Meeting #22

Carmel, California

March 31 - April 3, 2010

Present at the meeting were first-year scholars Lanier Summerall from Dartmouth, Marcy Verduin from the University of Central Florida, Meg Benningfield from Vanderbilt, and Anna Lembke from Stanford. Second-year scholars included John Wryobeck from Toledo University Medical School, Joanna Piechniczek-Buczek from Boston University Medical School, Michelle Lofwall from the University of Kentucky, and Laurie McCormick from the University of Iowa. The meeting was led by Marc Schuckit, Program Director with the assistance of Gavin Bart (a graduate scholar at the University of Minnesota Medical School) and Marcy Gregg.

I. The meeting began on Wednesday, March 31st at the Highlands Inn, Carmel, CA.
The group met with introductions of first and second-year scholars and guests. The agenda was determined for the next three days, and the group continued together through a working dinner at Casanova’s Restaurant in Carmel.

II. AMSP reconvened for the day beginning with a working breakfast on Thursday, April 1st at 8:00 a.m.

The agenda was reviewed once more, specific slots were assigned for each of the first-year and second-year lectures, and the discussion began regarding the presentation of reports from each of the first- and second-year scholars’ schools.

Marc Schuckit led the discussion of the optimal way of preparing new scholars for the development of a lecture for the AMSP Web site. He briefly reviewed a new set of bullet points to be given to new scholars in the October 2010 meeting, and delivered a shortened version of the “How to Give a Lecture” lecture.

John Wryobeck, second-year scholar, next demonstrated his lecture on Motivational Interviewing. This was a superb lecture that was highly effective. Suggestions were made about some minor modifications to specific slides, the potential of developing a livelier slide format, and the benefits of decreasing the amount of jargon in this talk. John agreed to demonstrate how flexibly lectures can be modified by preparing a second lecture, 10 minutes long, as part of a “white coat ceremony” for medical students moving from second to third year – demonstrating the importance of motivational interviewing techniques.

First-year scholar Marcy Verduin next delivered her lecture on “Substance Use Disorders and Bipolar Disorder.” This was an excellent presentation delivered with fine eye contact, clear slides, and a demonstration of excellent understanding of the topic area. Some suggestions were made regarding specific slides, but all participants agreed that the lecture was very effective and is close to being ready to load on our Web site.

A working lunch then followed during which career development was discussed. This included issues related to control of time during the day, seeking out grants at times when moneys are limited, the importance of publications, and a review of the DSM-V process

Lanier Summerall, first-year scholar, next demonstrated her excellent lecture on “Alcohol and Traumatic Brain Injury.” An excellent presentation with fine slides, and great care demonstrated in avoiding unnecessary levels of jargon. This is an excellent addition to the AMSP website, and with very few changes will be ready for loading on the website within the week.

Joanna Piechniczek-Buczek, second-year scholar at Boston University, then reviewed developments at her university. Dr. Piechniczek-Buczek has worked to expand her contact with medical students, and now has two or three third-year students in their psychiatry clerkship assigned to her clinical unit for six weeks at a time, and she has been asked to lecture on medical assessment in diagnosing psychiatric conditions in the med student second-year core lecture series. She remains active in teaching addiction fellows (three at a time) for three weeks, with a focus on assessing and treating SUDs in elderly patients, and is making an effort to reach out to psychiatry residents. Her profile in her hospital continues to increase as she attends the Division Chiefs meetings and Executive Committee meetings where she works to enhance alcohol and drug education at her institution, where she chairs the Alcohol Withdrawal Taskforce and Delirium Taskforce in her hospital. She is also working with the Chair of her psychiatry department on a research project.

The day’s meeting adjourned around 2:30 p.m. The scholars were on their own for dinner that evening and were expected to reconvene on Friday morning at 8:00 a.m.
III. The group reconvened over a working breakfast at 8:00 a.m. on Friday, April 2nd.

We began with the demonstration of a lecture on MDMA as delivered by Meg Benningfield, a first-year scholar. This lecture worked very well and was a lovely combination of technical information regarding the drug itself along with clinically useful information. This was delivered in a style that would likely be very effective for medical students. The lecture was bit short and several suggestions were made on ways that additional useful information could be added.

Joanna Piechniczek-Buczek, second-year scholar, next delivered her excellent lecture on “The Alcohol Withdrawal Syndrome in Medical Patients and the Elderly.” The lecture went very well, and the style of presentation was excellent. A few suggestions were made regarding modification of several slides, and the presentation was a fine demonstration of how a complex topic can be presented in a very effective way.

