSP staff of Drs. Marc Schuckit, Susan Tapert, and Marianne Guschwan, as well as Marcy Gregg. First-Year Scholars included Drs. Pirzada Sattar (Creighton University), Alisa Busch (Harvard University), Randy Brown (University of Wisconsin), and Carlos Hernandez-Avila (University of Connecticut). Second-Year Scholars included Drs. Sarah Book (Medical University of South Carolina), Andrea DiMartini (University of Pittsburgh Medical School), and Marian Fireman (Oregon Health & Sciences University). Guests at the New York meeting included Drs. Nina McGowan (New York University), Eric Gunderson (Columbia University), Karen Drexler (Emory University and an AMSP graduate), and Chris Welsh (University of Maryland and an AMSP graduate).
I. SESSION I.
The group met together in the lobby of the Park Lane Hotel in the late afternoon on Wednesday, March 30th. Introductions were made, guests introduced, and we proceeded to the evening dinner and discussion. The evening’s activities were held at Paoli Restaurant on East 84th Street Near Lexington Avenue.
II. SESSION II: Thursday, March 31st.
The group assembled at approximately 7:40 a.m. over breakfast, and the meeting was officially called to order at 8:00 a.m.
The meeting began with a review of the lecture entitled: “How to Give a Lecture” as originally presented by Marc Schuckit. The scholars were asked to think about whether this lecture helped prepare them for the AMSP process, and to offer suggestions about how to improve the presentation. Among the issues raised were the suggestion that scholars be warned that slides cannot be used instead of an outline (or else too much information is given on the slide), the fact that the development of lectures requires help from additional faculty at the person’s institution, and some specific items regarding some of the slides themselves.
Andrea DiMartini next presented a new lecture entitled: “How to Give a Research Lecture.” This was built upon the original How to Give a Lecture material, and is best delivered with the two lectures in tandem. The lecture was felt to be very useful, and will be added to the Web site.
The first Junior Scholar lecture on “Benzodiazepines and Similar Drugs” was next offered by Randy Brown. This was an excellent presentation that will not require much work to be placed into a form appropriate for the Web site. This material demonstrated an impressive evolution of Randy’s ability to organize the material, incorporate a large number of references, and to place together a very effective lecture format.
Over lunch, the group discussed issues of career development. Most of the conversation centered on ways to balance home and work requirements. This is an especially challenging process for women with children, and many useful suggestions were offered.
The agenda on the first day ended with a 30-minute version of the lecture entitled: “Hepatitis C” as modified by the Senior Scholar, Marian Fireman. Marian demonstrated how relatively easily a 45-minute lecture can be decreased to 30 minutes. In this case, most of the changes involved decreasing the level of detail offered regarding most of the slides. The lecture worked well and was delivered with great skill.
The meeting adjourned at 2:20 p.m. following a lively discussion of steps that can be taken to modify lectures for specific situations.
III. SESSION III, Friday, April 1st.
Our group assembled for breakfast after 7:30 a.m., and began the official session at 8:00 a.m.
The first order of business was the presentation of a lecture entitled: “A Comparison of Alcohol and Drug Dependence with Other Chronic Medical Disorders” by Alisa Busch. The material came across very effectively and was delivered very well. The slides worked well, and this excellent presentation might have been improved even a bit more with the incorporation of a few more clinical vignettes.
Next, Marianne Guschwan gave a clinically-oriented talk regarding: “Adult ADHD.” This was a fine demonstration of an alternative approach to developing lectures. Here, a clinician can utilize a limited number of review papers, as well as some additional references to pull together the basic crux of a topic. This is a useful approach in some clinical settings, but might prove challenging in an attempt to convince skeptical members of an audience that there are solid data to support the area being discussed. Marianne offered the group an opportunity to discuss pros and cons of the various approaches, and is looking forward to developing a more data-oriented version of the lecture for potential incorporation on the AMSP Web site. This was a very lively and tremendously useful discussion.
