Meeting #17

Kona, Hawaii

October 24 - 27, 2007

Present at the meeting were Marc A. Schuckit (Director), Susan Tapert (Associate Director), Marcy Gregg (Administrator), as well as the First-Year Scholars Timothy Lineberry from the Mayo Clinic College of Medicine, Leslie Buckley from the University of Toronto, Krishna Balachandra from the University of Western Ontario, and Maritza Lagos from Michigan State University, as well as an invited guest, Shannon Robinson. Also present were Second-Year Scholars Gavin Bart from the University of Minnesota, Larry Gray from the University of Chicago Comer Children’s Hospital, Anika Alvanzo from Virginia Commonwealth University Medical Center, and Maria Pagano from Case Western Reserve University.

I. Wednesday, October 24th

The group assembled in the late afternoon of Wednesday, October 24th. Introductions were made, the agenda briefly reviewed, and plans for the evening and following meetings described.

After a brief break, we reassembled in the dining hall for the Kona Village where participants had the opportunity to discuss their backgrounds, their goals regarding participation in AMSP, and suggestions regarding what needed to be accomplished at the meeting.

II. Thursday, October 25th

The group met from approximately 7:45 a.m. (beginning breakfast) through 3:00 p.m.

The morning began with each Junior and Senior Scholar giving a brief review of their roles at their universities, as well as their professional focus. Marc Schuckit then gave an overview of the history and goals of AMSP, as well as a review of the week’s activities.

The majority of the morning was spent in several lectures delivered by Marc outlining “How to Give a Lecture,” followed by a demonstration of what an outline/slides/delivery would look like. This was the heart of the meeting and represented what the Junior Scholars need to learn in order to carefully review the literature, organize thoughts, and present material. The information and approach works well for all types of lectures, as well as for papers and grant applications. A lively discussion ensued as the Senior Scholars added their thoughts on the most important aspects of developing lectures, and some of the material was briefly revised.

After a brief break, the group reassembled for a working lunch that included a discussion of academic challenges. These incorporated how to set priorities; the challenges of focusing on development of papers or lectures when it is easier to answer the phone or walk over to the ward—most AMSP scholars have more comfort with clinical skills than (at this early point in their careers) academic/ writing challenges; issues related to how one selects a career area for focus; as well as a host of additional important topics.

The next item on the agenda was the demonstration of a lecture on Attention Deficit Hyperactivity Disorder presented by Senior Scholar, Larry Gray. Dr. Gray’s presentation was very impressive, the slides worked extremely well, and the group had some additional suggestions regarding placing the information relating to alcohol and drugs a bit earlier in the lecture. This presentation would work well for medical students, pediatric residents (Dr. Gray’s discipline), or psychiatric residents or fellows.

The group moved on to the progress report for Senior Scholar, Gavin Bart, regarding his recent activities at the University of Minnesota. He noted that the current medical school curriculum continues to have only four hours of formal lecture on substance use disorders. Dr. Bart gave two of these lectures last year and is not scheduled to give them this year. He has, however, been able to introduce two lectures into the required internal medicine clerkships during years 3 and 4. Approximately half of all University of Minnesota students will rotate through the site where these lectures are offered. Dr. Bart is also working with the Director of the psychiatry clerkship to introduce a mandate for all students to review a web-based curriculum in screening and brief interventions. He continues to host second-year students during their 16 hours of Physicians and Practice series. Outside of the medical school, Dr. Bart lectured on the genetics of substance use disorders to high school science teachers participating in BrainU, an NIH-funded excellence in neuroscience program. He is coordinator of the psychiatry residency’s 16- lecture series on substance use disorders. In fall 2008, Dr. Bart will be coordinating an 8-lecture series in clinical aspects of substance use disorders for postdoctoral students participating in an NIH funded T-32 training grant in Neuroimmunopharmacology. At the national level, Dr. Bart is serving on the American Society of Addiction Medicine’s Medical Specialty Action Group where he helped design model core content for addiction medicine graduate training and is currently serving on the selection committee for the Board of Directors of the newly formed American Board of Addiction Medicine (ABAM). ABAM seeks to promote the recognition of Addiction Medicine as a distinct medical subspecialty recognized by the American Board of Medical Specialties with fellowship training programs accredited by the American College of Graduate Medical Education.

