Meeting #21

Mauna Kea Beach Hotel, Kohala Coast, Hawaii

October 7 - 9, 2009

Present at the meeting: Drs. Laurie McCormick, Joanna Piechniczek-Buczek, John Wryobeck, Michelle Lofwall (all second-year scholars); Drs. Jodi Prochaska, Lanier Summerall, Anna Lembke, Meg Benningfield, Marcy Verduin (all first-year scholars); Dr. Gavin Bart (graduate scholar); Dr. Marc Schuckit (Director); and Marcy Gregg (AMSP administrator)

I. Wednesday, October 7

The group met in the lobby of the Mauna Kea Beach Hotel resort where Marcy Gregg and Marc Schuckit introduced all first- and second-year scholars, noted that Gavin Bart would be acting as assistant director for the meeting, and reviewed the location of each session as well as the agenda for the entire meeting itself. The group then retired for a working dinner at Brown’s Beach House restaurant, located at the Fairmont Orchid Hotel.

II. Thursday, October 8

The meeting began at the Mauna Kea Beach Hotel resort with a working breakfast at 7:30 am. First- and second-year scholars were reminded that because of certain road closures on Saturday, everyone would be working longer days on Thursday and Friday to make up the total number of hours necessary for a successful AMSP meeting. However, individuals who needed to fly back to the mainland would be able to leave as early as necessary on Saturday morning.

The morning progressed to introductions around the table, where each member also noted his/her background and area of work. The group discussed the goals of the meeting and the necessity of selecting appropriate lecture topics for first-year scholars, as well as assignments of second-year scholars (along with Gavin Bart) as mentors.

The majority of the morning was spent discussing how to organize data, develop slides, and place this information into context for lectures, papers, and grant applications. Marc Schuckit presided by giving two lectures: first, demonstrating on how to give a lecture, and second, delivering a talk (accompanied with slide copy) on the genetics of alcoholism. Both lectures served as examples of what had been taught earlier in the morning.

A working lunch then focused on career development issues. These included the appropriate way that a junior faculty member can decide which new tasks to accept, how to recognize when one needs to say no regarding requests within the department, issues related to promotion, and how to balance home and work lives.

Michelle Lofwall, second-year scholar, then presented her lecture regarding the recognition and treatment of opioid dependence during pregnancy. This was an excellent presentation that demonstrated effective slides, a fine level of organization, and an impressive delivery style. The group then discussed the specific slides, the methods through which they were developed, and how decisions were made regarding what to include and exclude in the presentation.

John Wryobeck, also a second-year scholar, presented on Motivational Interviewing. This too was an excellent lecture developed by a second-year scholar and resulted in a wonderful opportunity to emphasize how different presentations can incorporate the same basic stylistic issues demonstrated by Marc Schuckit’s lectures from earlier that morning.

Subsequently, Michelle Lofwall, M.D., Assistant Professor of Psychiatry and Behavioral Sciences at the University of Kentucky (UK), gave her update of medical education on alcohol and drug use disorders over the last six months. She has served as the course director and developed the curriculum for a new continuing medical education (CME) course titled “Buprenorphine Diversion and Misuse: How to Protect Your Office-based Opioid Addiction Practice.” This 4-hour CME was conducted in Johnson City, Tennessee, on May 9, 2009, and in Milwaukee, Wisconsin, on May 26, 2009. It is now available online for CME credit. Dr. Lofwall was newly appointed to UK’s medical school curriculum committee and has been able to secure an additional hour of medical student teaching in the area of substance use disorders. She has continued to teach three hours of didactics to psychiatry residents and two hours of lecture to medical students in this topic area over this past 6-month time period. She also has two senior psychiatry residents working with her on a research project in the area of prescription opioid dependence.

Dr. John Wryobeck also reviewed the developments from the past six months at the University of Toledo Medical School. He reported that he had two hours of didactics on substance abuse with first year medical students this past year and will have a total of four hours in the next year. He provided a grand round presentation to family medicine on motivational interviewing and will be providing a one hour substance use presentation to emergency department residents in the spring. In the process of completing a survey of the alcohol and drug addiction educational opportunities within the medical school, he spoke with key faculty and clerkship training directors. There is general interest in improving education/training in this area — particularly if it is part of a broader health behavior management initiative (smoking, diet, physical activity, treatment/medication adherence). It was determined that in the four years of education, their medical students receive about seven hours of education in addiction. He has written a report of his survey results with some preliminary recommendations and awaits a response from the Director of Curriculum Development.

