Meeting #18

San Diego, California

April 30 - May 3, 2008

Present at the meeting were Marc A. Schuckit, Susan Tapert, and Marianne Guschwan (Director and Associate Directors); Marcy Gregg (Administrator); Second-Year Scholars Gavin Bart, Larry Gray, and Anika Alvanzo; First-Year Scholars Tim Lineberry, Krishna Balachandra, Maritza Lagos, and Leslie Buckley; along with guests Ryan Trim, Shannon Robinson, and Steve Groban.

I. Wednesday evening, April 30th

The meeting began at 6:30 p.m. through an introduction of the scholars, guests, and spouses. Dr. Schuckit took the opportunity of reviewing some of his recent AMSP activities, reminded the participants of the goals over the next three days, and to work through some of the details of the agenda. The group continued the discussion over a working dinner at the hotel.

II. Thursday, May 1st

The morning=s activities began with a working breakfast where Marc Schuckit shared details of his AMSP-based activities while on sabbatical in South Africa. His major task was to work with the two medical schools in Cape Town (Stellenbosch and Cape Town University), a local research center, and about five regional hospitals in the area to enhance education about research regarding alcohol and drugs. This included lectures to medical students, two single-day seminars about how to lecture and develop careers, a review of recent developments in alcohol and drugs, and clinically-oriented seminars at five local hospitals, as well as the medical school. Dr. Schuckit worked closely with young faculty members at all of the institutions with the goal of helping them with their clinically-oriented research projects focusing on the relationships between alcohol and drugs on the one hand, and schizophrenia, anxiety, and depressive disorders on the other. Additional outreach included helping young faculty members looking at aspects of the fetal alcohol syndrome, epidemiology of alcohol use, issues related to methamphetamine problems in South Africa, prevention efforts, and studies of outreach and prevention regarding substance-related conditions.

The next morning session was also delivered by Dr. Schuckit who presented his lecture on AHow to Develop a Lecture,@ presenting modifications regarding using the same approach for developing a research paper, a grant, a presentation at Grand Rounds, etc. Here, Junior Scholars were asked for suggestions about how the presentations might have been modified to have helped them better prepare the lectures they were about to develop. The first time they had heard this presentation they were planning for their own presentations, but had not yet begun to work on them, so they had a different perspective during this session.

The major points made were then emphasized through a presentation of An Overview of Genetic and Environmental Influences in Alcoholism, a full lecture delivered by Dr. Schuckit. The group discussed how the presentation affected their understanding of the process of developing materials in a systematic data-based way, as well as underscoring some of the aspects of appropriate slides and delivery.

Dr. Larry Gray of the Department of Pediatrics at the University of Chicago Pritzker School of Medicine, Comer Children’s Hospital next presented his accomplishments at his University. Dr. Gray continues to represent the need for alcohol and substance use education at the University of Chicago with his participation in the Pritzker Initiative, which is a medical school-wide curriculum redesign that began in 2008. Dr. Gray will participate in two committee meetings during his final phase of AMSP. In addition, he has successfully completed the Developmental and Behavioral Pediatrics fellowship training in “How to Give a Lecture.” The first DBP fellow completed this training and recently demonstrated her increased lecture effectiveness at a national meeting in March 2008. Finally, Dr. Gray has benefited by the mentoring afforded by the AMSP experience, traveled to meet a senior researcher in his field, and was invited to prepare a chapter reviewing the contribution of ADHD to the development of substance use disorders across the developmental spectrum.

Subsequently, Dr. Gavin Bart of the Department of Medicine at the University of Minnesota Medical School reviewed his accomplishments over the prior months at that Institution. Dr. Bart continues to provide substance use disorder education at all levels. Since the last AMSP meeting he has recruited another addiction medicine faculty to his division. This has allowed increased presence of addiction specialists on the general medicine wards. The medical school internal medicine clerkship now has three hours of substance use disorder lectures. One third of the University of Minnesota medical students are exposed to these lectures. It remains difficult to increase the four hours of substance use disorder education in the first two years of the medical school curriculum. At the residency level, Dr. Bart continues to host internal medicine interns during their behavioral medicine rotation and he coordinates the psychiatry residents’ 16-hour rotations available at the HCMC addiction medicine program. Outside of medicine, Dr. Bart has provided lectures to the Minnesota House of Representatives Committee on Health and Human Services, the Minnesota Department of Human Services managers meeting, social work departments, and the Minnesota Bar Association. He has also designed a full-day symposium on pharmacotherapy for substance dependence disorders for the fall 2008 meeting of the Minnesota Association for Resources in Recovery and Chemical Health. This conference is attended by 1000 alcohol and drug counselors throughout Minnesota.

