Meeting #25

Laguna Beach, CA

September 21 - 24, 2011



AMSP MEETING

September 21 through September 24, 2011

Present at the meeting were first-year scholars: Roberta Agabio, M.D., Ph.D. from the University of Cagliari, Sardinia, Italy; Jennifer Hanner, M.D., MPH, University of North Carolina Medical School; Courtney Bagge, Ph,D., from the University of Mississippi Medical School; Erik Gunderson, M.D., University of Virginia Medical School in Charlottesville; Iliyan Ivanov, M.D. from Mount Sinai School of Medicine in New York; and Claire Wilcox, M.D. from the University of New Mexico. Also attending were second-year scholars: Michael Mancino, M.D. from the University of Arkansas Medical School; Ann Manzardo, Ph.D. from the University of Kansas Medical School in Kansas City; Thomas Nguyen, M.D. from the University of Cincinnati Medical School; and Camila Silveira, M.D., Ph.D. from the University of Săo Paulo Medical School in Săo Paulo, Brazil. The meeting was chaired by Director, Marc Schuckit, M.D. from the University of California, San Diego School of Medicine and Marianne Guschwan, M.D., Acting Assistant Director, from New York University Medical School, and by Marcy Gregg, also of UCSD, Administrative Assistant.

Wednesday, September 21, 2011

The group met in the lobby of the hotel for introductions. This was the first meeting for the first-year scholars, and the general structure and goals were explained. First- and second-year scholars then had the opportunity of sharing a dinner together at the hotel during which backgrounds of each were discussed and networking began.

Thursday, September 22, 2011

The session began with more formal introductions. Each scholar presented their background and interests, and the first-year members were encouraged to begin to think about potential topics for their lectures.

Marc Schuckit then gave an overview of the structure of the meeting. This was a detailed description of the need to set aside time for: the presentation and discussion of how to give a lecture, full 45-minute presentations of first-year medical student lectures by the second-year scholars, reports by the second-year scholars on their accomplishments during the prior six months, decisions by first-year scholars regarding their topics, agreements regarding the pairing of first- and second-year scholars to work together in tandem for the development of the first year’s lectures, presentations of PowerPoint issues, an update on the Website, recruitment issues, and so on. Tentative times were assigned for each of these goals.

The major business on Thursday morning was a presentation and discussion facilitation by Marc Schuckit regarding how to develop a lecture, structure a paper, write a grant, etc. Marc used the material posted on the Website to demonstrate the lecture, with encouragement to scholars to offer similar lectures at their universities. As demonstrated in that posted lecture, the material focused on the philosophy in developing such presentations (e.g., that members of the audience are the most important people in the room – not the presenter; lectures must be developed to meet the needs of that audience; and that the material must be data-based and focus on ~ four major points). The second major point in the discussion was the need for a systematic approach to gathering the optimal data appropriate for developing an outline. Third, the manner in which the outline can be put together in a logical way that is easy for the audience to follow is important. The fourth point consisted of issues related to the development of optimal slides (with the request that these 45-minute lectures have no more than 40 slides if at all possible). Finally, suggestions regarding the optimal way to present lectures, handle questions, and deal with unexpected emergencies (e.g., PowerPoint isn’t working) were presented and discussed. During this extensive presentation on Thursday morning, second-year scholars offered additional advice to first-year scholars as they reflected on their own experiences. During the presentation, Marc Schuckit handed out typed suggestions for the development of the lectures and the development of slides.

The group next turned to a working lunch during which career issues were discussed. Topics included some thoughts on optimal ways to get grants in these difficult financial times, time management, when and how to say “no” when asked to do tasks for which time is not available, and issues related to whether R01 grants should be required for progression from assistant to associate professor levels.

Following lunch, Dr. Tom Nguyen, second-year scholar from the University of Cincinnati distributed an outline that he had developed for his lecture. Reflecting shortage of time, the discussion primarily focused on examples of slides, topics related to the flow of the lectures, and the potential importance of including a case history that can be woven into the presentation itself. A formal presentation of Dr. Nguyen’s lecture was scheduled for Friday morning.

