The Inaugural Meeting

Kona, Hawaii

September 14 - 17, 1999

I. The meeting was organized by Marc A Schuckit, M.D., the AMSP Director, and Marcia Silcox, the Program Administrator and President of Exponent Communications. The participants included invited representatives from seven medical schools, each of whom is a person relatively new to the alcohol field who has committed himself or herself to taking active steps to increase alcohol education in their medical curriculum. Appendix A lists the names, address, and phone numbers of these representatives. In addition, the Education Committee of the Research Society on Alcoholism, under the auspices of it's President, Yedy Israel, was represented by Dr. Karen Trocki. UCSD was also represented by Susan Tapert from the Clinical Psychology Program.

II. The meeting began with a welcome reception and dinner. At this time, scholars and staff had the opportunity to greet each other, share backgrounds, and discuss potential plans for the future.

III. The first formal session was held on Wednesday, September 15th from 8:00 a.m. to 2:00 p.m. (All meetings included working breakfasts and lunches).

A. Work began over breakfast with a review of the goals of the program. Our job is to identify opportunities for alcohol education in all years of the medical school curriculum, reaching out to postgraduate education and continuing medical education wherever possible. Whenever possible, the program offers financial support to free-up time of the first year Alcohol Scholars, two face-to-face meetings a year to develop lectures and strategies, along with the development of an ongoing support group through conference calls every three months. The group will also help with career development of the scholars.

B. The participants reviewed the goals of the first meeting. In addition to establishing an ongoing network, this includes developing specific plans for implementation of alcohol education at each facility, sharing of six lectures developed specifically for alcohol education (along with slide copy), developing plans for the production of additional lectures, the development of specific course material within medical schools, the development of appropriate strategies, and the discussion of several career development issues.

C. Dr. Schuckit then presented slide copy (supplying slides to each participant), outlines, and a brief demonstration of three introductory lectures that can be used as part of an elective course on alcohol use disorders, or that might be developed as part of ongoing core courses, such as pharmacology and psychiatry.

1. This included a lecture on drug categories and associated problems. These were incorporated into slides 1.1, 1.2, 1.3, 1.4, and 1.5 for Project Adept.

2. An introductory lecture regarding the clinical course of substance use disorders in general was also demonstrated. These include outline material and slide copy from Project Adept, including 2.1, 2.4, 2.5, 3.13, 3.14, and 4.1.

3. A typical course lecture along with slide copy was presented for an introduction to alcohol abuse and dependence. This material was covered within Project Adept Slides 3.1 through 3.15.

D. The discussion next turned to steps that might be taken to develop an eight to 10-session elective on alcoholism. As outlined in Appendix B, material might include an overview of substance use disorders, categories of drugs and problems, a focus on alcohol dependence, comorbidity, and so on. It was suggested that each lecture or discussion be scheduled for between 45 and 60 minutes, and that each session also incorporate an interview with an alcoholic patient specifically selected to demonstrate the unique material presented. During the course, students might have the opportunity of practicing their interviewing skills by serving as the interviewer while working under supervision of the course director. In addition, as shown at the bottom of Appendix B, other potential topics that might be considered were suggested.

E. The group next turned to a discussion of the various mechanisms for incorporating specific steps into the curriculum. These included an opportunity to offer a lecture and discussion to entering freshman regarding coping with the stresses of medical school (including the potential for developing substance use problems), elective courses, clinical rotations, sub-internships, offering lectures in ongoing courses, and so on. This first discussion of issues focused on how to begin to approach course directors, education committees, department chairs, and medical school deans. An emphasis was placed on the importance of attempting to fit the education into the ongoing educational scheme by offering additional information without costing the medical school major resources. Various strategies for this approach were discussed, and experiences in these areas shared. The need to reach out to additional interested faculty in medical schools was emphasized.

F. The potential for developing materials for each meeting was stressed. This includes specific lectures with slide copies, outlines of potential courses, and developing minutes of all of the proceedings.

G. The possibility of developing a newsletter was discussed, but this idea faced problems in the distribution of material as well as the great amount of time required for this mode of dissemination to be effective.

H. As a result of these discussions, the group decided to take immediate steps to develop a website. This approach will first be shared among members of the AMSP, with the goal of opening up the website to all interested parties within the near future.

