Meeting #20

New York, New York

April 1 - 4, 2009



Present at the meeting were: Marc Schuckit (Director), Susan Tapert and Marianne Guschwan (Associate Directors), Tim Lineberry and Krishna Balachandra (Second Year Scholars), Michelle Lofwall, Joanna Bukcek, John Wryobeck, and Laurie McCormick (First Year Scholars), Jill Williams (Graduate Scholar), and Marcy Gregg.



I. Wednesday, April 1st

The group gathered in the lobby of the Park Lane Hotel. The schedule for the following days of work was presented and scholars and significant others were introduced. The AMSP scholars then proceeded at the restaurant Abboccado.



II. Thursday, April 2nd

The group convened at 8:00 a.m. for a working breakfast. The meeting began with a review of the current status and future of AMSP, establishing the schedule for the next three days, and an assignment of presentations for the second-year scholars.

The majority of the morning was spent with Marc Schuckit giving an overview of steps that are useful in developing lectures, papers, and grant preparations. The goal was to get feedback from both first and second-year scholars regarding steps that might have been taken to improve the training of first-year scholars as they were beginning to prepare for their lectures. One of the suggestions was the importance of letting new scholars know the amount of detail and organization required for AMSP lectures and, therefore, for academic lecturers across the world to use. This requires more detail than what the average teacher assumes to be part of an outline process.

Marc then demonstrated the application of the lecture format to a new presentation developed for the 40th anniversary of the medical school at UCSD. This then generated additional discussion of lecture formats and adaptations of the approach for each of the scholars.

A working lunch focused on the discussion of career challenges. Topics included how to control time limits, optimize relationships with key personnel in the departments, and guidelines for when a junior faculty member can say yes vs. no regarding requests.

The first day=s session continued with the presentation by first-year scholar, John Wryobeck, of his lecture on Motivational Interviewing. This was a superb lecture that was delivered in an impressive style. The group had several suggestions regarding small issues of organization and focus on the most important material.

The Thursday meeting ended with a discussion of the material presented that day as well as the plans for Friday. Each member of the group was then on his or her own for dinner that evening. The schedule for the next day was reviewed.



III. Friday, April 3rd

The day began with a presentation by Michelle Lofwall, first-year scholar, of her lecture on Opioid Dependence and Pregnancy. This was an excellent lecture, well organized, well presented, and with effective slides. The discussion branched into how decisions were made regarding what to include and to exclude, as well as the way in which the lecture could be adapted in different circumstances.

Susan Tapert, Associate Director, next demonstrated a lecture where she presented her complex and impressive research program to research administrators at her university. This exemplified how any lecture can be adapted for almost any audience, as long as the presenter keeps the needs of the audience in mind.

Krishna Balachandra, a second-year scholar, next presented his report of the developments over the prior months at his university. At the undergraduate level, he hopes to become the faculty moderator for a medical student-initiated Website called QuizMD. This is a Website for medical students to answer questions regarding various specialties. He also has an opportunity to become Site Director for Medical Student Teaching at his hospital and to take over the Summer Externship Program, where interested second-year medical students perform electives. At the post-graduate level, he is designing a one-month rotation for PGY1 psychiatry residents, and lecturing to PGY2 residents on co‑occurring disorders. He has submitted questions to the Royal College of Physicians and Surgeons of Canada (RCPSC) for board exams that graduating residents must complete, and he volunteers to help foreign medical graduates to prepare for the RCPSC examinations. Dr. Balachandra has been invited to attend government committees, representing his University, as the province of Alberta integrates addiction and mental health.

Marc then updated the group on the progress for DSM-V. The process and tentative results were contrasted with DSM-IIIR in 1987, and DSM-IV in 1990. While no final decisions have been made, a discussion ensued regarding the decision process to be followed.

