Meeting #24

San Francisco, CA

March 9 - 12, 2011

Present at the meeting were first-year scholars Camila Magalhães Silveira, Fauzia Mahr, Ann Manzardo, Michael Mancino and Thomas Nguyen. Also present were second-year scholars Marcy Verduin, Lanier Summerall, Meg Benningfield, and Anna Lembke, alumnus Marianne Guschwan, Director Marc Schuckit, and Marcy Gregg.

I. Wednesday, March 9, 2011

The group convened in the early evening in the lobby of the Taj Campton Place Hotel for introductions and to begin to plan the agenda for the meeting. The discussions continued through a working dinner at the hotel.

II. Thursday, March 10, 2011

We convened at 8:00 a.m. for a working breakfast. Marc Schuckit reviewed the agenda and established timeframes for each of the lectures and reports, as well as additional items important for the meeting.

Marc Schuckit then led a discussion of his original lecture on how to give a lecture, with input from all first- and second-year scholars regarding the actual process that they went through in developing their lectures. Among the important items in the discussion was the usefulness some foreign medical graduates saw to the development of logic as part of the lecture; the dangers of putting off the actual lecture development by first-year scholars until a time when they felt pressured to get things done; the ease with which one lost the “forest for the trees” when rushed toward the end of the process; the benefits from warning first-year scholars that they might have about six drafts to do and 2 ½ months to do it, so that milestones should be established along the way; the assets and liabilities of handing out a lecture outline and slides from a second-year scholar for first-year scholars to follow during their first meeting; the need to not begin to work on slides or indicate where slides will be in a lecture until the lecture outline is done; the problems computers create in writing an outline and then trying to correct it, with the resulting suggestion that the first drafts of the outline should be done by hand and not placed on the computer until it is almost complete, etc.

Marcy Verduin, second-year scholar from the University of Central Florida, next presented her lecture entitled “Bipolar Disorder and Alcohol Use Disorders.” First- and second-year scholars had received the outline and the slides, and this excellent full second-year talk was used as a template for the first-year scholars to follow, as well as to complement Marc Schuckit’s overview of how to develop the lecture.

The noontime discussion of career issues then centered on the problems associated with learning how to set limits on one’s time and to delegate tasks. One of the scholars reviewed her own schedule and how her responsibilities at the medical school were growing larger, more difficult to organize, and encroaching on important personal time. Marc Schuckit presented an algorhythm of creating a schedule that begins with the very important things in life (sleep, time to eat, interacting with family, time to think, time with the children, etc.), and treating those “tasks” as nonnegotiable. That leaves a limited amount of work time that must be used for work-related issues, with the result that the number of work-related issues that can be handled are limited. That requires a regular review of responsibilities to determine which activities can be dropped (something has to give somewhere) and which take precedence.

The afternoon then progressed with a lecture by first-year scholar Ann Manzardo on “Alcohol and Nutrition.” This was a very effective lecture, an excellent addition to the AMSP Website, and an important demonstration of information rarely given to medical students. A number of suggestions were made to improve the lecture, all of which were easy to implement. Ann, as well as all first-year scholars, were reminded that the final draft of their outline and their slides are due in Marc’s office no later than April 1, 2011.

Meg Benningfield, second-year scholar from Vanderbilt University, next gave an overview of her AMSP-related activities. She provides clinical supervision for child and adolescent psychiatry fellows in both inpatient and outpatient settings, meets weekly with a second-year fellow seeing patients in the outpatient clinic and provides 10 weeks of inpatient clinical supervision for the first-year fellows. In each clinical encounter Dr. Benningfield emphasizes the importance of screening for substance use and substance use disorders in evaluation of psychiatric disorders in adolescents, and highlights the impact of substance use on the course of the illness and outcome of treatment. Fellows are encouraged to screen for substance use disorders in the family members of children and adolescents requiring treatment, recognizing that children of parents with substance use disorders carry increased risk for all psychiatric illness. Dr. Benningfield continues to provide 2 hours of didactic sessions for the child and adolescent fellows on formal assessment of substance use and substance use disorders in adolescent patients. Similar didactics are provided for residents in general pediatrics. This spring, Dr. Benningfield will be teaching second-year medical students in their Brain and Behavior course, where she serves as a small group leader, supervising clinical interviews by the students. This course allows for the opportunity to emphasize the critical need for screening for alcohol and drug use in every patient interview. Dr. Benningfield also continues her research focused on neurobiological factors related to risk for substance use disorders. After receiving a K12 award from NIDA, she is launching a functional MRI study evaluating brain activation patterns in children at risk for substance use disorders. In the coming year, Dr. Benningfield will develop a research skills curriculum for the child and adolescent psychiatry fellows, and encourage scholarly activities and research on substance use disorders.