The Senior Scholar, Sarah Book, next presented a full 40-minute version of her paper entitled: “Alcoholism and Social Anxiety Disorder.” This was a fine demonstration of the ability of a lecturer to focus the attention of the audience, and the presentation went very well, despite the temporary distraction caused by some noise from construction on the street. Many of the comments dealt with the effectiveness of this lecture and the wonderful delivery style.
Next, Randy Brown, a Junior Scholar, offered his report regarding his recent activities at the University of Wisconsin. Randy has delivered two new lectures on alcohol and opioid withdrawal assessment and management to students in the UW Nurse Practitioners Program specializing in acute/hospital care; he helped develop a reading list, handouts, and a short quiz for 2nd-year medical students for a pharmacology course small-group session on the pharmacotherapeutic management of heroin dependence; and he developed a new lecture for an undergraduate sociology course on the significance of alcohol and drug use in individuals involved in the criminal justice system. Dr. Brown continues to give two lectures a year to family practice residents on the assessment of substance use disorders (primarily opioid dependence) in patients with chronic non-cancer pain. Randy developed a package of instruments that was favorably reviewed as patient-care and teaching tools by family practice residents, and consists of an instructional video, patient-care flow sheets, and a pain management agreement for use in monitoring patients with chronic non-cancer pain for the signs and symptoms of opioid dependence that will soon be used in UW-affiliated clinics throughout the state of Wisconsin.
In his roles as Co-Director of the UW Hospitals and Clinics AODA Consult Service and Director of the 4th-year medical student elective in substance use disorders, Dr. Brown has instituted a program of formal hospital rounds with the students on the rotation in which the students are given instruction in the assessment of substance use disorders and substance withdrawal. Students perform the initial assessment on inpatients needing an AODA consult; the students then discuss the cases with Dr. Brown, who works with the students to formulate a management plan.
Dr. Brown delivered a formal presentation to policy-makers and law enforcement officials regarding the effectiveness and potential areas for improvement in the Dane County Drug Court Treatment Program, which provides an alternative to incarceration and traditional adjudication for individuals with drug-related charges and substance use disorders. He was elected Vice-President and Membership Chair of the Wisconsin Society of Addiction Medicine, is a member of the Resident Education Committee to assess curricular needs in the UW Family Practice Residency Program, and is working to expand resident education regarding substance use disorders.
Dr. Brown will be sitting for his preliminary examination in the doctoral program in Population Health Sciences at UW Madison in Spring-Summer 2005. He has been first or second author on 5 peer-reviewed publications in the last 12 months. A sixth is currently under review. In addition, he submitted his first application for NIH-R01 funding as Principal Investigator in February 2005, for a randomized clinical trial of gabapentin as adjunctive treatment for cocaine dependence. Randy is collaborating with a representative of the World Health Organization, Dr. Nathanael Wright, to present at the American Society of Addiction Medicine’s Annual Medical Scientific Conference in April 2005. They will conduct a workshop in which they summarize the evidence and the recently released WHO position statement regarding drug use in homeless populations. Dr. Brown will present findings from his research, “Provider attitudes in caring for patients with chronic non-cancer pain: The impact of pain management agreements,” at the Annual Conference of the North American Primary Care Research Group in October 2005. Finally, Randy has been invited to speak at the annual meeting of general practitioners for the National Treatment Agency in the United Kingdom in Spring 2006. This is a meeting of providers with interest in substance use disorders treatment in primary care.
Subsequently, Junior Scholar Alisa Busch brought us up to date on her challenges and developments at Harvard. Dr. Busch faces a number of challenges that she is actively addressing. Her university is in the process of revising its medical school curriculum, and she has been discussing this with the psychiatrist involved in the restructuring process. She hopes to be able to use this relationship to expand the amount of information being offered on alcohol and drugs, coordinate the lecture material, and work to be certain that the information being delivered is optimal. At the same time, she hopes to work with the every-other-Friday medical-student get-together (students self-identified as being interested in psychiatry) by offering them information on alcohol and drugs.