The Thursday session ended with an overview of what had been accomplished that day, the schedule for Friday and Saturday, as well as a reminder that all participants were on their own during the evening.

III. Friday, October 26th

The first order of business on Friday morning was the delivery of the lecture on Intimate Partner Violence by Anika Alvanzo, Second-Year Scholar. It was a highly effective and well-delivered lecture. Marc then used some of the slides to give examples to the Junior Scholars regarding how almost any slide can be simplified, and how a more straightforward visual aid is likely to be most effective. All scholars are reminded that any changes in their lectures need to be forwarded to Susan Tapert for loading on the website before November 15th.

Marc then raised the question to Junior Scholars regarding potential topics. Several possibilities were noted for each of the scholars, with a discussion regarding the need to select an area in which the scholar has a strong interest, to keep the question addressed very focused, and to remember that this is to be a 45-minute lecture on a medical student level.

Marcy and Marc then handed out materials to Junior Scholars regarding the activities they might take on to enhance alcohol and drug education at their universities. This included a discussion of the development of electives, the role of Doctors Ought To Care, the benefits of surveying a medical school to see the levels of education in alcohol and drugs, the benefits of meeting with the Dean of the medical school and Chair of relevant departments, a film club (suggested films are on the website), the development of an elective, and so on.

The next agenda item involved the report of recent activities by Senior Scholar, Larry Gray at the University of Chicago Pritzker School of Medicine. After completing the university-wide survey of substance abuse and addiction teaching, Dr. Gray was invited to participate on a committee involved in the medical school curriculum re-design called the Pritzker Initiative. The Pritzker Initiative is a medical school-wide curriculum redesign, which begins in 2008 and will be completed in 2010. For issues related to substance disorders training, the Dean of the Medical School and Assistant Dean for Medical School education have met with Dr. Gray and been introduced to the content on the AMSP website. Larry was subsequently invited to participate on a working committee of the Pritzker Initiative, which is focusing on integrating medical information on alcohol use disorders in a new year-long course on professionalism and wellness information. This would be a new and unanticipated application of the lecture information Dr. Gray developed during his AMSP experience. Second, Dr. Gray reported on a complementary AMSP activity completed during the past interval. Using the reputation of the AMSP, he traveled to meet a senior researcher in his field and spent a day in her laboratory learning about the research data to be presented in his AMSP lecture. Dr. Gray’s participation in AMSP in a large part facilitated this meeting. Thirdly, Dr. Gray has been invited to participate in the three-year medical school students informal mentoring during their rotations in pediatrics. This mentoring has taken the form of interacting with medical students during their trip to the Smart Art Museum. This mentoring will occur on a quarterly basis for the next year. Finally, he has presented to the University of Chicago Developmental and Behavioral Pediatric fellows and pediatric residents the AMSP lecture “How to Give a Lecture” twice during the past interval.

Next, Senior Scholar, Maria Pagano, reviewed her activities at Case Western Reserve University. Maria reported on four developments within the School of Medicine. As a direct result of her AMSP experience, she is delivering the December Grand Rounds for the Department of Psychiatry on the role of helping behaviors in staying sober. Her AMSP experience also informed a foundation grant application, which she is in the process of resubmitting to study how offering services helps the individual to recover from their own problems. She also supervised a summer research elective for a first-year medical student, the results of which were submitted to the annual meeting of the American Society of Addiction Medicine. Lastly, Maria examined the efficacy of fluoxetine among depressed adolescents with substance use disorders, the results of which were presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The lunchtime career development discussion included: choosing battles carefully when faced with several challenges at one time in an academic department; approaches to handling nervousness before presentations or lectures (and the fact that everyone gets anxious); approaches to enhancing efficiency in writing papers or grants (including the possibility of assigning sections of the paper to different participants); considerations useful in choosing which journal is appropriate for a submission; the assets (and liabilities) of serving as a reviewer on papers submitted to journals; the prevalence and ways of dealing with faculty turf wars; and how to gauge whether a department is functioning well and might be a good place to get a job.