The meeting progressed to an overview of potential topics by first-year scholars, hand-outs of activities relevant to medical schools, and a general discussion of issues that can be learned through AMSP as well as goals for the upcoming days.

Marcy Gregg, AMSP staff, next presented an overview of recent developments for the AMSP Web site. It is important to note that the website was thoroughly redesigned this past year. The result has been a marked increase in the number of website visits and, we hope, effectiveness of the material being developed. During the nine months between January 1, 2009, and September 30, 2009, the website had 472,000 hits, with an average of almost 2,000 hits per day, an increase from about 1,100 hits per day in 2008. There were almost 62,100 visitors during those nine months, and these individuals came from 79 countries. The most common sources of visits were the United States, the United Kingdom, Canada, and China, but all continents were represented. Among the most commonly downloaded files were those regarding medical problems, overviews of diagnosis and treatment, issues related to substance problems in athletes, psychopharmacological approaches to treatment, and important issues related to spirituality. Once again, we can say that the website has been a very important source of our ability to reach out to clinicians, researchers, and individuals with more personal interests in alcohol and drugs throughout the world.

The meeting adjourned at 4:30 pm with plans to reassemble at 8:00 pm at Monette’s Restaurant within the hotel for a working dinner.

III. Friday, October 9

The meeting began at 7:30 am with a lecture by second-year scholar Joanna Piechniczek-Buczek regarding the treatment of alcohol withdrawal syndromes in surgical patients and the elderly. This excellent lecture and fine presentation led to a discussion of how one can optimize the delivery of the information to an audience while still coming across as a dedicated and interested clinician. One of the issues that arose is how one can control the speed with which one speaks by imagining that the audience consists primarily of non-native-English speakers and recognizing that words and phrases need to be carefully enunciated. The clear divisions of the lecture also emphasized the fact that the material could be delivered in a shorter format focusing on either surgical patients or the elderly. In addition, the mode of presentation was an excellent example of how material can be carefully summarized within each section before the next subsection begins.

Second-year scholar Laurie McCormick next demonstrated her lecture on eating disorders and alcohol use disorders. This was a fine presentation where Laurie incorporated several video clips, an addition that led to a discussion of how these can be effectively delivered as part of the PowerPoint presentation, as well as the assets and liabilities of video clips in specific lectures. The presentation also offered a discussion of some of the important aspects of animation during presentations. Furthermore, as occasionally happens, the attempt to combine two topics (in this instance, eating disorders and alcohol use disorders) sometimes works smoothly and sometimes does not, but it is difficult to know how such a lecture will progress until one attempts it. Again, this lecture is an excellent addition to our website.

Joanna Piechniczek-Buczek, second-year scholar, then presented her report on the developments of her university. She continues to make efforts to get involved in enhancing medical students’, residents’, and fellows’ education at Boston University School of Medicine. In the past few months she has been involved in the following activities for medical students and residents: teaching Introduction to Clinical Medicine classes for first-year medical students where they learn how to adequately ask questions about substance use/abuse during the interview with patients, and teaching third-year medical students rotating through her academic site about bedside assessments, brief interventions, and treatment referrals. Dr. Buczek plans to reach out to medical students’ education coordinators from other disciplines (internal medicine, family medicine) and discuss further opportunities to advance substance abuse education among medical students and residents at BUSM. With regards to addiction psychiatry and psychosomatic fellows, she coordinates addiction psychiatry fellow rotations at her teaching site with regards to treatment and assessment of elderly substance misusers and treatment of substance withdrawal in medically ill populations. Finally, Dr. Buczek has revised her presentations and PowerPoints for her seminars on “Treatment of Pain in Opioid-Dependent Patients,” “Substance Abuse in the Elderly,” and “Delirium and Dementia” to be consistent with AMSP standards.

