Meeting #27

Kona, Hawaii

October 24 - 27, 2012



MINUTES OF THE AMSP MEETING

October 24, 2012 through October 27, 2012

The meeting began on Wednesday, October 24, 2012 in the late afternoon as the participants assembled for introductions and a description of the schedule for the meeting. The seminar was held at the Mauna Kea Beach Resort near Kona, Hawaii. Present were: Marc Schuckit (Director); Susan Tapert (Acting Associate Director); second-year scholars Courtney Bagge of the University of Mississippi and Claire Wilcox of the University of New Mexico; along with first-year scholars Ben Nordstrom from Dartmouth, Shelley Holmer from Duke, Melanie McKean from St. Louis University, Gail Basch from Rush University, and Evan Goulding from Northwestern University, and Marcy Gregg. The group retired to a working dinner where the goals of the meeting were discussed in more detail presented for the Thursday morning gathering.

Thursday, October 25

The meeting began at 7:30 a.m. at the hotel with Marc introducing himself and asking each of the first- and second-year scholars to briefly review their career goals, research interests, as well as clinical experience. Marc Schuckit reviewed the need for first-year scholars to decide on lecture topics, the aim of having each scholar matched with a mentor before the end of the meeting, and the importance of developing and expanding alcohol and drug education in their medical schools.

The first presentation was given by Marc Schuckit using a lecture on genetic and environmental influences in alcohol dependence as an example of the level of detail and slides appropriate for the AMSP website. Marc handed out a lecture outline similar to the documents expected from each of the first-year scholars and delivered the lecture. The 50-minute presentation was delivered as if to a group of first-year medical students, and the first- and second-year scholars then engaged in a lively discussion regarding what material could be added, information that did not come through as clearly as it might, and the structure of slides. At the end of the lecture Marc emphasized how it was important to pay close attention to the level of detail in the outline, the use of sentence fragments that would be easy for the audience of medical students to follow, and the use of the outline format. Marc then asked one of the second-year scholars to prepare the same lecture on Friday of the meeting to demonstrate how all lectures for AMSP are prepared for delivery by other individuals (e.g., a professor in Belgium) who can take the material from the AMSP website and deliver the material to his or her class of medical students.

Marc Schuckit then continued the discussion of optimal teaching approaches for medical students by delivering his lecture entitled: How to Give a Lecture. The first and second-year scholars then commented on material in that lecture that could be improved upon, and second-year scholars offered thoughts on aspects of the lecture that were most relevant to the first-year scholars as they turned to their own lectures over the next several months.

The meeting progressed to a preliminary discussion of potential lecture topics for the first-year scholars. The assets and liabilities of various approaches were considered, some of the challenges in making these topics most accessible to first-year medical students was emphasized, along with the need to select a lecture topic that is directly related to the scholar’s own area of interest.

The working lunch was then used to discuss issues related to thriving in academic settings. This included problems and challenges related to time management and balancing responsibilities between home life and work. The group also discussed how to say yes and when to say no when asked to take on new tasks, as well as the manner in which individuals are likely to be judged when time for promotion arrives.

Claire Wilcox, second-year scholar from the University of New Mexico, then delivered her lecture on decision-making. This was an excellent lecture, and the presentation was used to discuss how to decide which slides are the most essential to a lecture and appropriate for medical students, and which slides can be deleted. The entire group of first- and second-year scholars then reviewed all of the slides, suggested areas for changes, offered some thoughts on how material within the slides might be modified a bit, and Claire was asked to represent the shortened version of the lecture on Friday.

Courtney Bagge, second-year scholar from the University of Mississippi Medical Center (UMMC), then presented an overview of her AMSP-related activities at her medical school over the prior six months since the last AMSP meeting. Dr. Bagge used AMSP methods to lecture to psychology residents on “Suicide Risk Assessment” with a special focus on alcohol intoxication, and also gave a variety of lectures that included: presenting on “Acute Alcohol Use and Suicide Attempts” to first-year medical students; leading small group interviewing courses focusing on substance-disordered patients; providing a lecture on “Suicide Safety Planning” to psychiatry residents; and giving a lecture on “Mood Disorders” to the Physicians Assistant’s Program at another institution, Mississippi College. Dr. Bagge mentored psychology undergraduates, early-level graduate students, and residents in using AMSP techniques to present clinical case conferences, research rounds, and lectures for community providers, as well as to organize manuscripts for publication. She had active participation by students at all levels of training in her ongoing and expanding alcoholism research program, and was a mentor for the prestigious Medical Student Research Program’s Summer Student Research Fellowship. She has been awarded a R21 grant from the National Institute on Alcohol Abuse and Alcoholism, and a National Institute of Health Clinical Research Loan Repayment Renewal award focusing on substance use disorders within suicide attempts, and she continues to collect data on a project funded by the American Foundation for Suicide Prevention focusing on novel methodologies in the examination of acute alcohol use and suicide attempts. Dr. Bagge is also expanding her Mood Disorders Outpatient Clinic to incorporate dual diagnosis of substance use disorders where she will supervise psychiatry and psychology residents. Finally, she will present research focusing on acute alcohol use at two national conferences, and will continue to mentor and involve students at all levels of training in conducting and publishing alcohol research.