After a discussion of a variety and wide range of topics, the group adjourned, with a free afternoon from 3:00 p.m. onward. That evening we reassembled at 6:30 p.m. for some music and plans of carpooling for dinner. The group get-together over dinner included significant others and made for a most enjoyable evening.

IV. Saturday, October 27th

The first order of business was the presentation by Shannon Robinson demonstrating a socratic interactive approach used in teaching medical students. The ability to engage participants was most impressive, and the slides were effective in that they were limited in the amount of information they offered and served as a platform through which Dr. Robinson effectively engaged the audience.

Senior Scholar, Gavin Bart, then presented his lecture on Obesity. This presentation demonstrated a very effective way of using maps to demonstrate the remarkable increase in prevalence of obesity. Furthermore, the lecture demonstrated Dr. Bart’s ability to incorporate suggestion from his last AMSP meeting to refocus the material presented. The lecture worked very well, and with some minor changes (mostly cutting back on some sections) this will be a valuable addition to the website.

Following this discussion, Susan Tapert then demonstrated how a scientific lecture can be very effective even when the presentation was limited to 10 minutes. Dr. Tapert showed how simple slides can effectively move the lecture along while engaging the audience and keeping them focused. The discussion emphasized how amazing it is that so much information can be presented in such a brief period of time.

Anika Alvanzo, Second-Year Scholar, then delivered her report of her recent activities at Virginia Commonwealth University Medical Center. With respect to medical education, Dr. Alvanzo reported that as the Course director of the M2 Foundations of Clinical Medicine course, she had added a didactic lecture that included content on assessment for heavy drinking in the primary care setting. The lecture was given prior to the “Advanced Interviewing” workshop in which students had to demonstrate their skills with trained standardized patients. Additionally, she reported on plans to add a “Mental Health Assessment” workshop in the spring where four cases will be presented, one of which will be a substance misuse case. Dr. Alvanzo also reported that she had given a lecture on “Alcohol and Intimate Partner Violence” to a class containing primarily MPH students. Lastly, she had ordered the “Addiction” documentary from HBO and plans to hold a series of lunchtime lectures co-facilitated by herself, her mentor and Deputy Director of the VCU Institute of Women’s Health (IWH), Dace Svikis, Ph.D., and Michael Weaver, MD., Head of the Substance Abuse Consult Service. With regards to research, Anika is getting ready to begin implementation of her seed grant from the VCU IWH which will be a trauma-informed group intervention for heavy drinking women in a primary care setting. In August Anika submitted a grant to the Alcohol Beverage Medical Research Foundation.

The group then turned to a discussion with Junior Scholars regarding their topics and an appropriate Senior Scholar mentor. The assignments included: 1) Krishna Balachandra will prepare a lecture on the Clinical Approaches to Treating Comorbid Psychiatric and Substance Use Disorders—Larry Gray will serve as mentor; 2) Tim Lineberry will develop a lecture on Substance Use Disorders and Suicide—with Gavin Bart serving as mentor; 3) Leslie Buckley will develop a lecture on Medical Education regarding Substance Use Disorders—with Anika Alvanzo as Senior; and 4) Maritza Lagos will develop a lecture on Abuse, Dependence, and Misuse of Prescription Pain Pills—with Susan Tapert acting as mentor.

The next topic was to establish the place and timing for the Spring meeting. Of course, at that meeting all Junior Scholars will present the lectures they developed, as well as lectures by Senior Scholars. Our next meeting will convene in San Diego, California on Wednesday, April 30th, 2008 at 5:00 p.m. Marcy Gregg will look into the possibility of the Torrey Pines Hilton as the meeting venue.

Having dealt with the timing of the next meeting, it was now possible to set deadlines for first-year Scholars regarding the development of lecture materials for that meeting. Those deadlines include:

1. The Senior Scholars must receive a solid and detailed working draft of the lecture by December 1, 2007 at the latest. Junior Scholars are encouraged to get the material to the Senior Scholar before that date if at all possible.