Laurie McCormick, second-year scholar, next presented her AMSP related developments at her university. Over the past year, Dr. McCormick has enhanced education on alcohol and drugs at her medical school, the University of Iowa College of Medicine, through a number of ways. The first is that she had contacted two of the psychiatrists in her department who are involved with the chemical dependency service at the hospital and neighboring VA to ensure that they knew about AMSP. They both now have third-year medical students learn a lecture of their choice from the AMSP website and teach it during a group session with patients in the intensive outpatient chemical dependency service. In addition, Dr. McCormick has contacted the Medical Student Ambassador Program (MSAP) at her university to introduce the “Doctors Ought to Care (DOC)” program. The medical students of MSAP have already started incorporating some of the content of that program with their outreach program to educate children and adolescents in elementary, junior high, and high school classrooms. Next year, the MSAP will more fully incorporate DOC lectures, which include alcohol and substance abuse issues. The Dean of the College of Medicine was pleased to hear this as the college is looking for ways to encourage more local students to apply to medical school. The medical students see the DOC program as a way to do more outreach and public health prevention. Lastly, Dr. McCormick has worked with several of her colleagues at her university to make sure there is an adequate number of alcohol and substance abuse lectures, and she and the two psychiatrist who work on the chemical dependency service have found a way to incorporate a 30-minute patient based assessment module for third-year medical students to get an interactive lecture on how to deal with a patient with alcoholism.

Graduate scholar, Gavin Bart, next gave a very different type of lecture demonstrating his efforts to persuade administrators to incorporate brief interventions for substance use disorders in their clinics. The lecture was deliberately focused on “selling” a viewpoint, and in demonstrating how much information can be delivered in a very effective format in only 15 minutes.

The group then progressed to a working lunch with a discussion of career development issues. Among the topics were how and when to ask for raises in salary, how to begin to evaluate what your appropriate level of pay would be, how to deal with political in-fighting within the department, issues regarding requesting space, mixing K-awards with RO1 research, how to obtain temporary funding to maintain search assistance when money is tight, etc.

The next issue was the finalization of the assignment of topics and mentors. These included (1) Marcy Verduin selecting a lecture focusing on alcoholism and bipolar disorder, with Michelle Lofwall serving as mentor; (2) Meg Benningfield selecting a topic of genetic influences in opioid dependence, with Gavin Bart serving as mentor; (3) Jodi Prochaska selecting a topic of nicotine dependence, additional substance use disorders, and treatment approaches, with John Wryobeck as mentor; (4) Lanier Summerall selecting the topic of brain injury and alcohol, with Joanna Piechniczek-Buczek as mentor; and (5) Anna Lembke selecting a topic of alcoholism and GI diseases, with Laurie McCormick as mentor.

Issues related to the spring 2010 AMSP meeting were next discussed. The meeting will begin on Wednesday, March 31, and end at noon on Saturday, April 3. While this date appears to work for everyone, if necessary, a backup date could be April 7 – 10. The group favored meeting on the West Coast with the first choice being Cabo San Lucas, and the second choice either Santa Barbara or Santa Monica. It was felt that meetings on the East Coast at that time of year could be problematic due to weather, and that a meeting held near San Francisco might run the risk of fog and cool weather.

The next item was to establish deadlines for the development of first-year scholar lectures. These include:

(1) December 15 as the date by which senior scholars will have received a solid draft of the junior scholar’s lecture outline and reference list (JAMA style of references). It is hoped that the junior scholars will actually begin their rough outlines of lectures and their literature reviews within two weeks of the current meeting and will have discussed issues regarding the lecture outline with the mentor long before December 15.

(2) Between December 15 and January 14, the junior scholar and senior scholar will work to try to finish the lecture to the best possible format. Any correspondence regarding drafts of the lecture outline and references should (unless it isn’t appropriate) be shared with Marc. If Marc has additional suggestions (other than kudos), he will contact the mentors so that any suggestions to the junior scholars might be coordinated.

(3) Marc expects to receive a fully developed outline and references no later than January 15. An earlier set of “final” drafts would be welcome, but any delay beyond January 15 would be problematic. Marc will then work with the junior scholar (with carbon copies sent to the senior scholar) regarding continued development of the lecture. The junior scholars will then develop a series of slides based in part on their interactions with Marc as well as their mentors. Of course, drafts of slides are welcome at any time, but it is best that these not be fully developed until after the lecture has been close to formalized.

(4) The goal is to have the lecture, references, and slides in their final form (although additional small changes are certainly welcome) no later than March 1. This will give the junior scholar a month to practice the lecture, carry out fine-tuning, and prepare for the March 31 meeting.