The group offered several suggestions of additional activities that Dr. Busch might consider. These include working more directly with Doctors Ought to Care (DOC), finding other student special interest groups who might be interested (e.g, primary care), using the AMSP Web site’s posted elective developed by Susan Tapert, and meeting with faculty in charge of the current psychiatry course/neurology course/pharmacology lecture series to determine whether she might help add a lecture of two to these ongoing series. Additionally, Dr. Busch is speaking with her clinical supervisor who heads the Addiction Treatment Program at McClean Hospital to discuss ways she may assist in the medical students’/residents’ education during their clinical clerkships/rotations in substance use disorders.
The group then discussed career development issues over a working lunch. Topics included how to ask for promotion to the next level in an academic setting; the importance of knowing the guidelines under which an individual is being judged; how to handle workloads that might not be fairly distributed among colleagues; and time management.
The last official action of the day was the presentation of a lecture entitled: “Alcohol Withdrawal” as presented by the Junior Scholar, Carlos Hernandez-Avila. Carlos’ material demonstrated a logical progression from a review of key physiological data to lay the groundwork for a clinically-oriented lecture to the discussion of the clinical material. He was able to simplify rather complex ideas into a lecture that was both educational and clinically useful. The style of presentation was quite effective.
The session ended at approximately 2:15 p.m. as the group discussed the lecture and the plans for the following day of work. Everyone was reminded of a working dinner that evening.
IV. DINNER SESSION: Friday, April 1st.
The group met in the hotel lobby and walked together to our dinner meeting at Remi, a restaurant at 6th Avenue and West 53rd Street. This was a wonderful opportunity to informally discuss presentations and future plans. This also offered the chance for members to begin to network together regarding future activities.
V. SESSION V. Saturday, April 2nd.
Following a working breakfast, our session began at 8:00 a.m.
Senior Scholar, Andrea DiMartini presented a 20-minute version of her AMSP lecture entitled: “Clinical Assessment of Alcohol Use.” Once again, presented with great skill, this lecture demonstrated Andrea’s ability to refocus a lecture to another audience (in this instance, Emergency Room physicians) and to decrease the amount of time for the presentation. As with all lectures at this meeting, this was highly effective.
Senior Scholar, Joseph Sakai, next presented an update of his activities at the University of Colorado. First, Joe’s proposal to create a substance abuse Thread at his medical school was formally rejected by the Curriculum Committee, but this effort had some fortunate consequences. Because of these efforts, Dr. Sakai has been more widely recognized as someone interested in this topic, and he has been approached to lecture in a fourth-year medical student clinical pharmacology course, to be on the advisory committee for a proposal to teach about behavior change to medical students, and to be a faculty teacher at a local psychotherapy conference focusing on motivational interviewing. Joseph was also recently approached by the new psychiatry residency training director to begin discussing how to incorporate more teaching about substance use disorders into their program. He has continued to teach in Dr. Tom Crowley’s PG-III core substance use disorders course, has continued participating in Dr. Crowley’s fourth-year medical student elective on substance use disorders, and recently completed delivering his six-lecture series to psychiatry interns on substance use disorders. Reviews of Dr. Sakai’s teaching endeavors have been consistently very favorable. In addition, Joe’s standardized patient, used to test medical students’ ability to screen for alcohol use disorders in a general medical setting, will be included in the fourth-year medical student clinical skills exam this summer, and a modified version may again be included in assessing psychiatric residents this fall.
In terms of other academic pursuits, last fall Joe began a NIDA-funded K award for which he has hired and trained a research assistant, and has begun collecting data. He participated in his first NIMH grant review in March 2005 (NIMH Special Emphasis Panel for Developing an Advanced Center for Interventions and services Research – ZMH1-ERB-P 04). Dr. Sakai will present posters at the College on Problems of Drug Dependence and the Research Society on Alcoholism meeting in June. He also had two manuscripts and two book chapters published in 2004, has one manuscript in press, and has two in review. Another manuscript about to be submitted directly resulted from his work with AMSP. In 2003 and 2004, Dr. Sakai worked closely with his Vice Chair of Education (through AMSP), Dr. Mike Weissberg, and reflecting his continued interest in education, Dr. Weissberg invited him to co-author a manuscript that focuses on risk-taking attitudes and behaviors among medical students, and students’ perceptions of how much these factors might influence clinical decision-making.