The afternoon’s deliberations ended with reports of the prior six months’ activities for second-year scholars, beginning with Michael Mancino. In the last six months Dr. Mancino was involved in the Arkansas Rural Hospital Programs Telemedicine statewide conference and presented on geriatric substance use disorders. He was also invited to present on this same topic at the 30th annual Dr. Stanley Weiss Challenges & Solutions in Frontline Medicine meeting designed for primary care physicians in Texas, and he presented on limit setting for prescribing opiates to primary care physicians at the 33rd Annual Family Medicine Intensive Review Course held in Little Rock, Arkansas. Michael has been invited to present at the UAMS Department of Internal Medicine Grand Rounds and the University of Texas health Science Center’s Grand Rounds on geriatric substance use disorders in the upcoming months. In the future, Dr. Mancino will develop a prescribing course targeting physicians that have come to the attention of the state medical board for problems related to prescribing practices. Since his involvement in AMSP, he has assisted with restructuring the second-year medical student behavioral health science substance use disorders curriculum, and enhanced education in the College of Medicine at UAMS regarding prescription opioid dependence, and worked with the first Addiction Psychiatry Fellow on lecture development techniques learned at AMSP. Dr. Mancino continues to gather data for his project attempting to characterize amphetamine withdrawal in methamphetamine-dependent individuals, has secured an additional year of funding for this project from the Center for Translational Neuroscience, and continues to participate in ongoing collaborations with other substance use researchers, while developing newer collaborations with other faculty interested in substance use disorders at the University of Arkansas.

Ann Manzardo, second-year scholar from the University of Kansas presented her recent accomplishments. Ann held several meetings with representatives from the University of Kansas School of Medicine to identify deficits in the program and develop new ways to enhance medical student education on alcoholism and substance use disorders. She also met with medical student leadership to identify areas of interest/concern to them regarding their training on the topic. As a result of these meetings, Dr. Manzardo is using AMSP methods to develop a new lecture on the biological basis of substance use disorders to add to the medical student curriculum, which will also be adapted for psychology interns and psychiatry residents. She also conducted a workshop with medical students to review current NIAAA techniques for substance use disorder screening and brief interventions. During the spring and summer, Ann carried out an independent study program on addiction pharmacology for the KU Medical Center Addiction Fellowship program, and she delivered her AMSP lecture on Nutritional Deficiencies in Alcoholism to the Greater Kansas City Psychological Association and the Department of Psychiatry Grand Rounds. These activities were in addition to regular lectures on adolescent substance use problems offered to psychology interns and child psychiatry residents.

Tom Nguyen from the University of Cincinnati College of Medicine next gave an update on his recent activities. Dr. Nguyen continues to serve as the Medical Student Education Coordinator within the Division of Addiction Sciences and is contributing to the new "Organ Pathways" medical student education curriculum. Tom is part of the "Physician Wellness" committee which provides good-health advice to incoming medical students during the week of their orientation. In addition, he has revised all of his didactic presentations to medical students, psychiatry residents and fellows to the AMSP format. In August 2011, he was invited to give a lecture on "The Genetic Liabilities of Substance Use Disorders" to the Ohio Addiction Institute in Columbus, Ohio, and in September 2011, he was invited to give a presentation on "Medication Assisted Treatments of Opioid Dependence" to the Ohio Association of Residential Treatment Programs. As of April 2011, Tom was assigned by the FAA as the regional physician to provide pilots with comprehensive substance use disorder evaluations and to monitor those pilots who have been diagnosed with these conditions. Toward the end of August, 2011, Dr. Nguyen was assigned by the Chairman of his department to be the Interim Medical Director of The University of Cincinnati Methadone Clinic overseeing the care of over 450 patients receiving methadone maintenance. In addition, he is collaborating with his Chair as first author on a review article concerning substance use disorders among patients with bipolar disease. Finally, Dr. Nguyen continues to serve as a Study Physician for the Phase III trial of the nicotine vaccine, as well as for the Phase II-B trial of the cocaine vaccine.

