Meeting #16

New York Athletic Club

March 28 - 31, 2007

Present at the meeting were Marc Schuckit, Marianne Guschwan, Susan Tapert, and Marcy Gregg, AMSP Directors and staff. Also participating were Second-Year Scholars Jill Williams, Nioaka Campbell, Timothy Fong, Karin Neufeld, and Olivera Bogunovic. Joining our group for their second meeting of the first year were First-Year Scholars Larry Gray, Gavin Bart, Maria Pagano, Anika Alvanzo, and Avram Mack. Attending the meeting on at least one day were graduate scholars Sarah Book and Evaristo Akerele, as well as our guests Stephanie Moran and Shannon Robinson.

I. Wednesday, March 28th

The group convened in the lobby of the New York Athletic Club where participants were introduced, and had the opportunity of getting reacquainted at the initial reception. We then progressed to a working dinner at a restaurant where the agenda for the following days was discussed and the participants had the opportunity of getting together in an informal atmosphere.

II. Thursday, March 29th

The group convened at 8:00 a.m. for the day’s activities. Over a working breakfast, guests, first-year, and second-year scholars were introduced, and the agenda was discussed.

The first items were two presentations to illustrate the issue of development of lectures/ scientific papers/ review papers/ grant applications/ etc. Marc once again presented his lecture on “How to Give a Lecture,” asking for input from both first- and second-year scholars on how this material might be presented in an optimally effective way to the new scholars who will enter in October 2007. Following this, Marc handed out an outline similar to those that need to be developed for the Website, along with slide copy for his lecture on an Introduction to the Genetics of Alcoholism. The goal was to determine whether a demonstration of an outline and slide copy would have been useful to the junior scholars as they were trying to learn the process of developing lectures. The overall consensus was that this would be of use, and it was decided to incorporate this outline and slide material into the introduction to be offered to the new scholars in October.

Next, the graduate scholar, Sarah Book from the Medical University of South Carolina at Charleston presented a lecture she is developing on “Social Anxiety and Alcohol Use Disorders.” This was a 20-minute scientific lecture for the Research Society on Alcoholism, and Sarah felt that it might be useful to her to practice the material and get input before the actual meeting. As is true of all of Sarah’s work, this was an excellent lecture, highly effective regarding both delivery and structure. The group had some questions and additional suggestions, but everyone congratulated her on the lecture and those attending the Research Society on Alcoholism meeting in Chicago are looking forward to observing the final form and presentation of this fine material.

Following this, First-Year Scholar, Gavin Bart, from the Department of Medicine at the University of Minnesota Hennepin County Medical Center delivered his excellent lecture on Alcohol and Obesity. This had two independent parts, one developing material on obesity and its treatment, and the second an outline of alcoholism. When Gavin began to develop the material, it appeared likely that there might be a fair amount of overlap between the two disorders, with the probability that this would make a cohesive lecture. The development of the lecture itself, however, demonstrated that the major strength of the material related to obesity, its treatment, and the manner in which related treatments might impact on blood alcohol levels and how a person responds to alcohol. Gavin is in the process of altering his excellent material to focus more directly on obesity and its treatment. The lecture in its current form or, perhaps, the revised material, will be placed on the AMSP Website.

Having completed the morning’s work, the group next went on to a working lunch during which issues of career development were discussed. Topics included questions of how to integrate contrasting input from senior members of a department regarding either a grant application or a paper; discussions of the dangers of burnout in any job (including academic medicine), and how to avoid related problems; a discussion of how to prioritize and keep up with journals; along with other topics directly relevant to career development.

The last official activity during the day on Thursday involved Senior Scholar Jill Williams presentation of a 20-minute version of her original 45-minute medical school lecture. Here, Jill was asked to demonstrate how the material she developed for medical students could be altered for a discussion of smoking, nicotine dependence, and it’s treatment as might be delivered to a health class of senior high school students. The lecture style, ability to focus on three or four major points, the approach to modifying slides to be appropriate for a specific audience, and the focus on material most relevant to high school students was well demonstrated by this lecture, as was a fine lecture style.

