Meeting #23

New York, New York

October 20 - 23, 2010



WEDNESDAY, OCTOBER 20

Attending the meeting were Marc Schuckit, Director, Marianne Guschwan (graduate scholar and acting assistant director), and Marcy Gregg. Also present at the meeting were second-year scholars Meg Benningfield (Vanderbilt University), Lanier Summerall (Dartmouth University), Anna Lembke (Stanford University), and Marcy Verduin (University of Central Florida medical school). This was the first meeting for the junior scholars Camila Silveira (University of Sao Paulo, Brazil medical school), Michael Mancino (University of Arkansas medical school), Ann Manzardo (University of Kansas medical school), Fauzia Mahr (Penn State University), and Thomas Nguyen (University of Cincinnati).

The group met in the lobby of the Essex House hotel for introductions and a description of the meeting structure and agenda. The interactions continued through a working dinner that evening, where we were joined by family members of scholars.

THURSDAY, OCTOBER 21

We reassembled at 8:00 a.m. for a working breakfast. Each first- and second-year scholar was invited to introduce themselves and briefly describe their roles at their university.

The morning continued with a detailed description of how to develop a lecture, paper, presentation, and related activities through the presentation by Marc Schuckit of the AMSP lecture on “How to Give a Lecture.” Marc incorporated some suggestions made by the current senior scholars at their last meeting, including handing out slide copy of the lecture accompanied by bullet points regarding the key issues that new scholars need to remember when developing their own lectures. The scholars were informed that a second new step will be the presentation by one of the senior scholars lectures accompanied by the lecture outline and slide copy in order to best highlight the issues needed in optimal development of presentations.

Following a several-hour roundtable discussion, second-year scholar, Lanier Summerall, then handed out her outline and presented her excellent lecture on traumatic brain injury and alcohol. This was a very impressive presentation that led to continued lively discussion about alternative approaches for developing teaching materials through AMSP.

The group’s work continued over a working lunch dealing with career development topics, which included balancing time between family and work, methods for controlling and assigning time for a range of activities at work, interacting with chairs, the process involved in promotion, the importance of mentors, and additional issues.

The afternoon continued with discussions of the roles of second-year scholars as mentors, and a return to issues relating to the pros and cons of a range of types of visual aids, especially slides.

Thursday evening the scholars were on their own for dinner, with plans to reconvene on Friday morning.

Friday, October 22

The meeting began at 8:00 a.m. with a presentation by senior scholar, Meg Benningfield, of her lecture on MDMA. This was a fine lecture with very clear slides and excellent material that can be used as a template for additional lectures in the future when scholars focus on specific types of drugs. The excellent slides were used as teaching points and discussion issues related to development of such slides and the impressive use of animation.

The next issue was the discussion of potential topics for the first-year scholars. The scholars suggested the topic of amphetamine use disorders for Mike Mancino; the relationship between sleep disorders and substance-related conditions for Fauzia Mahr; an overview of heavy episodic drinking (also known as binge drinking) as it relates to age, gender, and other characteristics for Camila Silveira; an overview of thiamine and nutritional deficiencies in individuals with alcohol use disorders, and their children for Ann Manzardo; and the use of vaccines in treating substance use disorders for Tom Nguyen.

In a next step aimed at helping junior scholars to better understand the importance of the outline format and our goals of developing lectures that can be used by other teachers throughout the world, first-year scholar Mike Mancino volunteered to use Lanier Summerall’s outline and slides (as presented on Thursday) and deliver her lecture himself. This was a superb exercise, and Mike did extremely well. Everyone was very impressed (including Lanier Summerall who had developed the lecture). This turned out to be a useful approach that we will continue to utilize at AMSP meetings in the future.