This was followed by the report of AMSP-related activities by Lanier Summerall from Dartmouth University. Dr. Summerall has now trained four substance use disorders fellows in the pedagogical techniques and concepts she learned in the Alcohol Medical Scholars Program, and has developed 10 hours of lectures on substance use provided to second-year residents. The fellows she has supervised deliver 6 lectures on alcohol use disorders and other substance use problems to Dartmouth medical students, and also provide lectures to Dartmouth College. Lanier is planning to expand the substance use disorders fellowship at the VA to include 2 fellows per year. During her time in AMSP, she initiated the involvement of Dartmouth medical students in the Intensive Outpatient Treatment Program at the VA where they are introduced to evidence-based treatments for alcohol use disorders, including motivational enhancement, cognitive behavioral therapy, and contingency management, as well as pharmacologic interventions. This has greatly expanded the alcohol use disorders training available to students at Dartmouth Medical School, and provided exposure to a challenging and rewarding patient population. Dr. Summerall also has initiated a workshop where junior faculty develop talks on any subject following the AMSP model.

The meeting adjourned at 3:00 pm. All scholars were on their own that evening for dinner.

III. Friday, March 11, 2011

We reconvened at 8:00 a.m. with the lecture by first-year scholar Camila Magalhães Silveira on “Cross-Cultural Issues Related to Measures of Alcohol Use and Problems.” The lecture was clear, well organized, with excellent slides. The material was especially important for AMSP because cross-cultural issues have not yet been covered. The material was especially well delivered in light of the fact that Dr. Silveira is from Brazil and English is not her first language.

Fauzia Mahr, first-year scholar from Penn State University, next gave her lecture on “Alcohol and Sleep.” The material was delivered with great presence and Fauzia used excellent transitions with very good slide animation. The discussion mostly centered on specific items related to slides, along with some suggestions for potential additional graphics and animation.

Anna Lembke, second-year scholar from Stanford, next presented a 30-minute adaptation of her initial 45-minute lecture, but now focusing on high school seniors in a health class. The topic is “Alcohol and the Liver.” The lecture worked very well with somewhere between 20 and 30 slides, and it was well adapted for the new population. Marc Schuckit then worked with the group to see how the lecture might have been delivered with 10 or fewer slides, focusing on only the major points. This exercise also worked well and, therefore, two versions of the lecture were developed.

Michael Mancino, first-year scholar from the University of Arkansas for Medical Sciences, next gave his report on the activities he is engaged in to enhance alcohol and drug education at his university. In the last six months he was involved in the Psychiatry Telemedicine statewide conferences and presented talks on youth prescription drug misuse, as well as an update on buprenorphine treatment for opioid dependence. He was able to assist with restructuring the second-year medical student behavioral health course substance use disorders curriculum, expanding exposure of second-year medical students to substance use disorders. Dr. Mancino also participated in a special case conference where the entire department of psychiatry, including resident physicians, was informed about management of patients with opioid dependence. He is also involved in restructuring the Substance Abuse Treatment Clinic to be a more comprehensive treatment source, rather than a methadone maintenance program. Additionally, he has worked with the current psychiatry addiction fellow on the lecture development techniques learned at AMSP. While he awaits the score of his K-23 award application, he continues to gather data in his project attempting to characterize amphetamine withdrawal in methamphetamine-dependent individuals, and secured an additional year of funding for this project from the Center for Translational Neuroscience. He will continue to participate in the ongoing collaboration with other substance use disorder researchers, while developing new collaborations with other faculty interested in substance abuse and dependence at the University of Arkansas. Finally, Dr. Mancino continues to be available to medical students, psychiatry residents and faculty, other departments within the University, as well as community outreach to improve substance use disorder education throughout the state of Arkansas.

Fauzia Mahr, first-year scholar, next gave her plans both at Pennsylvania State University, as well as for enhancing alcohol and drug education when she carries out her yearly visit to Pakistan. Dr. Mahr plans to start a movie club to meet every semester with the Psychiatric Interest Group [PIG] at Penn State Milton S Hershey Medical Center for the medical students and psychiatry faculty. The movies will be selected around the theme of substance use disorders and the discussions will be lead by an attending psychiatrist. She also plans to train a standardized patient to portray a chronic substance user, who will then help educate medical students rotating through the psychiatry clerkship. Pre- and post-evaluation tools will be utilized to assess improvement in interview skills. Fauzia also plans to do a lecture targeting several areas of substance use disorders at a medical school in Pakistan during her next trip.

The noontime discussion of career development issues was carried out during the working lunch.

The afternoon began with the lecture by first-year scholar, Thomas Nguyen, from the University of Cincinnati, whose topic was “The Development of Vaccines for Treating Cocaine Dependence.” The lecture went well, the slides were very effective, and the group had several modest suggestions on moving some material around to present earlier in the lecture, as well as some potential animations.