The group adjourned on Thursday at 2:15 in the afternoon with several of the scholars getting together regarding additional materials relevant to presentations during the remaining two days of the meeting. On Thursday evening, members of AMSP were on their own.

III. Friday, March 30th

The AMSP group reconvened on Friday at 8:00 a.m. over a working breakfast. The first order of business was a presentation by Olivera Bogunovic, a Second-Year Scholar, that highlighted how a very technical lecture on HIV/ AIDS originally developed as a 45-minute presentation to medical students could be modified for a 20-to-30 minute lecture to be given to college freshman. Olivera demonstrated how some of the more technical original slides could be deleted, and worked to make sure that the level of jargon was minimized so that the material might be of greatest interest to college freshman. After this successful presentation, Marc Schuckit asked Olivera to take her modification of a lecture one step further and demonstrate how it might be presented on even a more basic level for the same group but delivered with 10 or so slides over no longer than a 10-minute period. Dr. Bogunovic agreed to the challenge, and began to prepare her demonstration of lecture modification to be presented later that day.

Next, First-Year Scholar, Larry Gray, presented his lecture on Attention Deficit Hyperactivity Disorder and Substance Use Disorders. Dr. Gray developed the material as it might be given as a 45-minute lecture to medical students, but emphasized his viewpoint as a pediatrician. The manner of delivery, quality of the slides, and flow of logic of the material were very effective. The group had a number of minor suggestions on simplifications of slides, and several ideas that Dr. Gray might consider before offering the final version of this lecture for the website itself.

Following this presentation, Senior Scholar Karin Neufeld demonstrated her modification of her original 45-minute lecture as developed for medical students, but now demonstrating how with a modest amount of change, the same material might be made appropriate for a group of judges interested in learning more about the antisocial personality disorder. Karin was able to show how with a modest amount of effort, it is possible to change both the audience (keeping them in mind is paramount for any lecture), and modify slides in a very highly effective format that could be used by anyone wishing to educate judges on this important topic.

The next presentation was given by First-Year Scholar Anika Alvanzo focusing on Alcohol and Intimate Partner Violence as would be delivered as a 45-minute lecture to medical students. These two topics (intimate partner violence and alcoholism) melded together quite effectively, and the lecture was most impressive. Anika’s style of presentation was greatly appreciated, as were the quality of her slides, and her command of the information. The group offered several minor suggestions regarding the need to define specific items and avoid jargon, and the way in which some specific tools (for example, the Alcohol Use Disorders Identity Tests) could be blended into the lecture itself. With very minor additional work, the entire group felt that this presentation would be an excellent addition to the AMSP website.

Next, as a change of pace, the group turned to reports by senior scholars regarding their activities this past six months as members of AMSP. Karin Neufeld from Johns Hopkins University in Baltimore, Maryland, is now a regular member of the Admissions Committee for Johns Hopkins School of Medicine. She is working actively to sensitize candidates applying to medical school and to other faculty members on the committee to the special challenges and needs of patients with substance use disorders and the role of medical education in providing better care for these patients. She continues as a member of the Education Policy Committee for the Department of Psychiatry and is one of the faculty teaching a 10-hour lecture series on substance use disorders (including motivational interviewing) for first-year residents. Karin has also been providing new lectures to the first-year medical students (including one dedicated to alcohol use disorders this year), has recently had a fourth-year medical student complete an eight-week elective in Addiction Treatment Services, and hopes to make this elective a regular occurrence. She continues to work with the treatment community to increase education in comorbid disorders among methadone maintenance treatment providers (related to a recent service grant). During March of this year Dr. Neufeld submitted a grant proposal to study the treatment outcomes of a new initiative that she and colleagues have developed, which offers specialty intensive treatment for poorly responding patients in other community methadone treatment programs in Baltimore. She is the principal investigator in this endeavor.