2. Following multiple drafts and interactions with Senior Scholars (Marc should receive copies of those communications, but it is just to keep him up to date), it is imperative that Marc receive the best possible draft of the lecture by January 1, 2008. The key here is the lecture outline, and it is not as essential at this point to have slides or references (although that would be welcome).

3. Marc and the Senior Scholars will then work with the Junior Scholars regarding finalized lectures, development of slides, as well appropriate references. The final, final lecture complete with slides and references must be finished and forwarded to Marc no later than March 15th, 2008.

The group also discussed the conference call, which is scheduled for Thursday, January 10th, 2008 at 12:00 noon San Diego time (2:00 p.m. Central time, and 3:00 p.m. East Coast time). The conference will start promptly, and will last no longer than 60 minutes. All scholars are asked to participate and to do so in a quiet place where the focus can be placed on issues being discussed on the conference call.

The discussion next turned to a presentation by Marcy Gregg regarding the website. The visitors to the website have increased almost every month this year compared to 2006. We now have up to 15,000 visits per month, and up to 36,000 hits (where individuals ask for a file). More and more people are turning toward AMSP as a direct entre to our website (rather than via Google, etc.), with the result that about half of the users come directly to us.

At the end of the meeting, some of the Junior Scholars presented preliminary thoughts on their activities to enhance alcohol and drug education at their universities. These included:

1. Dr. Timothy Lineberry from the Mayo Clinic will be surveying Mayo residency program directors regarding alcohol and drug abuse curriculum content. He will also attempt to define medical school course content on alcohol and drugs for the first- and second-year students on alcohol and drug abuse. Dr. Lineberry will liaison with the observed clinical skills examination case designer to determine feasibility of adding alcohol-related case presentations for the clinical skills examination. He will also attempt to better integrate alcohol and drug abuse and dependence into individual instruction blocks in the second-year Psychopathology course.

2. Dr. Leslie Buckley of the University of Toronto noted that she hopes to further integrate an addiction curriculum into the Medical School education. Currently there is a large gap in the curriculum with respect to addiction and there is not an active advocate for addiction. The bulk of the curriculum provided is in the third-year psychiatric clerkship rotation, which lasts one week. Dr. Buckley will take on the role of representative for addiction undergraduate education in her department and is planning to contact the Medical School Undergraduate Dean or their representative to communicate the importance of addiction education, provide options for enhanced educational content and discuss the perceived needs of the medical school in regard to this. Providing educational content, whether in the form of lectures or a ‘case-based' problem set (to fit in with their problem-based learning structure), is a goal if the medical school agrees to enhance the addiction curriculum. An associated goal will be to become a member of a Medical School Education Committee to provide ongoing addiction advocacy.

3. Dr. Krishna Balachandra of the University of Western Ontario plans to enhance substance abuse and dependence knowledge amongst medical students and residents at his University. His first initiative is to communicate with his Chair to outline his plan. Next, he is planning to meet with the Undergraduate Teaching Coordinator and the Curriculum Coordinator to survey the current context and amount of lectures provided to medical students. He has also started to provide a medical student elective in co-occurring disorders and has accepted his first student. Dr. Balachandra also plans to initiate a noon-time elective program for rotating medical students at his hospital where students rotate for six weeks. This elective will be in addition to their formal lectures and Dr. Balachandra plans to present the lectures from the AMSP website. He is also scheduled to present the substance abuse and dependence lecture to second-year medical students in 2008; will develop a novel teaching approach using case-based problem solving on the internet; plans to supervise a medical student movie night to discuss a movie about substance use; is presenting a lecture on motivational interviewing for residents, and is also participating in a national initiative to prepare all final year psychiatry residents for their board exams focusing on substance abuse and dependence using a practical case where the board candidate must rotate through a station, and work through a case. Krishna has also created an elective rotation for residents and is scheduled to supervise three residents in the first half of 2008.

The meeting adjourned with good wishes all around for a safe and speedy trip home. We are all looking forward to our conference call on January 10th at noon San Diego time; the presentation development due to Senior Scholars by December 1st (and to Marc Schuckit by January 1st, 2008); the final development of lectures due by March 15th, 2008; and our next meeting which will be in San Diego beginning on Wednesday, April 30th, 2008.

Marc A. Schuckit, M.D.