Marcy Verduin, second-year scholar from the University of Central Florida, next gave her report regarding her alcohol and drug-related activities, as well as academic development at her university. Dr. Verduin has continued to work to address alcohol-related issues over the past six months in medical education, student affairs, and research. Regarding medical education, she has continued to serve as an ex-officio member of the M.D. Program Curriculum Committee, as well as of the M1/M2 and M3/M4 Subcommittees of the Curriculum Committee. She continues to teach a Psychosocial Issues in Healthcare course for M1 students, during which she teaches students about alcohol use disorders, motivational interviewing, and impaired physicians. Additionally, she developed and delivered 3 hours of lecture covering substance use disorders and their treatment to M2 students in the Brain and Behavior course. Marcy also continues her term as the Association for Academic Psychiatry’s liaison to the PRITE Editorial Board, which provides an opportunity to write exam questions related to addictions for the PRITE. In addition, Dr. Verduin continues her service as the only addiction psychiatrist member of the Board of Directors for the Professionals Resource Network (PRN), which assists impaired physicians in the state of Florida. She is in the process of submitting a manuscript detailing the results of her study from the Robert Wood Johnson Foundation grant on health games, and the results of this study will be presented at the College on Problems of Drug Dependence meeting this year. Finally, Dr. Verduin spends the majority of her effort as the Associate Dean for Students, running the Office of Student Affairs, and serving on the Dean’s Cabinet at the College of Medicine.

The meeting adjourned at 3:00 p.m. with the understanding that the group would meet again at the hotel at 7:00 p.m. to walk to the restaurant for a working dinner.

IV. Saturday, March 12, 2011

The morning began with the lecture on Amphetamine Use Disorders by first-year scholar, Michael Mancino from the University of Arkansas. Dr. Mancino’s lecture was well organized and well received, and his PowerPoint slides were clear and effective.

Meg Benningfield, second-year scholar from Vanderbilt University, next presented her lecture “Ecstasy: Harmless Love Drug or Dangerous Neurotoxin?” Meg’s assignment was to modify her 45-minute lecture originally developed for medical students but now for college dormitory counselors in a situation where a student had recently died at a RAVE, potentially related to MDMA. The lecture worked perfectly, the slides were quite appropriate, and it was worthwhile to review how medical student-level material had been changed to deal with a college counselor group.

Thomas Nguyen, first-year scholar, then presented his plans for activities related to alcohol and drugs at the University of Cincinnati, As the coordinator of medical students for the Addiction Sciences Division, Tom plans to contribute to the new medical student curriculum to be implemented next year, and is scheduled to give a presentation on "Vaccines in Treating Substance Use Disorders" at Grand Rounds. In August, he is invited to give a presentation on "The Genetics of Addiction" at the Addiction Institute of Ohio State University. Dr. Nguyen has revised his PowerPoint presentations to the AMSP format in developing didactics for R-2, R-3 psychiatry residents and addiction psychiatry fellow, continues to serve as study physician in phase III clinical trial of a vaccine to treat nicotine dependence, and he is involved in a review article about prescription drug misuse for the Current Psychiatry journal.

Camila Magalhães Silveira, from the University of São Paulo in Brazil, gave her thoughts on steps to enhance alcohol and drug education at her university. Dr. Silveira continues to coordinate the alcohol and drug course for second-year medical students, and is scheduled to give a lecture about the Alcohol Medical Scholar Program principles and techniques in the meeting of the Group of Studies on Alcohol (GREA) - Institute of Psychiatry - University of São Paulo for medical students, residents, fellows and psychiatrists of the Institute. She authored a paper entitled “Sociodemographic Correlates of Transitions from Alcohol Use to Disorders and Remission in the Sao Paulo Megacity Mental Health Survey, Brazil” recently published in the journal Alcohol and Alcoholism. Camila is coordinating a project, funded by the Brazilian government, dedicated to improving a judge’s knowledge of the New Drug Legislation in Brazil, and will offer a Distance Education Course for 15,000 Brazilian judges and jurists. All medical lectures will follow the AMSP method. Dr. Silveira is discussing alcohol education with the chair of GREA with the hope of creating an AMSP in São Paulo. Finally, Dr. Silveira continues her research on heavy episodic drinking in college students and on subtypes of alcohol dependence, and is currently working on psychiatric epidemiology with the São Paulo Megacity data, which is part of the World Mental Health Survey.