Marcy Verduin, second-year scholar, next reviewed her accomplishments at her university. Dr. Verduin has worked to address alcohol-related issues over the past six months in medical education, student affairs, and research. Regarding medical education, she has been asked to serve as an ex-officio member of the M.D. Program Curriculum Committee, as well as the M1/M2 and M3/M4 Subcommittees of the Curriculum Committee. She served as the Module Director for the Psychosocial Issues in Healthcare course for M1 students last spring, during which she taught students about alcohol use disorders, motivational interviewing, and impaired physicians. Marcy recently presented this course in poster format at the Association for Academic Psychiatry meeting in Pasadena, and her poster won first place in the poster competition. Additionally, Dr. Verduin is responsible for the development and delivery of several hours of addictions lectures for M2 students, and she plans to collaborate with a pharmacology faculty member to integrate the basic and clinical sciences regarding addiction. She continues to work with the newly hired Psychiatry Clerkship Director to identify and develop addictions rotations/electives for M3 and M4 students. Marcy also continues her term 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 for the PRITE. Dr. Verduin was recently asked to serve as a member of the Board of Directors for the Professionals Resource Network (PRN), which assists impaired physicians in the state of Florida. She completed her work as the 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 and is in the final stages of data analysis and manuscript preparation. Finally, Dr. Verduin used the skills she has learned through the AMSP program to prepare and deliver a presentation as part of her interview for the Associate Dean of Student Affairs position at the UCF, and she was selected for this position from a national search of qualified applicants.

Next, Anna Lembke, second-year scholar, brought the group up to date on her AMSP-related accomplishments. Dr. Lembke from Stanford has expanded her teaching of substance use disorders, co-authored a chapter on the role of Alcoholics Anonymous (AA) and other 12-step mutual help groups in the treatment of substance use disorders, and is in conversation with the chair of her department on starting an addiction fellowship. Dr. Lembke has developed several new lectures using Dr. Schuckit’s method, including a talk on Alcoholics Anonymous, one on nicotine dependence and depression, and a talk on adolescent cannabis use. She has extended her reach to include didactics in the community, and has spoken on smoking cessation and Alcoholics Anonymous to psychiatrists at Stanford as part of several Continuing Medical Education (CME) courses. Anna has given a lecture to the lay public on co-occurring mood and substance use at Bipolar Education Day, is scheduled to talk to minority adolescents as part of local TEDx talks, and will use the lecture she developed on adolescent cannabis use. Dr. Lembke has co-authored a chapter on AA with her mentor Keith Humphreys, Ph.D., which will be published in the upcoming months in an American Psychological Association

textbook. Dr. Lembke is exploring the mechanics of starting an Addiction Medicine Fellowship at Stanford, for which she will prepare for and take the American Society of Addiction Medicine (ASAM) certification exam. Finally, Dr. Lembke continues her research into co-occurring mood and substance use disorders, and is currently working on a study of opioid therapy (prescription practices and clinical outcomes) in patients with psychiatric disorders.

The working lunch allowed the group to continue to talk about academic development issues. The discussion included the various tracks for academic scholars (clinical vs. administrative vs. research vs. combinations), as well as the assets and liabilities of each. Marc Schuckit emphasized that it is important to be appropriately matched to the track that best meets a person’s assets, and the need to talk directly with the Chair to be certain that they know the criteria by which they will be judged when they come up for promotion. Additional topics included how and when to say no, the implications of where an author’s name is listed on a paper or book chapter, the importance of doing favors for people in the department which then is returned when a person needs help with other tasks, and the assets and liabilities of joining multi-center trials.

After lunch, senior scholar Marcy Verduin gave her lecture on Comorbid Substance Use Disorders and Bipolar Disorders. This had originally been a fine lecture, and Marcy made the material even better by incorporating changes suggested to her at the previous AMSP meeting. The slides were excellent, as was the presentation style.

The afternoon progressed to the report of the AMSP-related developments at Vanderbilt University by Meg Benningfield. Meg has increased the teaching of substance use disorders for the Child and Adolescent Psychiatry Fellows by providing 2 hours of didactics during new fellow orientation. She continues to work to increase clinical exposure fellows get in working with substance use disorders in inpatient and outpatient settings and will seek opportunities to improve clinical training in this area. Dr. Benningfield has delivered 2 hours of lectures to residents in the Department of Pediatrics on identifying and treating substance use disorders in youth. After a recent panel discussion for parents at a local high school, she was invited to expand outreach in the community, addressing parents' concerns about drinking with their teenage children. Her primary accomplishment during the past 6 months was submitting a K award, which has been successfully funded to use fMRI to identify neurologic underpinnings for increased risk for addiction in youth with high impulsivity. Involvement in AMSP has been influential in the success of this grant application.

The group then adjourned in the late afternoon with plans to reassemble in the hotel lobby for a working dinner, where we will be accompanied by significant others who are also attending the meeting.