Jill Williams, a graduate scholar, next presented an early draft of her scientific presentation for the Society for Research on Nicotine and Tobacco Meeting. This was a fine presentation with many challenges regarding how to take a complex set of scientific developments and make them accessible to a scientific audience. A number of easy to include suggestions were made regarding the structure of the lecture and specific aspects of the already excellent slides.

Tim Lineberry, a second-year scholar, next presented the recent developments regarding alcohol and drug education related projects at his university. Tim has taken the position as Subject Matter Expert for the Department of Defense for Suicide Prevention. He also continues as Secretary of the American Association of Suicidology and recently gave a plenary lecture on research on suicide assessment in inpatients at the 5th Aeschi Conference on Treatment of Suicidal Individuals in Switzerland. He will be part of a plenary presentation for the American Association of Suicidology on suicide in schizophrenia at their 2009 Annual Conference. Tim noted publishing two manuscripts on smoking and suicide, and suicide risk assessment, as well as an editorial on inpatient suicide prevention; and his book chapter on treatment of suicidal inpatients has been accepted. He continues to be course director of the Psychopathology course and active in medical student education in the third-year clerkship B teaching a session on substance use assessment and treatment B and provides support for the first-year course in development. Along with his course co‑director, Mark Frye, M.D., he was awarded the Innovation in Continuing Medical Education Award from the Mayo Clinic College of Continuing Medical Education.

Laurie McCormick, first-year scholar, next presented her developments at her university regarding alcohol and drug education. She has worked with 4 other faculty members in her department that have an interest in improving medical student education. They discussed restarting the Doctors Ought to Care (DOC) Program for medical students to go into the community to teach elementary, junior high and high school students to promote healthy lifestyles, which includes education about drugs and alcohol. Dr. McCormick contacted 4 community leaders for the medical students who have agreed to arrange a working lunch to discuss this issue. She spoke to Dr. Livingston who directs the DOC program at the University of Wisconsin (http://doc.uwmedstudents.com/) and plans to borrow from their organization of the program and she is looking for pathological specimens (e.g. a smoker’s lungs and a cirrhotic liver) that were used when the DOC program used to be at the University of Iowa approximately 10 years ago. Three of Dr. McCormick’s colleagues have agreed to be mentors for the DOC program at the University of Iowa. She obtained a list of all lectures given to medical students during their 4 years of training and identified an area for more alcohol-related teaching to be done in the 2nd and 3rd clinical experience for students. A 3rd year med student patient-based assessment module will be modified to incorporate a case of a patient who is either alcohol dependent or has comorbid mood and alcohol issues. The 3rd year med student rotation on the chemical dependency service now includes information about the AMSP Website and students are starting to lead group therapy sessions during the week rotation there. Laurie volunteers at the psychiatry free medical clinic once every 6 months and is one of the clinical skill interview evaluators for psychiatry residents in addition to evaluating medical students and residents on rotation during her clinical assignments.

Krishna Balachandra next presented a brief version of his lecture on The Integration of Alcohol, Drug, and Psychiatric Services, but this time as it would be delivered in a 20-minute lecture to hospital administrators. Once again, this was an impressive demonstration of the modification of a 45-minute medical student lecture into an effective format for non scientist.

The luncheon regarding career development next focused on the evaluation process for promotions. Further discussion related to how papers are developed for publication. The noon time discussion then morphed into the potential future and challenges for addiction medicine and addiction psychiatry, along with discussions of the future of the national alcohol and drug institutes.

Laurie McCormick, a first-year scholar, then presented her lecture on Eating Disorders and Alcoholism. The very effective lecture was loaded with important information, but might be a bit challenging for the average medical student to utilize. Therefore, the lecture format was used as a discussion of how one first focuses on the major point appropriate to the audience; develops the lecture material and slides for that single most important topic; re-evaluates whether additional time is available; and then goes on to develop second and perhaps third-level goals.

The Friday meeting adjourned at 2:30 p.m. with a reminder that the group would reconvene that same evening at Restaurant Remi for further discussion.