The next report by a Senior Scholar came from Nioaka Campbell at the University of South Carolina School of Medicine. She continues to serve as the Director of the vertical curriculum on substance use disorders, involving integration of six hours of lectures in psychiatry along with other disciplines. She reports increased student interest in the PALS (peer advocate liaison) group at the medical school as well. Nikki is also working to revamp the simulated case presentation for the Mill exams involving substance use disorders. From a career standpoint, she is now the President-Elect of the South Carolina Psychiatric Association (SCPA), a district branch/state association for the American Psychiatric Association (APA). She will serve in this position as the Deputy representative to the APA for this coming fall Assembly meeting, and will be President of the SCPA in 2008-2009.

The group next moved onto a working lunch during which career development issues were discussed. The items included a return to the discussion regarding burnout; issues related to reasons to go into academics and some of the benefits of these activities; an informal discussion of the importance of the manner in which the term “abuse” is used in scientific articles dealing with substance use disorders; potential directions for DSM-V; and additional items related to personal growth within an academic setting.

The group also discussed how AMSP scholars can stay active even following graduation. Therefore, we have tentatively decided that: 1) We will attempt to convene a Continuing Medical Education meeting in San Diego the day before the Research Society on Alcoholism meeting in the summer of 2009. Karin Neufeld will also look into the possibility of an additional CME credit-generating meeting for practitioners on the East Coast, perhaps in the intervening time before the 2009 RSA. 2) The 2009 RSA meeting will represent the 10-year anniversary of AMSP. It is hoped that Marc can generate funds to help graduate scholars and current scholars to attend that meeting. It is also hoped that we will develop some separate sessions on posters representing the work in research, teaching, administration, and clinical activities of AMSP graduates. 3) Plans will be made to request permission from RSA to put together a symposium on mentoring in alcohol and drug use disorders. Marc will contact Gail Rose and Margaret Rukstalis who have written several papers on mentoring at least in part as related to their AMSP activity to see whether they would like to be co-chairs of the session. Again, this is for 2009.

Following lunch, Senior Scholar, Nioaka Campbell, demonstrated a modification of her original 45-minute lecture developed for medical students as might be presented as a 20-to-30 minute discussion of Alcohol Use Disorders and Women as part of a presentation to a college sorority. Nikki’s engaging style, her ability to present material on the level appropriate to sorority sisters, and her ability to pull in an audience as participants was greatly appreciated. The lecture demonstration was quite successful.

Reports of recent activities in developing materials on substance use disorders at their medical schools was continued by Senior Scholar Jill Williams from the UMDNJ-Robert Wood Johnson Medical School in New Jersey. Jill shared with the audience that she has a new role as the Director of the Division of Addictions and the Program Director of the RWJMS-Addiction Psychiatry Residency Program since January 2007. Jill also continues to give a new two-hour lecture on Introduction to Substance Use disorders for the MS III clerkship (three to six times per year) and other lectures on Club Drugs and Tobacco to MS II (Behavioral Science course) and general psychiatry residents. She also was asked to coordinate the six-week substance abuse curriculum for PGY2 residents including giving two lectures on Co-occurring Disorders and Club Drugs/ Methamphetamines, and remains very active in the didactic curriculum of the Addiction Psychiatry Residence program, and was appointed to the University CME Committee. Dr. Williams continues to offer CME activities and coordinates a twice a year course on tobacco dependence treatment for psychiatrists and advanced practice nurses which has been well received. She is also involved in numerous other training initiatives on treating tobacco including the UMDNJ-School of Public Health five-day Tobacco Specialist Certification course. Jill noted that skills she has improved through AMSP have been helpful in her success as a trainer and for her work in teaching students, fellows, and postgraduate courses, and as an addictions supervisor. In addition, she keeps in contact with numerous people nationally seeking knowledge in addictions and she frequently refers these individuals to the AMSP website to access the slides and outline resources.