Next, Dr. Shannon Robinson, a clinician, scholar, and teacher in the Department of Psychiatry at UCSD Medical School and San Diego VA Medical Center reviewed some of her work based on skills learned through her participation as a guest at meetings of AMSP. Shannon updated how activities now include a rotation of pain fellows on the Alcohol and Drug Treatment Program, and an expansion of a rotation of Navy psychiatry residents on her teaching unit, with each of these complementing the ongoing efforts in reaching out and teaching about alcohol and drugs. Medical students also rotate for three weeks with two-to-three students per session, spending full time on the Alcohol and Drug Treatment Program, second-year residents rotate for two months, and fourth-year psychiatric residents rotate for six months to a year. Shannon shared a manualized group treatment approach regarding helping patients to handle pain syndromes, which she developed along with other members of the faculty at UCSD.

The group next turned to a working lunch during which issues related to career development were discussed. This session included questions relating to the optimal implementation of training awards from the National Institutes of Health (K-Awards); mechanisms for keeping up clinical service obligations while funded by training awards; decision processes required for planning the continuation of research and/or clinical obligations after training awards have ended; the challenges of setting aside time to read the literature, as well as to write papers; and setting overall priorities in use of time.

Following lunch, First-Year Scholar, Krishna Balachandra, presented his newly-developed lecture on the Integration of Treatment of Co-occurring Psychiatric and Substance Use Disorders. This was an excellent effort, and few changes will be required before this presentation can be loaded onto the AMSP website for use by teachers and scholars at other universities. The lecture style, clarity of slides, and flow of logic demonstrated through this lecture were exemplary.

The meeting adjourned at 2:30 in the afternoon with the scholars and their families on their own for the evening.

III. Friday, May 2nd

The group convened at 8:00 a.m. over a working breakfast with the opportunity of hearing the lecture by Second-Year Scholar, Gavin Bart regarding the Recognition and Treatment of Obesity. This was a fine and effective lecture that generated a lively discussion regarding issues centering on slides, the application of the information to a range of audiences, and many compliments on the fine delivery style. Dr. Schuckit emphasized that with only a modest amount of work, this lecture could be easily modified for another audience. He asked Dr. Bart to re-present a similar lecture on Saturday, but this time limiting himself to 20 minutes and focusing on a group of professors at a university who are taking part in a weight reduction program.

Next, Dr. Krishna Balachandra presented his report from the University of Western Ontario. Dr. Balachandra continues his commitment to teaching undergraduate, post-graduate, and psychiatrists regarding substance use disorders (SUD). He completed his survey of the undergraduate medical curriculum to determine the amount of time devoted to substance use disorders, and received acknowledgment from his Dean and Chair of the Department of Psychiatry for his participation in the Alcohol Medical Scholars Program. He was able to introduce a movie related to substance abuse themes into the medical student psychiatry movie night, and continues to give the SUD and brief motivational intervention lectures. Dr. Balachandra’s current project involves a collaborative effort with the Information Technology Resource Centre at his university to develop case-based learning for medical students. At the post-graduate level, he lectures to final-year residents on SUDs as part of their preparation for taking the national board examinations in psychiatry, as part of a national review course supported by the University of Western Ontario. He was invited by psychiatry residents to give an additional lecture on toxidromes. Dr. Balachandra also contributes to educating psychiatrists by being part of the faculty providing a Fundamentals of Addictions course at the Canadian Psychiatric Association annual meeting. Later this year, he will transition from the University of Western Ontario to the University of Alberta.

Following this presentation, First-Year Scholar, Dr. Timothy Lineberry from the Mayo Clinic College of Medicine presented his lecture on Substance Use Disorders and Suicide. This was a well-focused lecture, highly appropriate for the medical student audience to which it was aimed, and delivered in an excellent and effective style. The group discussed various details regarding specific issues raised, as well as well as the slides, and Dr. Lineberry was encouraged to polish off minor remaining details be certain that the lecture was loaded on the AMSP Website within the next month.

First-Year Scholar Dr. Leslie Buckley of the University of Toronto next presented her activities at her University. She began by meeting with the Dean of the Medical School to discuss what is currently offered medical students regarding alcohol and drug education, and how things might be improved. Through these discussions, she became interested in optimal teaching styles and what might be done to help her University (and the field in general) enhance education through an interactive process. In addition, she interacts with medical students in their first two years, and is attempting to expand education to medical students in their third and fourth year, adding a three-hour lecture to their ongoing activities. Dr. Buckley helped develop an Addiction Psychiatry Education Committee to outline curriculum models for each year, and to try to initiate new ways of enhancing the delivery of the materials being developed.