SATURDAY, OCTOBER 23

The morning began with an excellent demonstration of a lecture on alcohol-related liver problems by the second-year scholar, Anna Lembke. The presentation went very well and the information shared with medical students through this lecture is impressive. Marc Schuckit then used this lecture and the slide copy to demonstrate how one might modify these materials for a different audience. Plans were made for Dr. Lembke to deliver such a modified lecture, using 15 slides and taking approximately 20 minutes, and as aimed at new residents rotating through internal medicine at a central city hospital. That lecture will be part of the spring AMSP meeting in 2011.

Lanier Summerall, second-year scholar, next reviewed her AMSP-related accomplishments at her university. Dr. Summerall was recently appointed as the Acting Chief of Service and Director of the TBI Clinic at the White River Junction VA Medical Center. She continues to deliver lectures on alcohol abuse and dependence at Dartmouth Medical School and to conduct 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 experienced brain injuries, and also suffer from PTSD and substance use disorders. Lanier is involved in an ongoing Department of Defense research initiative regarding the treatment of the cognitive sequelae of brain injuries, and she speaks frequently about veterans, traumatic brain injury, PTSD, and substance abuse throughout New England.

Meg Benningfield then led the group in a discussion of PowerPoint approaches to animation. These included demonstrating some of the techniques she incorporated into her own lecture, offering general advice on the assets and liabilities, as well as the most appropriate use of animation as others develop their lectures in the future.

The group then agreed on a plan for matching first- and second-year scholars for the development of additional lectures. These included Mike Mancino who will work with Meg Benningfield; Fauzia Mahr who will work with Lanier Summerall; Tom Nguyen who will work with Marcy Verduin; Ann Manzardo who will work with Anna Lembke; and Camila Silveira who will work with both the attending graduate scholar, Marianne Guschwan, and with Marc Schuckit.

The next order of business involved asking the new junior scholars to report some potential goals that they might focus on for AMSP-related activities to enhance alcohol and drug education at their universities. The reports began with the plans for Mike Mancino. Dr. Mancino presented a three-prong targeted approach to increase substance use disorder education at the University of Arkansas for Medical Sciences (UAMS) and Arkansas in general. This includes medical students, physicians at UAMS (residents, fellows and faculty), and community outreach. Specifically: 1) as director of the Resident Research Track he will present the “How to give a lecture presentation” to Residents as well as the addiction fellow; 2) as a member of Medical Staff Health Committee (MSHC), he will educate residents in various departments about physician impairment; 3) he will collaborate with other members of the MSHC to utilize funds set aside for prevention efforts for new residents regarding substance use, stress and suicide; 4) Mike will meet with the Chair of Psychiatry to discuss ways to increase education efforts within the UAMS system regarding substance use disorders; 5) interact with Family Medicine residents to increase education regarding substance use disorders; 6) create community outreach regarding substance use disorders in elderly and youth utilizing AMSP lectures; and 7) meet with the Director of the Behavioral Science Course for first-year medical students to discuss substance use disorders.

Ann Manzardo, first-year scholar, presented the following plans. Dr. Manzardo discussed her plan to advance medical education on alcohol and substance abuse through the presentation of her own research on alcoholism and AMSP lectures at the University of Kansas Medical Center (KUMC) and other affiliated medical and research institutions in Kansas and Missouri. She encourages active participation by medical students and psychiatry residents in her ongoing and expanding alcoholism research program. Additionally, Dr. Manzardo plans to align herself with the Kansas Rural Health Program and the Kansas Rural Preceptorship Program in an effort to advance medical student training in substance abuse screening and intervention in the context of rural health. All fourth-year medical students at KUMC participate in a four-week rural preceptorship to provide them the opportunity to integrate and apply the knowledge acquired during their third-year clerkship in a rural setting away from tertiary care medical centers and urban living. She plans to develop an educational program on substance use disorders for medical students entering their preceptorship and for their host preceptors that include practical training and workships using current NIH-approved methods for substance use disorder screening and intervention. The proposed program may also include student-led AMSP lectures or other community activities intended to discourage abusive drinking or increase awareness of drinking-related problems within the target community.