Sarah Book, Senior Scholar, was asked to take a few minutes to reorganize her 45-minute lecture into a 20-minute presentation for high school seniors. Sarah did a wonderful job, once again showing that when one focuses on the four basic points to be presented, and remembers to aim the lecture toward the audience (rather than the presenter) almost any lecture can be modified fairly quickly to address a new and different group. This was an excellent job and a fine demonstration of some of the most important basic material we are trying to teach in AMSP.
Carlos Hernandez-Avila then delivered his report on developments at Connecticut. During the three months prior to our meeting Carlos delivered his one-hour bimonthly lecture to third-year medical students on Alcohol Withdrawal and Detoxification during their rotation in the inpatient psychiatric service. This lecture has been well received by the students, and these efforts helped develop the PowerPoint presentation on Alcohol Withdrawal for the AMSP Web site. He also gave the one-hour bimonthly case conference on Alcohol and Drug Use at the inpatient psychiatric service, which increased the number of hours of exposure to alcohol and substance abuse topics for the third-year medical students and general psychiatry residents. Next, Carlos gave the one-hour lecture on Opioid Dependence to first-year psychiatry residents, largely based on the AMSP presentation developed by Joe Sakai; he gave a 45-minute lecture at the School of Public Health to MPH students on Pharmacotherapy and Public Health; and he delivered four one-hour lectures to social workers, counselors and nurses from the State of CT department of Mental Health and Addiction Services on Alcohol and Opioid Dependence, Alcohol Withdrawal, and Genetics of Addictive Disorders.
Sarah Book next brought us up to date on her activities at the Medical University of South Carolina. As a direct result of her participation in AMSP, she is a co-investigator of the Alcohol Research Center’s ‘Educational Core’ renewal grant application, which is a systematic revamping of alcoholism education at the University, including medical students, residents, and physicians both on the faculty and throughout the state. Dr. Book’s role as co-investigator will be to direct the medical student and resident component of education. She continues her involvement the medical student and resident selection processes, where she can influence and encourage applicants with an interest in alcoholism to be recruited to her university. Dr Book mentors medical students, residents and addiction fellows and in this role has used the helpful information she has learned in AMSP about how to be a quality mentor.
Sarah has refined her lecture on the Comorbidity of Social Anxiety and Alcohol Use, and has given this lecture in several different settings, including using the lecture to inform representatives of industry about the importance of developing treatments of alcoholism.
Also, Dr. Book will complete her Masters in Clinical Research in May 2005 and is preparing an R-21 grant application to NIAAA entitled “Topiramate vs Placebo for Alcoholism with Co-Occurring Social Anxiety Disorder.” In addition, she has had two first author papers accepted for publication in scientific journals. One paper, entitled “Novel Anticonvulsants in the Treatment of Alcoholism,” is in press in the journal Expert Opinion. The other one, entitled “Treating Alcoholics With a Co-Occurring Anxiety Disorder: A Markov Model to Predict Long Term Costs,” will be in an upcoming issue of the Journal of Dual Diagnosis.
Finally, at the upcoming meeting of Research Society of Alcoholism, in Santa Barbara, California, Dr. Book will present a poster entitled “Gender Differences in Alcohol Expectancies for Social Situations” and will participate in a scientific symposium by presenting her paper entitled “Treating Alcoholics With a Co-Occurring Anxiety Disorder: A Markov Model to Predict Long Term Costs.”
Joseph Sakai, Senior Scholar, next delivered a 20-minute, 14-slide-based variation of his lecture on “Opioid Replacement Therapy,” but now aimed at counselors in drug treatment programs. The presentation was very effective, and Joe was able to adapt the material to a totally different audience than the one for which the material had originally been developed.
Susan Tapert, one of the two Associate Directors of AMSP, next demonstrated a new lecture for our group on: “Substances and the Brain.” In addition to her excellent delivery style, this lecture also shared important information highly relevant to medical students. This will be added to our Web site.