I. Members of the group then discussed the need to develop an outline of the appropriate knowledge base and objectives for each level of medical school education. In order to do this most appropriately, it was felt essential that all existing sets of objectives and knowledge-based guidelines be reviewed. This task will be taken on by the Alcohol Scholar from Washington University in St. Louis, Laura Bierut. She will develop such information, share it with additional program participants prior to our conference call to be scheduled three months hence, and will facilitate the development of this material for the website.

J. Working over lunch, members of the group shared specific information about alcohol education at their own universities. These experiences generated discussions about a required AA meeting for medical students rotating through psychiatry or taking a psychiatry lecture series, specific suggestions about alternative topics that might be useful in elective courses, a discussion of how medical schools that have multiple campuses (such as the University of Indiana and the University of Washington) might coordinate efforts regarding alcohol education during the first two years, the assets and liabilities of courses that involve only a portion of a day per week, ideal and less than optimal venues for education, and the importance of working with diverse departments within medical schools including psychiatry, preventive medicine, family medicine, obstetrics, and so on. Additional topics included the need to be certain that alcohol related information was incorporated into journal clubs, and that participants explore the possibility of developing noontime or evening discussion groups focused on the role of alcohol in physical and mental health as demonstrated by books, movies, and plays.

K. This information, along with the material handed out from Project Adept, facilitated the discussion of additional lectures that might be needed. Initial ideas included possible discussions regarding specific populations (such as women, older patients, minority groups, etc.), lectures focusing on the neurobiology of alcohol, lectures dealing with the recognition and treatment of impaired physicians, and issues related to HIV infections in the context of alcohol use disorders.

L. The meeting ended with a review of the goals to be accomplished on the following day (Thursday), along with a discussion of our desire to further our efforts to get continuing medical education credit for our gatherings.

IV. The session on Thursday, September 16th from 8:00 a.m. until 2:00 p.m.

A. The day began with a review of the accomplishments from the day before along with the agenda for the current session.

B. Marc Schuckit presented a lecture on how to give a lecture. The key issues were divided into sections on preparation (including development of slides), delivery, and how to field questions.

C. This was followed by the presentation of a lecture reviewing the importance of genetic influences in alcoholism. Slide copy from Project Adept relevant to this genetics overview includes 6.3 through 6.9. This presentation focused on the adaptation of a lecture as if genetics of alcoholism was to be used as an example of the approach for studying complex genetic issues in general. However, it was pointed out that the average teacher would usually limit the lecture to the material covered in the appropriate Project Adept slides, perhaps using 15 to 20 minutes of a teaching session dealing with causative factors in alcoholism overall.

D. The group returned to specific issues relating to the development of a website.

1. The goal is to have the website up and running by January 1, 2000. Efforts will involve a collaboration between Marc Schuckit, Susan Tapert, and Marcia Silcox.

2. Marcia will check on the development of a server.

3. We will establish links to the websites for all appropriate organizations including RSA, NIAAA, the American Association of Medical Colleges, Project Adept, the American Medical Society on Alcoholism, the American Psychiatric Association, the American Psychological Association, the American Association of Addiction Psychiatrists, ETOH (the alcohol database) etc.

4. It will be important to monitor the "hits" at the website to have an idea of the impact that the site is having.

5. One aspect of the site will be to develop a survey asking users what they find of benefit and what they would need in addition. This might be a requirement before users are allowed to download any slide copy.

6. It is hoped that the Project Adept slide series (only with their permission) and all additional lecture outlines and slide copies developed as part of the AMSP will be available for any users to download.

7. Marcia Silcox will look into our need to develop copyright for anything that we have produced. The issue is not for the AMSP to make money, but to be certain that no one else copyrights it so that we don't have full access to the material.

8. Additional components of the website will include the logo (of course), objectives of the AMSP, list of participants, minutes of all meetings, an updated list of references that individuals might find important in preparing lectures, a list of available lectures, a list of goals, a section on frequently asked questions, an outline of a ten-session elective, etc.