Finally, Dr. Camila Silveira of the University of Sao Paulo Medical School overviewed her recent accomplishments. Dr. Silveira continues to provide four hours of didactic sessions and four hours of practical classes for the second-year medical students on epidemiology, diagnosis and treatment of substance use disorders. Camila also coordinates a project funded by the Brazilian government dedicated to improving judges’ knowledge on the New Drug Legislation in Brazil towards a Distance Education Course for 15,000 Brazilian judges and jurists. All medical lectures were elaborated following the AMSP techniques. Dr. Silveira coordinates an NGO call Center for Information on Alcohol and Health whose main purpose is to generate a source of information from renowned scientific journals on topics related to alcohol use and disseminate it in her organization, CISA's database. This year she was invited by the ABC Medical School to give lectures to the first-year medical students of this University on alcohol use disorders. In addition, Dr Silveira gave the lectures "how to give a lecture" and " how to organize a paper" to residents from two important medical schools in Brazil (University of São Paulo and ABC Medical School). Finally, she is pleased to report that the Group of Studies on Alcohol (GREA) - Institute of Psychiatry to which she contributes was chosen by the Brazilian government to become a reference center for treatment, research and education on substance use disorders in Brazil. Dr. Silveira will coordinate the research section on alcohol use disorders.

The meeting adjourned after a discussion of the goals for the next day (Friday), a review of the schedule for the remainder of the meeting, and some suggestions on where scholars might choose to go to dinner for this single night of the meeting when they are on their own.

Friday, September 23, 2011

The morning began with a demonstration of the 45-minute lecture for first-year medical students developed by Dr. Camila Silveira on measures of global public health. The lecture went very smoothly, was quite effective, and had excellent slides. The discussion highlighted some of the outstanding attributes of the slides, and progressed to some thoughts on whether, if time for the lecture was a bit short, the material would be just as effective and perhaps a bit smoother in transitions if several of the subsections were deleted (e.g., gender differences in global health measures related to alcohol use).

This was followed by a full presentation of the lecture by Dr. Tom Nguyen describing the development of vaccines for the treatment of cocaine dependence. This was a fine lecture with excellent slides and a good example of weaving in material relating to a specific patient. The lecture also demonstrated challenges that Dr. Nguyen faced and dealt with regarding how much detail was required for each step being presented to medical students (e.g., immunology was not the focus of the lecture and was therefore only briefly covered to help students understand the basic issues of how a cocaine vaccine was developed and tested). Following these two excellent lectures, first-year scholars were reminded of the basic issues for their own lecture development and creation of their slides.

Ann Manzardo from the University of Kansas, a second-year scholar, next presented her excellent lecture on nutritional deficiencies and alcohol use disorders. The material was an excellent example of how to focus on what first-year medical students need to know, and an excellent series of slides (including a creative use of animation to demonstrate nystagmus and ophthalmoplegia in the context of Wernicke’s disease). Dr. Manzardo was requested to return to the issue of how she developed these animation approaches when animation is discussed regarding PowerPoint on Saturday.

The working lunch continued with the discussion of career development issues. Questions were raised regarding the steps required for promotion among clinician educators who do not focus primarily on research, the role of a corresponding author in publications, assets and liabilities of volunteering to become a grant reviewer at the NIH, and additional potential problems regarding time management.

Rounding out the afternoon were some preliminary thoughts by first-year scholars on the topics they might address in their lectures. Dr. Agabio, from the medical school in Sardinia, Italy is considering a lecture focusing on acute alcohol intoxication and alcohol/drug acute interactions; Dr. Bagge from the University of Mississippi Medical Center is considering a lecture on the relationship between acute alcohol use and suicide attempts; Dr. Gunderson of the University of Virginia is considering a lecture on the relationship between pain syndromes and the use, abuse, and dependence on opioid medications; Dr. Hanner from the University of North Carolina Medical School is leaning toward developing a lecture focusing on the impact of substance use disorders on consult liaison psychiatry and medicine; Dr. Wilcox of the University of New Mexico is considering a lecture on the neurobiology of decision-making and the impact that such neurophysiology has on substance use disorders; and Dr. Ivanov of the Mount Sinai Medical School is considering a lecture on different neuroimaging techniques in both clinical and research settings regarding substance use disorders.