Anika Alvanzo of the Virginia Commonwealth University Medical Center next presented her lecture on Intimate Partner Violence and the Role of Alcohol and Drugs. This, too, was a fine lecture and was well delivered, with the slides contributing effectively to the presentation. After a discussion of several details, Dr. Schuckit emphasized how similar material could be delivered to yet another audience using a totally different time frame for presentation. Dr. Alvanzo agreed to return to her lecture the following day but now focusing on physicians about to begin their new jobs in Emergency Departments, where she was only given 10 minutes to cover what she felt was the key material. The group discussed some of the approaches that might be used, and looked forward to Dr. Alvanzo=s subsequent presentation.

The next topic was the plans for the AMSP reunion to be held in conjunction with the Research Society on Alcoholism meeting in San Diego beginning Saturday, June 20th. The AMSP meeting, therefore, could begin the Wednesday before RSA (June 17, 2009), or might be slated to begin Wednesday at RSA closes (the evening of June 24th). In addition to the usual First and Second-Year Scholars as participants in this meeting, a letter will be sent to all graduates of AMSP inviting them to participate as part of the AMSP audience and discussion sessions themselves. For those graduates interested in attending, but who do not have financial resources to help them come to San Diego, as many as AMSP can afford will be invited to attend at our expense. The RSA meeting will also be used as an opportunity to highlight activities of AMSP. One idea is to propose an RSA roundtable of as many appropriate graduates as possible to discuss various approaches for enhancing alcohol and drug education in medical school settings. A second possibility is to highlight the research developments of several (up to four) scholars who have graduated from our program and who have gone onto develop a successful research careers as a seminar at the RSA. A third proposal is to make a poster for one of the poster sessions at RSA, a step that can help with appropriate recruitment in the future.

The noontime career development discussion then focused on various roles for researchers and clinical scholars at medical schools; discussions of the development of DSM-V; assets and liabilities and appropriate timing for Junior Scholars to begin to ask to serve on national committees and review groups; and problems in clinical practice with the application of careful diagnosis to help guide treatments, as well as thoughts on what can be done to improve the situation.

Following lunch, Dr. Anika Alvanzo presented the educational efforts she was able to develop at Virginia Commonwealth University Medical Center. She has initiated a lunch-time Addiction Seminar Series. Prior to the series she had the opportunity to meet with Dr. Ike Wood, who was at the time Associate Dean of Student Affairs and has since been appointed as Dean of Undergraduate Education. He thought the groups were a good idea and asked for a copy of the documentary series for potential use in other settings. Dr. Alvanzo was happy to provide him with an extra copy of the documentary. The Addiction Seminar Series began this semester, were held monthly from noon to 1:00 p.m., with light refreshments being provided. They were marketed specifically to the first- and second-year medical students but were open to all medical students. The series were co-facilitated by Dr. Michael Weaver, Director of the Substance Abuse Consult Service at VCU. The last seminar was scheduled for the same week that Dr. Weaver was lecturing on substance use disorders to the M2 medical students. Portions of the HBO documentary, “Addiction,” were shown and an informal discussion followed. The seminars were well received by the students who participated. As Dr. Alvanzo will be leaving VCU, she has left a copy of the documentary series with Dr. Weaver in hopes that he or one of his colleagues would be interested in continuing the seminar series.

As stated above, Dr. Alvanzo will be leaving VCU and will be joining the faculty at Johns Hopkins University. She has taken a position as the Medical Director of the Broadway Program, an intensive outpatient substance use disorder treatment program, located on the downtown campus. In addition, she will continue her research on psychological trauma and substance use. Dr. Alvanzo is the recipient of a 2008 College on Problems of Drug Dependence Travel Award and has a manuscript that will be published in Substance Use and Misuse.

Subsequently, First-Year Scholar Maritza Lagos of Michigan State University presented her accomplishments at her University. Her plan was reviewed and approved by Michael R. Liepman, MD, Director of Research & Clinical Professor, Dept. of Psychiatry, Michigan State University/Kalamazoo Center for Medical Studies. These past six months she used a noon meeting to describe AMSP and her role as a scholar and showed the residents and attendings the Web page and encouraged them to use it for educational purposes. In this midst of this process she became the Psychiatry Clerkship Director where she implemented the lecture on Substance Use Disorders with emphasis on alcohol abuse and dependence for the third-year medical students. In concert with Dr. Liepman, she has also developed and delivered lectures on substance use disorders for the new residents starting in Psychiatry. Also, the second-year residents have borrowed the AMSP lectures to prepare topics for their own use. The goal is that these topics will be initially discussed with the clinical supervisor and then delivered to the medical students during the week of Substance Use Disorders rotation. The hope is that the residents will learn by teaching and the medical students will benefit by reviewing these lectures on an individual basis.