E. The group returned to a discussion of alcohol education efforts at each of the medical schools. Topics included a reiteration of the importance of presenting patients whenever possible in any of the sessions, as well as the assets of strongly encouraging, or even mandating, attendance at an AA or other 12-step meeting. In addition to material mentioned at the prior session, ideas included developing a one-half hour to one-hour module on the presentation of a fictitious case (perhaps an actor) as part of a larger course, development of elective luncheon meetings (perhaps one or two) where students can discuss their questions regarding alcohol and drug related issues as they relate to themselves, their relatives and friends, and their patients; efforts to get additional lectures on the genetics of alcoholism added to medical genetics courses; adding material to courses in physical diagnosis, community health, neurology, neurobiological mechanisms of disease focused course, etc.; being certain that people in the alcohol field are represented at luncheons and dinners given to help medical students with career choices; attempting to have an alcohol and drug rotation as part of a psychiatric clerkship; an outpatient elective focusing on field trips to treatment centers, recovery homes, etc.; developing a primary care rotation on alcohol and drugs; developing a lecture on the fetal alcohol syndrome to be included as part of an obstetrics course; lectures on the identification and treatment of withdrawal to be part of a surgery course; regular lectures to emergency room personnel; being certain that alcohol lectures are part of a pediatric medicine program; including alcohol issues in a geropsychiatry course; adding alcohol lectures to a course on infectious diseases (focusing on AIDS, hepatitis, and tuberculosis); developing courses in dual diagnoses as part of a psychiatry clerkship; pushing to have alcohol education included in grand rounds; encouraging medical students and residents to reach out to community programs and schools (an example of this is a medical school program called "DOC"); reaching out to relevant Ph.D. programs to incorporate them in education on alcohol; etc.

F. The meeting ended with a review of goals for Friday, September 17th. This included the need for each participant to list specific lectures they would like to develop for future meetings, and to identify specific goals they are establishing for themselves over the upcoming 12 months.

V. The meeting on Friday, September 17th from 8:00 a.m. to 2:00 p.m.

A. The meeting began with a summary of how the Alcohol Medical Scholars Program participants from the current year will be encouraged to continue their work for a second year.

1. At that point they will become Senior Scholars and will help lead discussions and demonstrate lectures for new entering scholars during the meetings.

2. The Senior Scholars will continue to participate in meetings and conference calls.

3. Senior Scholars will receive an honorarium (but no salary offset), as well as expenses to meetings.

B. The group discussed the goals of adding three to four new scholars on September 1, 2000. These three to four scholars will receive all of the benefits of a first year participant in the program, including one year of salary offsets. Potential scholars to approach include individuals in family practice, occupational and preventive medicine, psychiatry, or internal medicine at:

1. The University of Arizona (with contacts their through Beverly Taylor).

2. The University of Miami (perhaps through the Chair, Karl Eisdorfer or Barbara Mason).

3. The University of Pittsburgh (especially individuals dealing with adolescent psychiatry).

4. A university in the Chicago area in order to reach out to the community of medical schools in that city. Potential contact persons there include Dr. Sheldon Miller at Northwestern University or Karen Antel who works with one of the family practice programs in Chicago.

5. In order to reach out to the far Northeast, approach individuals in family medicine at Dartmouth. Specific contact persons might include Peter Silverford or Robert Drake.

6. Reaching out to a university in Texas to impact on the group of medical schools in that state. One suggestion from Beverly Taylor was to contact people in preventive medicine as it relates to correctional medicine.

7. The possibility of having an impact on geriatric alcohol programs at the University of Oregon through Dr. Roland Atkinson.

8. Establishing a contact at the University of Colorado Medical School, perhaps through the Fellowship Director, John Ritvo.

9. Developing contacts at the University of Oklahoma. A potential entree is through Dr. Ray deHart of the Occupational Medicine Program.

10. Determining the potential participation of the University of Maryland Medical School, perhaps through Dr. Joe Liberto.

11. Other suggestions included asking for potential candidates through organizations that deal with historically black medical colleges, those that deal with colleges in predominantly Hispanic areas, and determining potential candidates through suggestions from existing organizations such as the RSA and the American College of Addiction Psychiatrists.

C. The group next turned to a listing of assignments for development of lectures and slide copy for our next meeting, approximately six months hence. As individuals develop these materials they should feel free to circulate drafts of outlines and slide copy to any of the members of our group, and Marc Schuckit expressed a special interest in helping whenever possible. In developing these lectures it is important to keep in mind the goal of a 45 minutes to one-hour lecture with a medical school audience.