The day ended with a distribution of two books written by Marc Schuckit (Educating Yourself about Alcohol and Drugs, and Drug and Alcohol Abuse, 6th Edition). The group adjourned around 3:00 pm, although several of the first-year scholars remained to discuss among themselves and with Marc Schuckit issues related to potential lectures they might develop. The group reconvened for a working dinner (primarily networking, discussion of potential topics, and potential optimal pairing of first- and second-year scholars) at the Nirvana restaurant in Laguna Beach.

Saturday, September 24, 2011

The group convened at 7:30 am with the first goal of hearing the full 45-minute lecture on amphetamine dependence as presented by second-year scholar, Michael Mancino. This was a fine lecture with very good slides, including animation that was used to demonstrate how amphetamines work, and the related consequences of heavy use. Following this lecture, Marc Schuckit then used the 41 slides appropriate for this 45-minute lecture and worked with both first- and second-year scholars to show how a 10-minute lecture using nine of these slides could be used if Michael had been told at the last minute that his time had been cut from 45 to 10 minutes. The process involved: 1) establishing four major points that the lecture could not function without; 2) scanning through the 41 original slides to select one slide (or at most two) for each of the four major points; 3) then additional slides that might be required to introduce the four major points or to emphasize them at the end of the lecture were reviewed. Through consensus nine slides were selected. Marc then demonstrated how to weave a case history into the lecture to enhance interest to students, use the nine slides, and sufficiently cover all four major points within a 10-minute lecture. Second-year scholars were reminded that the spring 2012 meeting, they will be asked to carry out such exercises, with perhaps only a few hours or a one-day warning to demonstrate how flexible lectures can be in addressing specific audiences and changing time requirements.

Marcy Gregg next presented an overview of the activities between January 1, 2011 and April 30, 2011 regarding the AMSP Website. In this short period of time (four months), the AMSP Website had over 200,000 hits, or an average almost 1,700 hits each day. In the four months, the site was visited by 29,000 individuals, including 14,000 (almost half) unique visitors, with the remainder being individuals who repeatedly visited the Website. During those four months the Website was visited by people from 117 different countries including the United States, China, United Kingdom, India, Canada, Russia, Netherlands, Japan, Germany, and Australia. This level of activity represented a > 20% increase over the same period in the prior year. Thus, the Website is serving as a very important vehicle through which AMSP is impacting on general knowledge about alcohol and drugs, as well as educational activity at schools and universities across the world.

This busy Saturday morning next addressed potential activities for junior scholars to attempt to develop between the current time and the time of the spring AMSP meeting. The first report was from Claire Wilcox from the University of Mexico. Claire is the dual diagnosis clinic didactics coordinator at UNM (and gives a number of talks to third-year residents on dual diagnosis, assessment, and treatment, stimulant use disorders, motivational interviewing, cannabis use disorders, neurobiology of addiction, etc.). In this role Dr. Wilcox will update her slides using an AMSP format, and will use an AMSP pain talk for teaching about co-occurring pain and opioid use disorders and obesity to primary care physicians at the Indian Health Service. Claire plans to approach ECHO (a telemedicine-based statewide educational format) about the possibility of teaching on any of the above topics as well. Dr. Wilcox will also approach medical student and/or resident education committees about whether there is an interest in a wellness in medical school group, and/or a talk on how to give a lecture. In addition, she will prepare and give a grand rounds lecture either on her research or on the neurobiology of decision-making, and will approach psychiatry residents and/or Mind Research Network grad students to see if there is any interest in hearing a talk on the neurobiology of decision-making.