An update of recent developments at Creighton University was next presented by the Junior Scholar, Pirzada Sattar. Pirzada reported that his activities in AMSP have facilitated his ability to increase the amount of required education on alcohol and drugs given to medical students. This included a doubling (from one to two hours) of the lecture time allotted to substance use disorders for Year 1 medical students, with a similar increase for those in Year 2. In addition, he has been given time to cover important information regarding the application to substance use disorders for special populations (e.g., the homeless, youth, women, etc.). Dr. Sattar is currently working to try to increase the amount of medical education for medical students in Year 3 (currently he only has the opportunity to lecture to one-third of the class), as well as the potential for developing clinical electives for Year 4 students. Regarding psychiatry residents, Dr. Sattar offers 12 hours of lectures to those in Year 1 and Year 2, as well as five hours of lectures to those in Years 3 and 4. He is pleased to report that he has had two recent publications, one dealing with training in substance use disorders, and the other in the use of antipsychotic medications in these conditions, and he is planning to submit an R21 application.
Andrea DiMartini next reviewed her accomplishments at Pittsburgh. These included a number of activities regarding curriculum development. First, regarding first-year medical students, she joined the First-Year Medical School Curriculum Committee. She joined the first-year medical school Curriculum Committee for the advanced physical diagnosis course and is attempting to increase the amount of exposure of first-year medical students to drug and alcohol issues. Four hours of didactics have been added, as well as a half-day clinical experience at either an inpatient or outpatient addiction treatment program, and students will now attend a 12-step meeting. For the didactics she plans to use her “Clinical Assessment of Alcohol Use and Disorders” lecture and Dr. Busch’s lecture on “Alcohol and Drug Dependence: Comparison to Other Chronic Medical Disorders,” and hopes to develop an interactive video interview demonstrating motivational interviewing techniques. These didactics will be coordinated with small group sessions the next day for students to practice interviewing techniques with patients with alcohol/drug disorders. This will comprise another half day. In total, she will have added 1½ days of drug and alcohol teaching to the first-year medical student curriculum. All of the drug and alcohol teaching throughout the medical student psychiatry curriculum will be evaluated with the intent of weaving a consistent theme throughout the four years, with each year building on the prior year’s teaching.
This semester Andrea designed and gave a lecture to the hepatology fellows on alcohol use disorders and liver disease using parts of Dr. Marian Fireman’s AMSP lecture on HCV and liver disease. She is also giving her lecture on “How to Give a Lecture” to graduating psychiatry residents, all of who must give a Grand Rounds lecture to graduate. This has now become a standard part of the psychiatry residency curriculum. In addition, she presents Dr. Tapert’s “PowerPoint” lecture. The series will be expanded to include other issues of professional development, using other AMSP lectures such as Dr. Drexler’s “Managing References” and Drs. Tapert’s/Villier’s “Organizing a Paper.” Beginning this year, graduating residents also need to complete a senior project and Andrea is working with residency training to help residents develop their projects. Andrea also offered the graduating residents an opportunity to work with her on her alcohol relapse research. Dr. DiMartini will also mentor a psychiatry resident on alcohol research.
Currently, Andrea is working with UPMC Website developers to create educational materials for patients for her medical center Web site. She hopes to have a resident design educational material as part of their senior project. She is also co-authoring a review article on alcohol and drug-related issues for hepatologists, and will speak at the APA and the Academy of Psychosomatic Medicine meetings on psychiatry and transplantation - a third of this lecture is on alcohol and drug issues.
Regarding research, she presented a paper entitled “Alcohol and Tobacco Use after Liver Transplantation for Alcoholic Liver Disease” at the annual meeting of the American Association for the Study of Liver Diseases, in Boston, MA on November 2, 2004, and she will present her data on relapse after liver transplantation for alcoholic liver disease as a poster at the RSA meeting this June. Over the past year as an AMSP scholar she has authored/co-authored five articles on alcohol/substance use issues and one book chapter in which alcohol and substance use issues were a third of the chapter. One article was co-authored with another AMSP scholar, Dr. Marian Fireman, regarding a review of alcohol and substance use in transplant populations.