Next, Senior Scholar Tim Fong, of UCLA shared his activities over the prior six months. Regarding teaching, Tim, along with a colleague in Internal Medicine, has established quarterly dinners for the medical students entitled “Staying Well in Medical School” in an effort to bring faculty and students together in an informal setting to discuss ways to stay healthy physically and emotionally. In addition, he is starting a collaboration with the pain medicine and family medicine departments arranged in four hours of lectures on substance abuse to be given to pain medicine fellows and to family medicine residents (3rd year). Family medicine and pain medicine fellows will also be able to rotate through the UCLA Addiction Medicine Clinic to get further experience. He has also helped establish quarterly “Addictions and Culture Movie Nights” to show movies related to substance abuse that have a strong cultural theme. Regarding research teaching, three medical students have signed on to do a summer research fellowship in Tim’s gambling research lab where they will have their own projects and will be provided training in substance abuse research. Tim has also branched out to the neuroscience department and obtained a predoctoral student to join the lab to investigate neuroimaging in pathological gambling. Finally, regarding administration, Tim has been able to obtain support for the Addiction Psychiatry Fellowship as well as funds to help promote the UCLA Addiction Medicine Clinic. Projects will include establishing a website, brochures and improving visibility of the clinic’s service funding a mini-fellowship for community physicians to rotate through the Addition Clinic in order to receive additional training. Tim will formally take over the Addiction Psychiatry Fellowship starting July 1, 2007.

Next, Senior Scholar Olivera Bogunovic originally chosen from the University of Buffalo Medical School and currently at the McLean Hospital Division of Harvard Medical School brought the group up to date on her recent activities. Since her move from Buffalo she has been getting involved with the teaching activities at McLean and becoming part of the addiction fellowship. She has given two lectures to the fellows including HIV and substance abuse. Olivera will organize the interview course for the PGY 1 and PGY 3 residents and medical students during their rotation on the alcohol and drug abuse program and was asked to write a column on Women and Aging for the Harvard Psychiatry Review. Also she is in the process of starting a new group for elderly substance abusers who are early in recovery with the hope that this pilot group will give her a possibility to do some research in that area.

Closing out the day’s activities, Olivera Bogunovic took her lecture on HIV/AIDS and demonstrated how even a more simple and shorter version could still be quite effective. The group was very impressed with both modifications of her original lecture as presented on that date, as well as Olivera’s remarkable flexibility in being able to continue her coning down on the most essential elements of her presentation.

The meeting adjourned at 2:30 p.m. on Friday. Members were reminded of our working dinner that evening at Remi Restaurant. The plans for Saturday’s activities (as well as the starting and ending times to be certain that everything that was needed was completed) were reviewed. There was also a discussion of the potential venue and timing for the next AMSP meeting which will be attended by graduating junior class scholars who have successfully completed their first year’s work.

IV. Saturday, March 31st

The group convened over a working breakfast at 8:00 a.m. The activities began with a presentation by Junior Scholar Maria Pagano of her new lecture dealing with Altruism and Service as both helping mechanisms for the giver, as well as for the receiver. This fine lecture with excellent slides originally attempted to incorporate information on a broad range of topics related to the manner in which offering help can be important to persons who themselves have a similar disorder. As the lecture progressed, it became apparent that the material would be more effective if it focused solely on service delivery in the context of 12-step (or Alcoholic’s Anonymous-like) programs for alcohol and other substance use disorders. A lively discussion ensued as Maria and the group worked to determine how the lecture might be simplified, focused more directly on a narrower topic, and how this could be successfully accomplished without adding any new material other than two or three transition slides. This was an excellent exercise for AMSP overall, and a slightly modified lecture will be developed by Maria for inclusion in the AMSP Website.