The potential goals for Courtney Bagge of the University of Mississippi include plans to meet with the Department of Psychiatry and Human Behavior Chairman to discuss reviewing the medical student curriculum to enhance alcohol and drug education, and to discuss educating residents and fellows about substance use disorders using AMSP methods and lectures. Subsequently, Courtney will survey lecturers of existing courses to document what is currently being offered on alcohol and drugs and how alcohol and drug education might be better incorporated into the curriculum, and will offer to provide AMSP lectures to psychiatry residents and fellows on “How to Give a Lecture” and “PowerPoint Tips.” In addition, Dr. Bagge will explore whether she can become involved with medical students’ education on enhancing initial patient contact using motivational interviewing techniques, and offer to provide lectures to emergency room physicians on brief interventions and/or motivational interviewing techniques. She plans to provide in-service presentations concerning substance use disorders by using existing AMSP presentations to a low- to no-cost community facility. Finally, Courtney also encourages active participation by psychiatry and psychology residents in her ongoing and expanding alcoholism research program.

Roberta Agabio of the University of Cagliari, Italy presented her potential goals. Before coming to the Laguna Beach meeting as a first-year scholar, Dr. Agabio had discussed with her Dean of the School of Medicine the potential goals to enhance alcohol education. Jointly, they decided on the following plans: 1) To carry out a survey on existing medical school classes on AUDs at their University and other Italian universities; 2) To propose to students enrolled in the degree courses for Medicine, psychology, professional nursing, healthcare workers, and various PhD courses a class on AUDs comprised of lessons available at the AMSP website; 3) To offer the same students a brief lesson entitled “How to Give a Lecture” focused on the lectures available at the AMSP website; 4) To develop a program in which students attend an AA meeting, with a faculty-led back-up discussion; and finally, Dr. Agabio hopes to add some movies on substance use disorders to show to medical students.

Jennifer Hanner of the University of North Carolina Medical School then reviewed her potential goals for the upcoming six months. Jennifer joined the Department of Psychiatry at the University of North Carolina (UNC) one year ago. During her first year in the department, she participated in a number of lectures on substance use disorders for residents and also led a patient case-based group discussion with medical students as part of their full-day substance use disorder curriculum. In this academic year she plans to continue with regular lectures to residents and medical students, mainly while supervising their rotations on the Consultation-Liaison Psychiatry service, as well as in her new role as a supervising attending in a substance use disorder outpatient treatment clinic. She will also be more formally involved this year in planning the curriculum on substance use disorders for first- and second-year medical students at UNC, also serving as a lecturer for these courses. In addition, Dr. Hanner plans to seek out other opportunities to increase medical student interest and involvement in substance use disorder treatment. Her plans include possibly having informal small group discussions on various related topics, such as approaches to addressing student impairment, as well as having medical students provide education to local high schools through the Doctors Ought to Care program.

The goals for the following six months for Erik Gunderson of the University of Virginia (UVA) were next presented. Dr. Gunderson plans to enhance medical education on drugs and alcohol, targeting all levels of training, including pre-medical undergraduates, medical students, house staff, and practicing physicians. For pre-medical undergraduate students, he will lead a meeting sponsored by the Alpha Epislon Delta (AED) national pre-medical honor society on substance use treatment career opportunities. For medical students, he will incorporate the AMSP training into his substance use lecture and outline for the Mind, Brain and Behavior Course in the Spring of 2012. Highly interested undergraduate and medical students may be able to participate in Dr. Gunderson's research activities. For house staff, Erik will utilize AMSP techniques to prepare and present a noon conference lecture, and deliver a case-based lecture on substance use disorders and chronic pain to Addiction Psychiatry Fellows at Columbia University College of Physicians and Surgeons, where he maintains an Adjunct Research Scientist appointment. AMSP lecture preparation and delivery strategies will be utilized when preparing a research talk on synthetic cannabinoid consumption, which will be delivered at the November 2011 Annual Meeting of the Association for Medical Education and Research on Substance Abuse (AMERSA). For practicing physicians in the community, Dr. Gunderson will lead a "Meet-the-Professor" group on substance use disorders in primary care for the 38th Annual Recent Advances in Clinical Medicine Conference, sponsored by the Department of Medicine, UVA School of Medicine.