IV. Saturday, April 4th

The meeting began with the presentation by first-year scholar, Joanna Buczek, of her lecture on Alcohol Withdrawal Syndromes in Special Populations (Surgical Patients and the Elderly). This was a superb lecture with an excellent and detailed outline, as well as highly effective slides. The more detailed material, however, might be a bit challenging for medical students to appreciate, and a discussion ensued regarding how to cut back on the level of detail, while maintaining the emphasis on the major components. The lecture was reviewed slide by slide with a number of suggestions regarding how the material could be simplified for the usual medical audience.

Marcy Gregg next presented an overview of the performance of the AMSP Web site during the prior year. This is very important because the Web site is the vehicle through which AMSP reaches out to medical education at additional institutions. Briefly, Marcy was pleased to report that in the prior calendar year there had been almost a half million hits, with almost 1100 hits per month, and a mean of approximately 3 hits per visit. During that same time period, there were 200,000 page viewings, with an average of almost 500 per day. Unique visitors included almost 75,000 individuals. It was interesting to note that most of the visitors came directly to the AMSP Web site, rather than through a search engine B indicating that the Web site is becoming well known among educators who directly seek out AMSP for information.

Tim Lineberry next presented a 20-minute version of his original 45-minute lecture on Alcohol and Suicide as if it were to be delivered to primary care physicians on their first day in a clinic. The major focus of this revised presentation was on how to identify alcohol and drug use disorders, but a sub-theme was the impact that such recognition and treatment can have on depression and suicidal behavior.

Michelle Lofwall, first-year scholar, next presented her report on developments in alcohol and drug education at her university. She has given several lectures in the area of substance use disorders, including grand rounds to the OB department about opioid dependence treatment during pregnancy with a focus on how to treat pain during delivery and postpartum; and two new 50-minute didactics to neurology residents on screening and brief interventions for substance use disorders as well as prescription opioid abuse/dependence treatment. Dr. Lofwall revised and gave two 50-minute lectures to second-year medical students about alcohol and illicit drug use disorders during their psychopathology course. She gave a 75-minute lecture to physician assistant students on substance use disorders; this is new to their curriculum. Dr. Lofwall met with the curriculum director of the medical student psychiatry course and was successful in gaining another 1 hour of teaching on substance use disorders. She has been invited to teach family medicine residents about opioid dependence during pregnancy at an outside community hospital in KY (St. Elizabeths) in June, and to give a half-day symposium on opioid abuse/dependence at the KY School for Alcohol and Drug Studies (mostly counselors, therapists, social workers attend this) in June 2009. Dr. Lofwall was chosen to become a Physician Clinical Support (PCSS) Mentor B a national program of physician mentors, sponsored by the Substance Abuse and Mental Health Services Administration, aimed at providing free mentorship to physicians who prescribe buprenorphine for opioid dependence. She is course director for a CME in May 2009, which will teach physicians (primarily non-psychiatrists) best practices in office-based opioid dependence treatment that utilizes buprenorphine in order to decrease the risk of buprenorphine diversion and misuse.

Joanna Piechniczek-Buczek, first-year scholar, next reviewed the developments at her university regarding alcohol and drug education. Dr. Buczek noted that she may move to Boston University’s major teaching where she hopes to continue medical student rotations regarding substance use disorders, pain management, and consultation services. She continues to be involved in enhancing education on alcohol and drugs. With regard to medical students, she met with the director/coordinator of medical student education in the psychiatry department and discussed substance use disorders teaching. In the current curriculum most topics are taught, although smoking cessation seems not to be well covered, so the potential for developing a lecture in this area was discussed. She will remain involved in teaching the ICM course to 1st-year med students in the new academic year. She does formal and informal teaching to 3rd-year medical students who rotate through her clinical site. She focuses on covering a variety of substance abuse topics and cases during the rotation. For psychiatry residents she gives biannual talks on Dual Diagnosis and Elderly Substance Abuse to PGY 1 residents. With regard to fellows, she taught “Management of acute and chronic pain in opiate-dependent patients” to the psychosomatic fellows. Within the hospital, she discussed substance abuse issues and pain management in the elderly in the case conference format.