Next, second-year scholar Michelle Lofwall presented her accomplishments at the University of Kentucky. Michelle has served as the course director and developed the curriculum for a 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 and Milwaukee, Wisconsin in 2009 and will be conducted again in Miami on May 22, 2010. It is now available on-line for free CME credit. Dr. Lofwall continues to serve on UK’s medical school curriculum committee advocating for more substance abuse teaching. She taught medical students for two hours about substance use disorders this past March and also has three senior psychiatry residents working with her on two research projects in the area of prescription opioid dependence.

Laurie McCormick, second-year scholar from the University of Iowa, next presented her very effective lecture on “The Relationship between Alcohol Use Disorders and Eating Disorders.” The material was very effective and the presentation was followed by a demonstration by Marc Schuckit of how with a few minor modifications the lecture would work well for him in delivering data on this important topic in San Diego.

The working lunch on Friday covered a range of topics, especially those focusing on seeking out grants, phasing out grants, and running multiple grants at the same time.

Following lunch, second-year scholar Michelle Lofwall demonstrated how her lecture on “Opioid Dependency during Pregnancy” could be modified to address Grand Rounds in an Obstetrics Department, rather than the original lecture which was for medical students. Using the assigned 30 minutes as might be appropriate for grand rounds, Michelle showed how lectures developed for one venue can easily be modified for another. She then worked with Marc Schuckit on demonstrating how this could be shortened further to a 10-minute lecture that might be used at an end of a department meeting as part of a discussion of problems that had developed in the department over the prior week. This was a fine demonstration of an excellent command of a topic area.

Lanier Summerall next presented her information regarding developments at her university. She has delivered lectures on alcohol abuse and dependence at Dartmouth Medical School and has conducted seminars for other faculty and Substance Use Disorders Fellows on constructing lectures using AMSP techniques. Clinically, she is overseeing the development of an innovative Rural Residential Treatment Program for veterans who have been exposed to brain injuries and who also suffer from PTSD and substance use disorders. She is involved in an ongoing Department of Defense research initiative into the treatment of the cognitive sequelae of brain injuries, and is initiating a trial of repetitive transcranial magnetic stimulation in veterans of the Iraq and Afghanistan conflicts. She speaks frequently concerning veterans, traumatic brain injury and substance abuse throughout New England.

Second-year scholar, Laurie McCormick of the University of Iowa, then reviewed her developments over the prior six months. Over the past 6 months Dr. McCormick has identified all formal lectures on alcohol and substance abuse education for medical students at the University of Iowa College of Medicine in an effort to improve the delivery of alcohol education in particular. She has worked with 2 other colleagues in her department who teach third-year medical school lectures on alcohol, and they have been able to recap some of what is taught in the first 2 years of medical school so that they are able to concentrate more on alcohol in their substance use disorders lectures. This has given her colleagues the chance to reinforce and build on what was learned previously in each successive lecture on this topic. Working together, her colleagues have also added on an alcohol use disorder module in a case-based learning presentation for third-year medical students. She has also developed a sub-intern rotation for fourth-year medical students to work specifically with patients who have eating disorders, and will present her AMSP lecture on eating disorders and alcohol use disorders for those sub-interns. She has also worked on incorporating the Doctors Ought to Care (DOC) model into the Medical Student Ambassador’s Program (MSAP) at her university. She is working with second- and third-year medical students on the service distinction tract in the MSAP to incorporate the DOC public health messages on alcohol used disorders and eating disorders to elementary, junior high and high school students.

The group adjourned at about 2:30 p.m., with plans to reconvene in the early evening for dinner. AMSP met in the lobby of the hotel and attended a working dinner (along with significant others) at Grasing’s Restaurant in Carmel.

IV. On Saturday morning April 3rd the group reconvened for its final session of the Spring 2010 meeting.

First-year scholar Anna Lembke began the meeting by presenting her superb lecture on “Alcohol and Liver Disease.” The presentation style was very impressive, the slides worked very well, and overall the lecture was a great success. There were a small number of suggestions regarding alterations of slides, as well as a philosophical discussion regarding how some individuals might interpret some of the data differently (although both interpretations were valid).

Second-year scholar John Wryobeck next shared his progress at the University of Toledo University Medical School. John continues to teach about alcohol and substance use in the behavioral science course and the hours of instruction went from 2 hours last year to 3 hours this year. He held didactics on screening and brief interventions for physicians, residents and medical students in the Emergency Department. He reported that training for brief interventions is being incrementally added to the medical school curriculum, with relationship building and brief intervention rational being added in year 1; health behavior intervention added to special topics and an alcohol-related case being added to the problem based learning (PBL) course in year 2; motivational interviewing added to the bridge course between year 2 and 3; and an Objective Structured Clinical Examination (OSCE) concerning an alcohol use disorder patient given to all students during their Psychiatry Clerkship. Dr. Wryobeck also reports initiating research that will look to develop an interactive Web site to be used by medical students to assist them in recognizing and reducing their own harmful drinking behavior.