Marian Fireman then presented her update from the Oregon Health & Sciences University. She continues as the clerkship director for psychiatry. In that role she has doubled the number of substance use disorder lectures in the didactics for the clerkship (from one hour to two hours) by adding a lecture she gives on “Emergencies related to Substance Use Disorders.” Dr. Fireman also teaches a weekly interviewing seminar with the medical students and has a medical student one-half day per week for an elective in the Geriatric Substance Use Disorders Clinic. She assisted in the development of a half-day curriculum on substance use disorders for the third-year medical student class, which was well received and delivered a lecture as part of that curriculum on “Medical Complications of Substance Use Disorders.” She has incorporated objectives into the goals of the clerkship related to substance use disorders. She continues as a member of the Medical Student Education Committee and the Clinical Services Subcommittee of the School of Medicine Curriculum Committee. Dr. Fireman is co-investigator on an NIH grant for enhancing Behavioral and Social Sciences into the medical school curriculum – if this grant is received there are proposals within the grant to enhance teaching of substance use disorders across the entire 4-year curriculum. Marian will present a poster on AMSP at the Association for Directors of Medical Student Education in Psychiatry meeting in Monterey, California in June 2005.
Dr. Fireman has joined the Department of Psychiatry Residency Training Committee and has initiated discussions within that committee to enhance the three-year resident rotation in addictions and to increase the time devoted to the addiction psychiatry seminar given to the second and third-year residents. She will coordinate and lecture in this seminar, which begins in the fall of 2005. She also presents a lecture in the neurosciences seminar on the “Neurobiology of Withdrawal Syndromes.” Marian interviews residency applicants and continues to supervise residents in the outpatient clinic, the geriatric substance use disorders clinic, the hepatitis C clinic and the transplant clinics. The OHSU Addiction Psychiatry Fellowship had a site visit in July 2005 and received a positive report. The fellowship has a new director and Marian will become more involved in the fellowship in the future. Marian also presented a lecture at the National VA Advanced Liver Disease Training Program in September 2004 on Substance Use Disorders and Liver Transplant. She will present a similar lecture at the National VA Liver/Kidney Transplant Conference in April 2005.
Dr. Fireman was recently appointed to the School of Medicine Continuing Medical Education Committee. She also serves on three committees for the Academy of Psychosomatic Medicine: the Fellowship and Awards Committee, the C/L Residency Training Committee, and is Co-chairman of the Women’s Network Committee. She is on two committees for the Oregon Psychiatric Association (the Program Committee and the Member’s Assistance/Board of Medical Examiners Committee), and she is the representative from the Oregon Psychiatric Association to the Oregon Board of Medical Examiners. Additionally, she has had three manuscripts published in the past year: one on med psych drug interactions — immunosuppressants; one on transplants and substance use with Dr. DiMartini as the lead author; and one on trimorbidity (hepatitis C, psychiatric and substance use disorders.
Susan Tapert and Marcy Gregg then brought us up to date on AMSP Web-site statistics. There has been a steady increase in the number of visits, hits, and so on throughout the year. For example, in the first 28 days of March, 2005, there were 8138 visits, including almost 17,000 hits, for a total number of pages viewed of nearly 7,300. Over the months, the most commonly viewed lectures included Substance Use Among Athletes, the Diagnosis and Treatment Lecture, Medical Problems Associated with Substance Use Disorders, Personality Disorders, Substance-Related Pharmacology, and Spirituality. Almost 400 of the hits in March 2005 came from individuals directly seeking out our Web site. Visits included individuals from North America, many countries in Europe, Asia (including India, North Korea, China, Hong Kong, the Philippines, and so on), Oceana (including Australia, New Zealand, Guam, and Fiji), as well as South America and Africa.
The meeting ended with a discussion of a variety of topics. This included the selection of our next meeting date to begin on Wednesday, September 14th and end on Saturday, September 17th; the selection of Monday, June 20th at 11:45 a.m. (San Diego time) for our one-hour conference call; as well as plans for a get together at the Research Society on Alcoholism.
The meeting adjourned at noon on Saturday, April 2nd.
Marc A. Schuckit, M.D.