In preparing this list, Karen Trocki shared with participants the provisional list of lectures that might be of use to the Research Society on Alcoholism. The hope is that some of the current lectures developed for the AMSP might be of value to the RSA, and vice versa.

Specific lectures include:

1. Karen Trocki will develop a lecture on interpersonal and psychosocial contributors to substance use disorders.

2. Marty Hoiness will develop a lecture on AIDS, other infectious disorders, and alcoholism.

3. Laura Bierut will develop a lecture on identification of alcohol dependent individuals and the appropriate use of brief intervention techniques.

4. Eric Raimo will develop a lecture dealing with the medical consequences of alcoholism.

5. Vijay Ramchandani will develop a lecture on the pharmacology and neurobiological effects of alcohol.

6. Vania Modesto-Lowe will develop a lecture on pharmacological treatments appropriate for alcohol rehabilitation.

7. Marianne Guschwan will develop a lecture on the impact of 12-step programs and spirituality in recovery from alcoholism.

8. Beverly Taylor will produce a lecture on the prevention of alcoholism.

While each of these lectures will focus on alcoholism, they will, of course, mention other substance use disorders wherever appropriate.

D. Marc Schuckit presented the last of the demonstration lectures. This was to serve as an example of a one-hour lecture on comorbid psychiatric disorders in the context of alcoholism. Project Adept slides appropriate for this lecture (in the following order) include 5.1, 5.2, 2.8, 2.6, 2.4, 2.5, 5.5, 2.10, 5.4, 5.8, 2.7, 5.6, 5.3, and either 5.7 or 2.9. This lecture also demonstrated problems with some of the current slides from Project Adept, along with the suggestion of new slides that might be developed. Marc Schuckit will work with Eric Raimo to produce those additional slides, and will share disks with Powerpoint as well as slide copy regarding these new slides with the participants of the AMSP program.

E. The group next turned to the timing, scheduling, and goals of our next meeting to be established in approximately six months.

1. This will take place in a large city somewhere in the continental United States in order to preserve money and to make travel to the meeting a bit easier.

2. This big city meeting will alternate with another meeting (i.e., for September of 2000) that will be in a more relaxed rural environment.

3. The goals at the meeting to be held six months hence will be to present each of the eight new lectures, along with (should the presenter desire) critiques of lecture styles, a review of the progress on the website, a discussion of the progress being made at each center along with potential problems, suggestions for problem solving, discussions of measures of our success, additional suggestions regarding reaching out to other medical schools, and additional issues related to career development (Laura Bierut will lead a discussion based on a series of articles in JAMA and focusing on how to read and evaluate articles in the literature).

4. In order to accomplish these goals it was felt that three days was required.

5. The format of beginning early in the morning and working through both breakfast and lunch, allowing people to have some relaxing time after 2:00 p.m. was felt to work very well. Therefore, we plan on three days of meetings from 8:00 a.m. to 2:00 p.m.

6. After reviewing everyone's schedule, it was felt that an appropriate weekend would be that of May 4-7, 2000. Marc Schuckit and Marcia Silcox will review potential dates and venues and share final decisions with the group.

F. As part of the tradition of incorporating career development issues into the meetings, Karen Trocki then led a discussion of how to keep current with the literature. Karen produced an excellent overview of computer-based literature reviews (Appendix C). Marc Schuckit then talked about keeping up each month with a limited number of journals, highlighting especially the Journal of Studies on Alcohol, Alcoholism: Clinical and Experimental Research, and Addiction, among others. The discussion then progressed to topics related to utilizing computer programs, such as Procite, to maintain individualized reference lists with easy access.

G. Each program then shared their goals for the following 12 months.

1. Eric Raimo at UCSD.

a) Develop a survey of the existing efforts regarding alcohol education in all departments at UCSD.

b) Develop a ten-session elective on alcoholism to be given (perhaps at lunchtime) and open to all medical students and psychology Ph.D. students and fellows at UCSD. It is hoped that this will be developed jointly with Susan Tapert of Psychology and with Marc Schuckit. An important aspect will be the presentation of patients at each session, along with attending one AA meeting.

c) Develop an evaluation tool (perhaps based on the second-year boards in medical school or on the PRITE) assessing medical school and resident knowledge in alcoholism. It is hoped that a series of such tests might help establish the impact that the AMSP program is having at UCSD.

d) Taking advantage of a survey already developed from the AAMC regarding fourth-year medical students' opinions of the amount and quality of education they are receiving in substance use disorders. Evaluating the results of this survey over the years can be another indirect measure of the impact of the AMSP.

e) Reaching out to the existing DOC medical school program at UCSD.

f) Developing a book club, movie discussion group, or journal club focusing specifically on alcohol related issues.