The final activity on Friday afternoon ended with the presentation by Dr. Timothy Lineberry regarding alcohol and drug education at the Mayo Clinic College of Medicine. Dr. Lineberry reported on progress made at Mayo Clinic in Rochester, MN. The observed clinical skills examination case this year will involve a patient with a substance use disorder. He has also surveyed other residency and fellowship programs in the Mayo Graduate School of Medical Education regarding their coverage of alcohol and addictive disorders. There is strong interest in these programs for increasing the amount of training provided. The second-year psychopathology course will continue with strong focus on substance dependence. Dr. Lineberry is also Co-Chair of an inaugural Continuing Medical Education (CME) course sponsored by the Mayo School of CME, “Acute Care Psychiatry,” in Chicago, October 2008. This course will weave alcohol abuse, dependence, and other substance use disorders into the educational blocks. He also noted continuing progress academically and pointed out the first-author publication in Schizophrenia Research of a medical student, Rebecca Capasso (currently training psychiatry at NYU), whom he has mentored since the last AMSP meeting.

The group then adjourned after making plans for the working dinner (with spouses) to be held that evening.

IV. Saturday, May 3rd

This last day of the AMSP meeting began with the presentation by First-Year Scholar, Dr. Maritz Lagos of her lecture focusing on the Recognition and Treatment of Opioid Dependence. This was an excellent lecture, with very appropriate slides. There were suggestions from the group regarding expanding the information relating to treatment issues, and making room for this within the time frame of the presentation by decreasing some of the data offered on brain mechanisms of opiate effects. Dr. Lagos will incorporate these changes in modifying her lecture and offer the final version within a month. All scholars were impressed with the quality of the work.

Dr. Leslie Buckley, a First-Year Scholar from the University of Toronto, next presented an early version of her lecture focusing on Medical Student Education. The core of the work involved incorporating data-based educational tools into the medical school curriculum, and she used education on substance use disorders as the example. The delivery was excellent, the material offered of great use to medical educators, and the slides covered important information. Suggestions were made regarding the possibility of relating more directly material already posted on our website by Dr. Gail Rose (separate topics but a cross reference would be useful), as well as some additional work to clarify the slides.

Dr. Larry Gray of The University of Chicago Comer Children’s Hospital next addressed the challenge given to him by Dr. Schuckit to take his original lecture on Attention Deficit Hyperactivity Disorder (ADHD) and modify it to a 30-minute presentation focusing on teachers for exceptional children. This was a beautiful demonstration of how a longer lecture developed for one audience can be modified for another. The discussion then focused on what Dr. Gray would do if he only had 10 minutes; only five minutes; etc. The answer rests with being able to focus on the major points that might be appropriate to be made during that period of time.

Our final presentations of the morning were the shortened version of the Obesity Lecture originally developed by Gavin Bart, as well as the shortened lecture by Dr. Anika Alvanzo. As with Dr. Gary, these were superb demonstrations of how slides can be modified for specific audiences; the areas of emphasis can be identified; and a basic lecture once developed can be delivered to a variety of audiences using a range of time frames.

Additional topics were then reviewed toward the end of the morning=s session:

1. Marcy Gregg presented an update on developments for the AMSP Web site. March and April this year demonstrated the largest number of visits ever observed at our website, and throughout the year the number of downloads and the time spent on our site were remarkably higher than those ever seen in the past. An example is the fact that visitors spent 334 hours per month this past year, compared to 227 hours per month in the prior year. Several suggestions were made regarding the additional improvements that can be added to the website including a brochure on motivational interviewing (to be done by Dr. Guschwan), and the possibility of adding a video of the lecture on How to Give a Lecture.

2. The next meeting of AMSP will begin on October 15, 2008. Marcy Gregg will look into the possibility of booking the Surf and Sand Hotel in Laguna Beach.

3. The Spring 2009 AMSP meeting will be in Del Mar, California (a suburb of San Diego) beginning on Wednesday, June 24th.

4. The next Conference Call for AMSP will take place on July 10, 2008 at noon (San Diego time - 3:00 p.m. East Coast time). All First- and Second-Year Scholars will need to attend this one-hour conference call to wrap up our year.

5. First-Year Scholars are reminded that all lectures must be in the San Diego office by June 2, 2008 to be loaded on the Web site.

The group adjourned at 12:15 p.m., with all participants wished a safe and swift return home.

Marc A. Schuckit, M.D.

Layout and design by Brian Klima