First-Year Scholar Avram Mack from Georgetown University Medical School then presented his approach to taking an existing lecture on Methadone Maintenance and Other Agonist Treatments as originally developed by Joseph Sakai, and showing how the material might be cut back to a 30-minute lecture for a professional audience (including medical students). The presentation generated an excellent discussion of how one decides what to include and what to delete, some discussion of how much of the original slides would be appropriate to modify, as well as an issue related to how much time must be spent by a person using any of these lectures as originally developed in studying both the original references as well as additional data sources. The AMSP group enjoyed both the presentation and the subsequent discussion.

Second-Year Scholar Tim Fong from UCLA next demonstrated how his original 45-minute lecture for medical students dealing with Pathological Gambling and Substance Use Disorders could be modified for a very different audience, managers of casinos. Once again, this was a very successful demonstration of how the same basic lecture material can be modified (both in slides and outline) to focus class on a very new and quite different audience. The presentation was both entertaining and highly successful.

The meeting next progressed to the opportunity for each of the first-year scholars to present to the group their accomplishments in alcohol and substance use disorders over the prior six months at their medical schools, as well as to offer some thoughts about what it is they hoped to do over the subsequent six months or so leading up to our next meeting in October 2007. The presentations began with Larry Gray from the Department of Pediatrics at the University of Chicago Medical School. He surveyed the 13 course directors of medical school education at the University of Chicago. He found that psychiatry provides a two-hour lecture related to substance Abuse and Dependence and a two-hour laboratory session with case studies. Medicine, Pediatrics, Surgery, and anesthesia course directors replied that the curriculum contained requirements, but they were not currently being covered; they requested assistance. Other course directors, however, replied it was “not applicable.” Dr. Gray contacted the Dean’s Office in Medical School Education and learned that the medical school is launching a curriculum redesign initiative called the “Pritizker Initiative.” He was invited to offer input into curriculum redesign, especially as it related to substance use. Larry also delivered the University of Chicago Department of Pediatrics Grand rounds in January 2007 entitled “Untreated and Unfair: ADHD in 2007" using material based on his AMSP lecture. New initiatives for next year include a plan to offer the curriculum redesign committee (rather than developing new curriculum) adjunct activities for either current activities or freshman/sophomore electives. Examples may include (but are not limited to) informal lunch discussions about alcohol-related matters, movie evenings, mentoring opportunities, or participating in other medical school activities that require information regarding alcohol use disorders.

Next, Gavin Bart from the Department of Medicine at the University of Minnesota Hennepin County Medical Center shared his recent work. This included giving addiction lectures last fall to the second-year medical students, including screening and brief interventions and neurobiological bases of addictions and their treatment. He also serves as preceptor for a second-year medical student selective rotation in novel health care delivery systems where the students are exposed to methadone maintenance and outpatient alcohol pharmacotherapy treatment and a multidisciplinary approach to addiction treatment. Dr. Bart is a faculty advisor to one medical student and hopes to inspire this student to consider a career in addiction medicine. At the non-medical school level, he has been serving on the American society of Addiction Medicine Medical specialty Action Group (MSAG) making recommendations to ASAM regarding the establishment of addiction medicine as a formal American Board of Medical specialties recognized subspecialty with accredited training programs available to psychiatrists and non-psychiatrists alike.

Anika Alvanzo from the Virginia Commonwealth University next reviewed her activities, accomplishments, and plans. She stated that students at VCU get four hours of lecture in the first two years, a 90-minute lecture on their M3 clerkship rotation, and a 60-minute lecture on their internal medicine rotation. Two to three M3 students rotate on the Substance Abuse Consult Service during the Psychiatry clerkship. Finally, there is an M4 Addiction Medicine elective. Dr. Alvanzo has structured the M2 OSCE to include alcohol or tobacco, such that this year each student will have to complete one case in which they will have to counsel a patient about behavior change (education case). With respect to career development, Dr. Alvanzo has submitted a K-Award to NIAAA and received a priority score of 216 encouraging her to revise and resubmit. She submitted the modified proposal of a similar project to the Robert Wood Johnson foundation. Lastly, Dr. Alvanzo submitted a small internal grant proposal regarding integrated therapy for history of physical and/or sexual trauma and substance abuse.