The next agenda item was a discussion of PowerPoint developments lead by Gavin Bart. Everyone chipped in regarding issues that included the use of footers in the slides, animation, appropriate selection of font, the optimal use of colors, etc.

Meg Benningfield at Vanderbilt, a junior scholar, next presented her tentative plans regarding development of alcohol and drug education at her university. Dr. Benningfield plans to expand on the teaching of substance use disorders for the Child and Adolescent Psychiatry Fellows and will also work with the Division Chief in Addictions to evaluate the teaching for the medical students, which is already quite extensive. She will also work to identify partners in the Department of Pediatrics to extend education about substance use disorders for Pediatrics Faculty and Trainees.

Marcy Verduin, a junior scholar from the new Medical School at the University of Central Florida, next presented her plans for development of alcohol and drug education at her university. Dr. Verduin plans to develop educational sessions devoted to alcohol and substance use disorders in the first- and second-year medical curriculum in her roles as the Module Director for Psychosocial Issues in Healthcare (M1) and Co-Module Director for Brain and Behavior (M2). She will also seek to collaborate with module directors for other organ system modules, such as the Endocrine, Reproductive, and Genitourinary module and the GI, Hepatic, and Renal module. Dr. Verduin will also advocate for including experiences for the care of patients with drug and alcohol disorders in the psychiatry clerkship (M3), and will work with the module directors for the Practice of Medicine module (M1 and M2) to try to incorporate standardized patients with drug and/or alcohol misuse into the curriculum. Finally, as the faculty advisor for the American Medical Student Association, she will ask AMSA members to consider projects similar to those proposed by Doctors Ought to Care.

Anna Lembke from Stanford University, a junior scholar, next offered her tentative plans regarding development of alcohol and drug programs at her university. In order to enhance addiction training at Stanford University Medical School, Dr. Lembke plans to meet first with the Chair of her department, Dr. Alan Schatzberg, to discuss the AMSP program and its goal of improving medical education in the area of addiction. She will discuss her participation in the AMSP program with him, and what she has learned about teaching and resources for addiction training. She will also emphasize the relative paucity of training in addiction at her medical center, as well as the likelihood of future Joint Commission mandates for screening and brief intervention for substance use disorders for certain subgroups of inpatients. Dr. Lembke will put forth a plan to expand addiction training at Stanford and ask Dr. Schatzberg for protected time to accomplish this goal. This plan will include a series of lectures taken from the AMSP website, specifically targeting residents and medical students already in clinical training.

Dr. Lanier Summerall, a junior scholar from Dartmouth College, next presented her thoughts on developments to focus on at her medical school. Dr. Summerall plans to work closely with the director of the Substance Use Disorders Service at WRJ to revise the 10 hours of lectures on substance abuse currently provided to second-year residents to incorporate the pedagogical principles and techniques of the Alcohol Medical Scholars Program. In her capacity as Lead Psychiatrist, she has proposed a lecture working group for junior faculty in the psychiatry department at Dartmouth Medical School to assist others in developing lectures that incorporate AMSP principles and techniques, and to provide a forum for practicing talks; this suggestion has been received enthusiastically. Dr. Summerall plans to deliver the AMSP lecture “How to Give a Lecture” to inaugurate the working group. Finally, she plans to develop a series of lectures on the psychiatric manifestations of medical illness to medical and surgical residents, beginning with topics in substance abuse including alcohol withdrawal syndrome.

Next, Dr. Jodi Prochaska from the University of California, San Francisco (UCSF) stated her plans to increase attention to addictions training in the UCSF School of Medicine by (1) incorporating additional lectures on addiction content in the Clinical Seminar of the UCSF Clinical Psychology Training Program for pre- and post-doctoral fellows; (2) talking with faculty leading the Brain, Mind and Behavior block for first-year medical students to offer consultation on content for the sessions on alcohol and illicit drugs; and (3) reaching out to Dr. Laura Dunn who is working on a funded study examining curriculum development related to the addictions in medical school training.

The meeting ended at 3:30 pm with a general discussion of plans for the upcoming spring meeting. Questions were addressed regarding the development of lectures, and the meeting adjourned with all scholars being wished a safe and enjoyable trip back home.

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