John Wryobeck, first-year scholar from the University of Toledo, then reviewed developments in alcohol and drug education at his university. He reported that he is currently preparing a 100-minute lecture to be given to students in the Behavioral Science course. He has been told he will have additional presentation time in next year=s class and is being encouraged to develop internet-based material (online presentations, videos, interactive exercises) on alcohol use disorders for students to use. He will be presenting Motivational Interviewing to Family Medicine physicians and residents, and how it can be used with patients with substance use disorders. He continues to assess the alcohol education that is taking place across the four years of medical school and has been asked to present his findings to the faculty with recommendations in the Fall of 2009.

Associate Director, Susan Tapert, next re-reviewed approaches to the optimal use of PowerPoint. After a brief primer on the basic aspects of PowerPoint, most of the time was spent dealing with the effective use of animation.

The meeting ended with a review of important new developments, as well as the graduation of important scholars and Associate Directors. This included:

1. Marc and Susan reviewed the assets of the Research Society on Alcoholism and the CPDD meetings. Members of AMSP were encouraged to come, with a notation that, historically, current and graduate scholars get together for breakfast at each of the RSA meetings.

2. The group established the time for the next conference call of all current junior and senior scholars. This will be Tuesday, July 7th, at noon San Diego time, 3:00 p.m. East Coast time.

3. The next meeting of AMSP will take place (in all probability) at the Mauna Kea Resort on the Big Island of Hawaii on Wednesday, October 7, 2009 at 5:00 p.m. (scholars were reminded of the importance of arriving well before the start time), and ending at 11:00 a.m. on Saturday, October 10, 2009. The resort, schedule of meetings, and goals were reviewed. Scholars were encouraged to make their airline reservations as soon as the decision regarding the venue for the meeting is definitively established.

4. Marc announced several developments regarding the future of AMSP. First, he is taking the funding made available for calendar year 2009, and spreading the resources as best as possible into 2010. Therefore, there will be at least one 2010 meeting; he is recruiting at least 4 new scholars; and he hopes that there is enough money available for two or three meetings in 2010. Two scholars have already been chosen, and letters have been sent out, as well as telephone calls made to chairs of departments regarding recruitment of the final two scholars who will attend (among the four first-year scholars) the Hawaii meeting.

The graduation ceremonies for the second-year scholars and the Associate Directors, along with handing out of plaques, was the final agenda item for this meeting. Both Associate Directors, Marianne Guschwan and Susan Tapert, have become linked to many additional activities at their universities. Therefore, they are only able to attend occasional AMSP meetings. Marc presented plaques to both of them with much appreciation for all of their work over the years. At least one graduate scholar will be invited to each of the additional meetings to help teach on a rotational basis, but both Marianne and Susan will be sorely missed.

The two current active senior scholars, Krishna Balachandra and Tim Lineberry, were both given plaques for graduation, as well as many thanks for their current activities. It is very, very much hoped that the additional senior scholar, Maritza Lagos, who has been unable to attend meetings this year because of illness, will be available as a second-year scholar to attend the October 2009 meeting in Hawaii.

Finally, but perhaps, most importantly, the entire group expressed their appreciation to Marcy Gregg. She is the guiding light and organizer for all of our meetings, and every participant is deeply grateful for her warmth, dedication, and her efforts on our behalf. The group also expressed their thanks to Marc for his outstanding mentorship and inspiring leadership.

The meeting adjourned at noon on Saturday, April 4th, with good wishes for a safe trip home, a reminder of the conference call for all current first and second-year scholars, and enthusiasm regarding the get together with the soon to be second-year scholars and the new group of first-year scholars in Hawaii in October.

Marc A. Schuckit, M.D.

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