2. Laura Bierut at St. Louis.

a) Reviewing all medical education regarding alcoholism in each of the years.

b) Developing information regarding the appropriate knowledge base and objectives for alcohol education. Laura will be using surveys developed by the AAMC, APA, RSA, ASAM, etc. and will be sharing the results with the additional AMSP centers.

c) Enhancing a third year outpatient elective by adding a substance use disorders treatment program rotation.

d) Developing a field trip to substance use disorders treatment programs as a newly required part of the psychiatric clerkship.

e) Adding to the ongoing clerkship a lecture on brief interventions in individuals with substance use disorders.

f) Developing a substance use disorders component to a web-based learning program at Washington University.

g) For the future, considering the development of an interactive component on the web regarding brief interventions in individuals with substance use disorder.

h) Also for the future, considering the possibility of establishing a program to educate psychiatric residents about how to teach about substance use disorders and additional topics.

3. Marianne Guschwan at New York University. She began with goals for the next meeting:

a) Establishing herself as the Coordinator of Alcohol Education within the Division of Alcoholism and Drug Abuse.

b) Meeting with the Director of Medical Student Education to determine the extent of alcohol education within the four years of medical school and identifying areas where alcohol education can be implemented or enhanced.

c) Meeting with substance abuse fellows to review and enhance the four-course substance abuse curriculum for the third-year psychiatry clerkship.

d) Establishing an elective on the alcohol detoxification program for fourth year medical students, psychiatry residents, and psychology interns/externs. This will include a lecture series based on the Alcohol Medical Scholars Program slide series.

e) Reviewing the substance abuse curriculum for the psychiatry residency, and identifying areas where alcohol education can be implemented or enhanced.

f) Developing a plan through collaboration with other participants in the AMSP to enhance alcohol education in the medical students and psychiatry resident curriculum based on identified areas of weakness.

g) Identifying other non-traditional learning opportunities such as a movie/lecture series, and a careers in medicine series to incorporate teaching about alcoholism including epidemiology, how to screen for alcoholism, and how to treat .

Marianne went on to some long term objectives:

h) Developing a lecture series based on AMSP slides/lectures on how to teach alcohol and drug abuse beginning July, 2000 with incoming substance abuse fellows at NYU.

i) Investigating the possibility of giving this lecture series to other fellows in the New York City area including Columbia University, Cornell University, Beth Israel Medical Center, as well as other programs.

j) Incorporating workshops into the annual meetings of the American Academy of Addiction Psychiatry, the American Psychiatric Association and the American Society of Addiction Medicine and other appropriate professional societies. The topic would be how to teach about alcohol and drug abuse, and it would be based on the above lecture series.

4. Beverly Taylor at Morehouse.

a) Using the facilities of Project Cork to review current education on alcohol at Morehouse.

b) Working with Cork and other programs to identify additional faculty with interest in addiction medicine, and helping them to develop courses.

c) Developing an eight-session, one month, fourth-year medical school elective focusing on alcoholism as part of an existing preventive medicine elective.

d) Developing a new outpatient elective that involves visiting and working with outpatient treatment facilities dealing with substance use disorders.

e) Developing round table discussions or stand alone lectures for the School of Social Work, Nursing, Theology, the Masters of Public Health Program, and for medical schools.

f) Working with existing courses at Morehouse to get alcohol lectures incorporated into family medicine, medicine, and rural medicine courses. The latter could be especially exciting, and involves developing a module related to alcohol dependence as medical students work with their preceptors in rural settings.

g) Develop at least one lecture as part of the graduate level training in preventive medicine, and for the courses on the noon conferences in family medicine and internal medicine.

h) In the more distant future, developing an elective on alcoholism for non-preventive medicine residents.

i) In the future, hope to be able to reach out to CME programs at Morehouse to incorporate alcohol education.

j) Also in the future, developing a two-day conference for physicians and other health care providers in the community focusing on alcohol.