Finally, regarding plans for first-year scholars, Dr. Iliyan Ivanov of Mount Sinai Medical School then reviewed his goals for the following six months. Dr. Ivanov has been involved with teaching to the first- and second-year medical students at Mount Sinai School of Medicine on the topics of SUD among physicians, and the use of neuroimaging techniques to study the neurobiological basis of substance abuse and dependence. He will expand these teaching activities both by improving his current presentations with information provided at the AMSP website and by introducing additional topics. Dr. Ivanov is also a member of the department of psychiatry faculty group that provides liaison to the medical students’ interest group in psychiatry and will offer topics on SUD to be presented to the members of the group. Iliyan will also participate in the development of a new Brain and Behavior course for medical students by preparing lectures on SUDs. In addition, as a member and president-elect of the New York Council on Child and Adolescent Psychiatry, he will participate in the council’s outreach effort to medical students across New York City, which includes presentations on the topics of SUDs. Further, Dr. Ivanov has taught seminars on SUD as part of the Crash Course for child psychiatry fellows and a three-lecture course on the neurobiology and treatment of adolescent SUDs. He plans to expand and improve these lectures by adopting information and materials from AMSP, particularly in relation to stimulant abuse. He has also been invited to present on the topic of opioid abuse and dependence to the residents in anesthesia and pain management, and plans to structure his talk making use of materials presented at ASMP. Lastly, Dr. Ivanov regularly presents at national and international scientific meetings and he plans to augment his presentation at such forums by incorporating new data and slides from the ASMP website.

Marianne Guschwan next led the group in a discussion for the development of PowerPoint for optimal slides. Because of shortage of time and the high level of sophistication regarding PowerPoint among the group, topics were only briefly reviewed. These included discussions of font type, font size, the use of color, backgrounds of slides, the importance of the AMSP footer, and, especially, issues related to animation. Scholars were advised to look closely at PowerPoint lectures posted on the AMSP Website by graduate scholars Meg Benningfield and Susan Tapert.

Prior to adjourning, the group made the following decisions regarding deadlines and dates:

1. The next AMSP meeting will begin at 5:00 pm on Wednesday, March 28, 2012. As usual, it is expected that no one leave the meeting before noon on Saturday, March 31st (although if some of the scholars coming from particularly long distances need an earlier adjournment and if this can be arranged ahead of time, efforts will be made to meet those needs).

2. Potential sites for the meeting included Monterrey/Carmel, California, Napa, California, and Miami, Florida. Marc Schuckit and Marcy Gregg will look into the relative specifics of meeting at these three places and will inform the scholars within the month.

3. Completion of the initial literature review and the development of a relatively detailed outline is to be completed and sent to the senior scholar no later than October 24, 2011. Please note that for all correspondence between first- and second-year scholars, a copy should be sent to Marc Schuckit.

4. The first- and second-year scholars will work on multiple drafts with the goal of sending the best and most appropriately detailed outline possible to Marc Schuckit no later than December 15, 2011. This draft can be accompanied by potential slides, although it is probably better to wait until after Marc’s reading of the drafts before slides are produced. Also, any scholars who can get their more advanced drafts to Marc prior to December 15th will be greatly appreciated.

5. It is hoped that close to final drafts of the lectures and slides will be produced by ~ January 15, 2012.

6. This will leave about two months for the scholars to finish up minor details or correct slides, and to practice delivery of the lectures to local graduate students or medical students, etc. before the AMSP meeting beginning at 5:00 pm on March 28, 2012.

The following is the listing of general topic areas and pairings between first- and second-year scholars:

1. Roberta Agabio will develop a lecture on acute alcohol intoxication, working directly with Marc Schuckit.

2. Jennifer Hanner will develop a lecture on substance use disorders in consult liaison settings, working with Marianne Guschwan.

3. Erik Gunderson will develop a lecture on pain, prescription opioids, and substance use disorders, working with Michael Mancino.

4. Iliyan Ivanov will develop a lecture on neuroimaging and substance use disorders, working with Tom Nguyen.

5. Courtney Bagge will develop a lecture on acute alcohol intake and suicidal behavior, as well as alcohol expectancies, working with Camila Silveira.

6. Claire Wilcox will develop a lecture on neurobiology of decision-making, working with Ann Manzardo.

The meeting adjourned with lots of work to be done, but a feeling that a great deal had been accomplished in the prior three days. Everyone was wished a pleasant and swift trip home.

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