Maria Pagano, originally from Brown University and currently at the Cleveland Clinic Department of Psychiatry (Case Western Reserve), next shared her activities. She highlighted her accomplishments of gaining a grand rounds slot in November 2007 based on her lecture developed through AMSP. Appointed to the Addiction Fellowship Committee, Maria has added a research component to the Addiction Fellowship training curriculum that she will oversee. She worked with members of the Psychiatry Residency Training Committee to develop a medical student rotation at an adolescent residential treatment facility for alcohol and drugs. In addition, Maria submitted a grant application based on her AMSP-developed lecture and prior research to study helping behaviors among adolescents in treatment for substance use disorders.

Finally regarding first-year scholar reports, Avram Mack from the Georgetown University Medical School noted that as a request of the continued need to coordinate teaching on addictions in the first two years of medical school, he has been meeting with the course directors of the Behavioral Science courses in those years in order to reduce any redundancy. Within the Department of Psychiatry he has encouraged increased exposure to addiction issues — the second-year psychopathology course has been given increased lecture time in addictions, particularly adolescent addiction. Considering these endeavors, Dr. Mack and others will resubmit the internal Georgetown grant for planning, coordinating, and improving all addiction education throughout the entire school and through all four years of the medical student curriculum at Georgetown.

Marcy Gregg then shared the most recent six months’ activities regarding the AMSP Website. She noted that in almost all of the months between the prior and current meeting, the activity at the website increased by between 15% and 50%, with most activity in October and November (perhaps reflecting the beginning of a new academic year in medical schools). The total time per month occupied by activities at the Website hit a high of 231 hours in October, during which time there were over 36,000 hits, involving 16,000 repeat visitors, and almost 13,000 pages being viewed. Looked at from the standpoint of specific lectures, the downloads from our Website over the prior months included 6,000 for the Substance Disorders and Athletes lecture, over 3,000 for the Pharmacology lecture and for the Medical Consequences lecture, and approximately 2,000 each for the remaining lectures. Browsers included individuals with languages focusing on German, Polish, French, Dutch, Czech, Swedish, Hungarian, Finnish, Turkish, Greek, Arabic, Slovak, Russian, Catalan, Bulgarian, and many others. Our Website was most often accessed through Google, Yahoo, MSN, AOL, and Ask Jeeves. Indeed, this was most rewarding information demonstrating that AMSP appears to be highly successful in our ability to reach out to a much broader audience than just those representing the medical schools where our scholars have attended.

The final bits of official information included establishing our next AMSP meeting (which will be the first meeting for our new scholars) to occur in Hawaii beginning on Wednesday, October 24, 2007. In addition, we established our next conference call for all current first and second-year scholars will take place on Thursday, June 14th at 11:00 a.m. San Diego time (1:00 p.m. Central time and 2:00 p.m. East Coast time). This will begin promptly at 11:00 a.m. and end no later than noon San Diego time, and it is important that all first and second-year scholars participate.

Before adjourning, Susan Tapert presented an excellent overview of PowerPoint approaches to developing lectures. She began by reviewing basic topics to PowerPoint, and then spent the majority of her time dealing with a discussion of questions and answers relevant to the entire AMSP group. This is a most important and enjoyable aspect of our meetings.

The final activity was the presentation of AMSP graduation plaques to departing Senior Scholars. The group shared plans for the next several days, including their trips home, and we adjourned with heartfelt wishes for a fast and safe trip home for everyone.

The meeting adjourned at noon.

Marc A. Schuckit, M.D.

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