First-year scholar Marcy Verduin then reviewed her developments over the last 6 months at the University of Central Florida Medical School. Dr. Verduin has worked to address alcohol-related issues over the past 6 months, including medical education, student affairs, and research. Regarding medical education, Dr. Verduin continues to serve as a member of the M1 Subcommittee of the M.D. Program Curriculum Committee at the UCF College of Medicine, and she has recently been invited to join the Curriculum Committee as an ex-officio member. She serves as the Module Director for the Psychosocial Issues in Healthcare module for M1 students, during which she teaches students about use disorders, motivational interviewing, and impaired physicians. As the Module Co-Director for the Brain and Behavior module for M2 students, Dr. Verduin continues to work collaboratively with other faculty to develop a robust addictions curriculum. She is also working with the newly hired Psychiatry Clerkship Director to identify and develop addictions rotations/electives for M3 and M4 students. In the fall of 2009, Dr. Verduin was appointed as the Association for Academic Psychiatry’s liaison to the PRITE Editorial Board, which affords her the opportunity to write exam questions related to addictions on the PRITE. In her role of Assistant Dean for Student Affairs, Dr. Verduin attended the board meeting of the Professionals Resource Network (PRN), which assists impaired physicians in the state of Florida. She also continues her work as PI on a Robert Wood Johnson Foundation grant to develop and evaluate a video game for alcoholics to use to practice their relapse prevention skills. She is discussing possible collaborations using this video game with other alcohol researchers from the University of Florida. Finally, Dr. Verduin was selected as one of 15 faculty members at the University of Central Florida for the Women Making History Celebration 2010 – Faculty Women of Prominence Project.

The next report was from first-year scholar Meg Benningfield at Vanderbilt University. Dr. Benningfield has focused on working to increase the teaching of substance use disorders for the Child and Adolescent Psychiatry Fellows. She has provided one hour of didactics to them this year and will work to increase the didactics to three hours in the next year. She will also assess how much clinical exposure fellows get in working with substance use disorders and will seek opportunities to improve clinical training in this area. She has been invited to give a lecture to residents in the Department of Pediatrics on identifying and treating substance use disorders in youth. Over the past 6 months, she has engaged in outreach beyond Vanderbilt, giving lectures on “Substance Use Disorders and the Family” to staff from the Department of Children’s Services and representatives from Juvenile Justice, and a panel discussion for parents at a local high school on how to address concerns about drinking with their teenage children.

Finally, regarding progress reports, first-year scholar Anna Lembke reviewed her recent developments at Stanford University. Dr. Lembke has been using the AMSP Website lectures available on-line to teach medical students and colleagues about substance use disorders. In the months since the last meeting, she has presented an AMSP lecture on brief interventions for substance use disorders and an AMSP lecture on nicotine and alcohol use disorders. She recently completed and contributed an AMSP lecture of her own on the relationship between alcohol and liver disease. Anna has used her participation in AMSP to promote her visibility in the department as an authority on substance use. Since her involvement as an AMSP scholar, she has been getting more requests and referrals to teach on and treat patients with substance use disorders. Most recently she was asked to represent Stanford University Medical Center for in-house psychiatric support services related to substance use at Google. Dr. Lembke continues her collaboration with the Center for Disease Control and Prevention at the Menlo Park Veterans Administration hospital, where she is working on a study of the relationship between scores on the alcohol screening tool (AUDIT-C) and risk of gastrointestinal-related hospitalization and illness. She is also a collaborator on a randomized controlled clinical trial of smoking cessation treatments, including looking at the effects of depression and concomitant alcohol use.

The group next reviewed the dates for the New York meeting in October. The preferred dates will be the 20th to 23rd or the 6th to the 9th. The potential meeting date of October 13th to 16th does not work out very well for some members of the group.

Graduate scholar Gavin Bart next led a discussion regarding an overview of animation in PowerPoint. The specific examples from lectures were used and approaches to how animation can be effectively incorporated as well as some thoughts about times when animation might not have been as effective were all covered.

Dr. Schuckit then discussed the new scholars for October. There will be two foreign-based scholars, one from Germany and another from Brazil. Discussions ensued regarding the recruitment of scholars for 2011.

Marcy Gregg led a discussion of the excellent developments on the AMSP website. The total number of hits in 2009 increased by 60% over the 2008 figure.

The Spring AMSP 2010 meeting ended with the distribution of graduation plaques to the second-year scholars. Everyone wished each other a safe trip home, and the graduation of first-year scholars to second-year slots will take effect at the October 2010 New York meeting.

Marc A. Schuckit, M.D.

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