Fauzia Mahr next reviewed her plans at Penn State University. For medical students, she hopes to: 1) train standardized patients to enhance students understanding about substance use disorders; 2) review the medical student clerkship curriculum to enhance alcohol and drug education; and 3) involve rotating medical students in the substance use disorders movie club for fellows. For residents and fellows, she hopes to: 1) add movies about substance use disorders to the monthly movie club; 2) add pre-test and post-test questions about substance use disorders into the consultation liaison rotation; 3) involve residents and fellows in community outreach programs; and 4) involve residents and fellows in scholarly activities about substance use disorders, e.g.., poster presentations at the Pediatric Research Day. Dr. Mahr also visits Pakistan each year where she plans to: 1) contact colleagues at Aga Khan University Karachi and medical schools and Children’s Hospital in Lahore about using AMSP as a resource for teaching medical students and residents; 2) deliver a lecture about substance use disorders at one of the medical schools or affiliated hospitals; 3) affiliate with the substance use task forced in Parkistan and familiarize them with AMSP to develop community outreach programs and to explore the possibility of a virtual AA meeting or use of Skype/video to enhance support and education; and 4) review the curriculum for medical students at Aga Khan University for enhancing education on substance use disorders.

Thomas Nguyen then reviewed his plans at the University of Cincinnati College of Medicine. Following our meeting, Dr. Nguyen plans to incorporate “Time and Stress Management” as part of his annual talk to the first-year medical students and he will meet with the Department of Psychiatry Chairman to discuss educating residents and fellows from the various clinical departments about substance use disorders and physician impairment. Additionally, Dr. Nguyen, in his role of Coordinator of Medical Student Education in the Division of Addiction Sciences will utilize information from “How to Give a Lecture” and topics from previous AMSP presentations as the basic format in the delivery of information concerning substance use disorders to rotating medical students, psychiatry residents and fellows in the Addiction Psychiatry and Medicine programs. Lastly, he plans to provide in-service presentations concerning substance use disorders by using existing AMSP presentations to various community facilities, including halfway houses, inpatient rehabs, and drug court programs.

Camila Silveira next presented her plans for activities at the University of São Paulo Medical School. Dr. Silveira is sending a brief report about her recent participation in the AMSP meeting to the Chair, Department and Institute of Psychiatry. In it she reports that AMSP is a great opportunity to optimize her teaching skills regarding alcohol and other substance use disorders, and stressed that the techniques for developing lectures will benefit medical education at USP. She plans to meet with the coordinator of the Group of Studies on Alcohol and Drugs and the chief of the Alcohol and Drugs Unit of the Institute of Psychiatry to present suggestions for enhancing education on alcohol and drugs, based on AMSP methods, for medical students and psychiatric residents. She will translate into Portuguese all AMSP lectures available in the AMSP website and will propose some modifications to the Medical School Curriculum Committee for more substance use disorders teaching.

The next order of business was a review of AMSP Website activity over the prior of the last nine months by Marcy Gregg. Briefly, in the first nine months of 2010, our Web site (www.alcoholmedicalscholars.org) experienced almost half a million hits, which averaged out to almost 2000 a day. These included almost 100,000 total page views for close to 50,000 unique visitors in the nine-month period. What is most relevant to our impact worldwide is the fact that there were more than 50 countries represented among those visitors. Just looking at the top 10 countries with the most frequent visits, in addition to the United States as number 1, China was number 2, the U.K. was 3, Canada 4, India was the 5th most frequent origin of visitors, number 6 was Australia, number 7 was Ireland, 8 was the Philippines, Germany 9, and number 10 was the Netherlands. Prominent among the next group were Japan, Romania, Iran, Singapore, South Africa, Saudi Arabia and Brazil.

Then the group worked to establish the time table for activities between this meeting and the next meeting. These plans include:

1.The next meeting of AMSP will take place beginning the afternoon of Wednesday, March 9, 2011 and will end at noon on Saturday, March 12, 2011. The group will meet in San Francisco.

2.Junior scholars are to begin work on their lectures immediately after the current meeting. It is expected that they will work with their senior scholar (with cc’s of all relevant material to Marc Schuckit as well from both junior and senior scholars) and have a draft that is close to final ready for Marc Schuckit’s more direct input no later than December 20, 2010.

3.During the subsequent month the junior scholars will work with Marc Schuckit (with cc’s to second-year scholars) with the goal of finishing off the lectures by January 15, 2011.

4.Beginning on January 15 (or earlier if the scholars prefer) they will then turn to working on slides through interactions with both their senior scholar and Marc Schuckit.,

5.It is expected that all lectures, outlines, slide copy, references and any other needed materials will be fully completed by February 15, 2011.

6.This will leave almost a month for the junior scholars to practice their lectures and adjust them as they see fit.

The meeting adjourned at noon on Saturday, the 23rd. We are all looking forward to preparing for our next meeting in the spring of 2011.

Marc A. Schuckit, M.D.

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