Anna Lembke, second-year scholar from Stanford University, next gave her report of alcohol and drug enhancement at her university. Dr. Lembke continues to use the AMSP-method to prepare and give lectures on substance use disorders to high school students, undergraduates, medical school students, residents, physicians, and myriad other health care providers at Stanford and in the greater Bay Area. Most recently she spoke to local high school students on the use of marijuana as part of a local TEDx conference, and to a group of child psychiatrists at the annual meeting of the Northern California Child and Adolescent Society. In the near future she will present to Stanford psychologists who work at the Stanford HELP Center, a counseling resource for Stanford faculty and staff, and she will be the Grand Rounds speaker at Alta Bates Medical School in San Francisco. Dr. Lembke’s research paper on the use of an alcohol screening scale as a predictor of future gastrointestinal-related health risks has been accepted for publication in a prominent peer-reviewed journal (Lembke, A., Bradley K.A., Henderson, P., Moos, R. Harris, A.H.S., Alcohol Screening Scores and the Risk of New-Onset Gastrointestinal Illness or Related Hospitalization, Journal of General Internal Medicine, 2011). Anna was also recently asked to write an editorial on the self-medication hypothesis for the journal Addiction. Finally, Dr. Lembke has recently been made the Chief of Stanford’s Addiction Psychiatry Initiative, a larger project to improve the teaching of addiction to physicians here at Stanford, which includes efforts to establish a fellowship in Addiction Medicine at Stanford University Medical School.

Ann Manzardo, first-year scholar from the University of Kansas medical school, reviewed her efforts to enhance alcohol and drug education at her university. Dr. Manzardo has continued to work with program coordinators in the University of Kansas Rural Preceptor Program to expand the current curriculum to include specialized training on alcoholism screening and interventions for both medical students and their preceptors in an effort to increase alcoholism screening at the primary care level, especially in rural communities. The expanded preceptor program will include student scholarly service activities related to alcoholism education at the community level such as medical student presentation of AMSP lectures at local schools. Dr. Manzardo applied for a $5,000 grant from the University of Kansas Medical Alumni Association to support the pilot educational program. Ann plans to develop a special lecture series on alcoholism for medical students at the University of Kansas Medical Center, which will be led by Psychiatry Residents who will be trained in the AMSP lecture format. Her scholarly activities include several research projects examining risk factors for the development of alcoholism, and this research resulted in the publication of one original research article. In other projects Dr. Manzardo examined the epigenetics of alcoholism, as well as the effects of B1 vitamin supplementation on drinking patterns in severely dependent subjects, which resulted in the submission of 2 abstracts to the annual convention for the Research Society on Alcoholism.

The morning progressed with a lecture by Lanier Summerall, second-year scholar from Dartmouth, who revised her original lecture on traumatic brain injury and alcohol, but now as a 30-minute lecture aimed at high school football coaches who are concerned about brain damage in their players. The lecture flowed very well, the slides were excellent (about half of the slides were new to this lecture), and the outline was very effective. Lanier volunteered to place this lecture on the AMSP Website where we think it will add an important new component.

The group next turned to a tutorial on PowerPoint led by Meg Benningfield. The emphasis was on questions that had been asked in the context of lectures given during the meeting, including how to space out material from the top to the bottom of a slide, animation, the use of colors, and so on. Marc Schuckit asked that a first-year scholar think about the possibility of being able to deliver this lecture next year.

Marcy Gregg next delivered a review of the AMSP Website activity in 2010. During that period of time AMSP had almost 630,000 hits (an average of almost 2,000 per day), including roughly 130,000 page views (352 per day). Of the 68,000 visitors to the Website, 41,000 were unique visitors (never having come to AMSP before). Furthermore, the largest proportion of visitors came directly to the AMSP Website (having no referral), indicating that news about the Website has been widely disseminated. Visitors included visitors from over 50 countries, including the United States (59%). China (6%), India (4% of visitors), the U.K. (4%), Canada (3%), Australia / Germany / Russia / Japan / Netherlands / Philippines each for 1% to 2% each, plus additional visits from Sri Lanka, Serbia, Jordan, Lithuania, Nigeria, Jamaica, Mexico, and so on. Some of the more frequently downloaded files were lectures on substance use disorders in athletes, alcohol withdrawal, an overview of diagnosis and treatment of substance use disorders, medical problems associated with alcohol dependence, pharmacology update, spirituality, genetics, and so on.

The meeting ended with the distribution of graduation plaques. The scholars were reminded of the following:

1. Reports on activities in the last six months are due to Marc Schuckit no later than March 19, 2011.

2. The final version of lectures and outlines by first-year scholars are due in Marc Schuckit’s office by April 1st.

3. The next AMSP meeting will take place in California (city to be determined) beginning no later than 5:00 p.m. on Wednesday, September 21, 2011 and ending no earlier than noon on Saturday, September 24, 2011.

Marc A. Schuckit, M.D.

Layout and design by Brian Klima