5. Vania Modesto-Lowe at the University of Connecticut.

a) Developing a needs assessment as a first step. This will involve interviews with the Director of Medical Student Education and a member of the Medical Curriculum Committee.

b) In addition, a survey will be carried out regarding the medical students thoughts about what they believe they need to learn in the alcoholism field.

c) Developing a one-hour lecture for medical students on their psychiatry rotation.

d) Developing three additional lectures on comorbidity, pharmacological treatments in rehabilitation, and detoxification.

e) Developing a clinical elective focused on individuals with substance use disorders in prisons.

f) Developing a 12-lecture course on substance use disorders for psychiatry residents.

g) Developing an introductory course on substance use disorders as a medical student elective.

h) Developing a 12-week lectures series for psychiatry residents.

i) In the future it is hoped that a clinical elective rotation for medical students and psychiatric residents will be produced.

j) Evaluating how to develop an integration of teaching about alcoholism for fellows, residents and medical students.

k) Efforts will be made to reach out to fellows in various programs, with an emphasis on how to teach about alcoholism to medical students and psychiatric residents.

l) Working with the department chair to recruit faculty interested in substance use disorders and to enhance efforts of existing faculty.

6. Marty Hoiness at the University of Washington.

a) The needs assessment will incorporate an overview of efforts on alcohol education at all five sites across the five states served by the University of Washington Medical School.

b) As students from all of the five campuses come to the University of Washington during their second year, a nonclinical elective course on alcoholism will be developed to meet the needs of those students.

c) In the future, it is hoped that this nonclinical elective on alcoholism can be incorporated into the first-year program at each of the five sites via an interactive website program.

d) All third-year medical students will be expected to spend a minimum of a half day in an outpatient alcoholism treatment program as part of their psychiatry rotation.

e) All efforts related to alcoholism education will be evaluated for possible inclusion in clinical psychology programs.

f) A series of luncheon lectures will be developed, along with discussions of alcohol related issues in movies and books.

g) Exploring a medical student rotation to a dual diagnosis day-treatment program.

h) Exploring development of a clinical rotation for medical students to learn about alcoholism and related disorders in prison inmates.

7. Vijay Ramchandani at the University of Indiana.

a) The needs assessment will have to consider eight satellite schools across Indiana through which medical students receive their first and second year education.

b) Each satellite facility will also be surveyed to determine the best way of incorporating alcohol education into their programs.

c) Efforts will be made to include alcohol education in pharmacology, the Introduction to Clinical Medicine, and additional courses.

d) Efforts will be made to incorporate alcohol education into the third year clinical rotation in psychiatry. In order to do this, Vijay is establishing a working relationship with Dr. Chris Selzer, an MD clinician.

e) Working with Dr. Selzer, an effort will be made to develop a preclinical elective (perhaps eight to ten lectures) on alcoholism.

f) In the future, it is hoped that any web-based interactive courses on alcoholism developed at any of the other AMSP sites (e.g., the University of Washington) will prove to be useful.

H. The importance of efforts to evaluate the impact of the AMSP was stressed.

1. The efforts at evaluating the impact of our program are inherent in many of the issues discussed over the prior three days. Thus, each of the sites will be carrying out a needs assessment, many will consider evaluations of the desires of medical students, and efforts at evaluating changes in medical student knowledge have been incorporated into most, and perhaps all, AMSP programs.

2. An important part of our evaluation is to determine over the next four to five years how fourth year medical student opinions about the adequacy of their education in substance use disorders have changed.

3. Specific outcomes that can be evaluated include:

a) The quality and number of new lectures and slide copies developed.

b) The development of the website.

c) Monitoring the number of website hits, along with the results of surveys users must fill out before they download lecture copy or slide copy.

d) The requirement that each center document progress being made in each of the areas of effort outlined immediately above.

e) The requirement that each center track the number of students who have participated in programs developed through the AMSP.

4. A brief overview of some of the evaluation approaches is presented in Appendix D.

VI. The concluding session was held beginning at 7:00 p.m. on Friday, September 17th.

Over an informal dinner, members of the group had the opportunity of reviewing their goals, sharing their immediate plans, and establishing contact over the future months.

Marc Schuckit and Marcia Silcox will work to establish a conference call sometime shortly after the first of the year, 2000, and to schedule the next face-to-face meeting in approximately May, 2000.

Layout and design by Brian Klima