The group then adjourned to consider topics and reports scheduled for Friday’s presentations. On this Thursday evening, scholars made their own dinner arrangements.

Friday, October 26, 2012

The AMSP meeting was called to order at 7:30 a.m. The meeting began with a revisit of the issue of appropriate topics for the first-year scholars. Decisions were made that: 1) Ben Nordstrom will develop a lecture related to drug courts as appropriate alternative mechanisms for substance-related crimes; 2) Gail Basch will focus her lecture on problems related to implementing recent research findings in clinical treatment programs, with an emphasis on the application of this problem to programs that treat individuals with substance abuse and dependence; 3) Melanie McKean will develop a lecture on alcohol use in pregnancy; 4) Evan Goulding will explore if he wishes to present material on the role of motivation in the initiation and continuation of substance use and related problems; while 5) Shelley Holmer will develop a lecture related to spice, dronabinol, and other cannabinol agonists.

Courtney Bagge then presented her lecture developed as a first-year scholar regarding alcohol and suicide attempts. Once again, this was an excellent lecture and was used as a format to discuss whether some slides can be removed and others clarified a bit to develop a shorter focused lecture as well. This exercise progressed well, and Courtney will consider whether she wants to change any of the slides currently listed as part of her excellent lecture.

Next, Marc Schuckit followed through on a request made by scholars the prior day to take his 50-minute original lecture on the level of response (or sensitivity) to alcohol and produce a 10-minute lecture appropriate for fundraising. He had promised to take no more than 20 minutes tat evening to modify his original 50 minute lecture with 40 slides into a 10 minute presentation with 10 slides as is it was a request to donors for money to support his research. The goal was to demonstrate how similar information can be delivered in different ways to different audiences to accomplish different goals. The lecture went well, the material was quite different in tone from the context from the lecture given the day before, but the slides were taken from that prior lecture with only small modifications. The group discussed the process of altering a lecture from one format to another.

Claire Wilcox next presented her altered lecture on decision-making. Here, she had deleted nine slides that dealt with neuroanatomy (beautiful slides that were difficult to jettison but that were not essential and might be a bit difficult for medical students to follow) Claire also clarified several other slides, making minor changes that allowed for easier flow and closer following of the major points by the audience. This produced an excellent result that will be loaded on the AMSP website as an alternative shorter version of Claire’s original effective lecture developed the prior year.

Claire Wilcox next presented her AMSP-related accomplishments over the last six months at the University of New Mexico. Dr. Wilcox, has done a variety of things as a result of her experience with AMSP to improve medical education recognition and treatment of substance use disorders at the University of New Mexico. As coordinator/lecturer of didactics for residents in the dual diagnosis clinic and didactics for the addiction fellow, she has revised many of her talks using the AMSP format and has referred colleagues to the AMSP website for lectures. She also gave Grand Rounds to the Department of Psychiatry using a version of the talk she developed for AMSP, and has given other variations of that talk in many settings across the university, including via video and telephone to rural areas, to residents in other years and to students in the School of Pharmacy. In addition, she is currently in the process of helping to plan a faculty development lecture series in which she will likely have the opportunity to give the ‘How to Give a Lecture’ talk from the AMSP website, as well as pass on some of the career development pearls she has learned from lunch discussions with Dr. Schuckit. Claire is a mentor and/or supervisor for a number of medical students and psychiatry residents, and hopes to be closely involved with a push to expand the medical school curriculum to include more hours of didactics on and clinical exposure to assessment and treatment of substance use disorders.

Marc Schuckit then gave an overview of recent activities on the website. Because of changes in the reporting format for the website, Marc placed an emphasis on the prior reporting style as it generated information most relevant to the functioning of the site over time. In the prior five months ALCOHOLMEDICALSCHOLARS.ORG had been visited by individuals from ~120 countries, with the majority from the U.S., but 5% or more of the visits coming from 10 additional countries, including China, Russia, Australia, Canada, and New Zealand. The website results demonstrate a robust interest in AMSP lectures and can be used by our scholars to document the national and international impact that they are having through their work with us. This is important as such evidence is often required for promotions for the next stage in an academic setting.

Courtney Bagge then presented her alterations to Marc Schuckit’s lecture on the sensitivity to alcohol. This demonstrated how someone who comes from a vastly different field (psychology as opposed to genetic studies on alcoholism) can take the lecture outline format developed for AMSP and deliver a very effective lecture that has modifications that fit the new lecturer’s interest. Hopefully, the demonstration of the original lecture with an outline, followed by the modification of the original material and delivery by someone from a different field of work is a useful exercise to help first-year scholars as they turn toward their own areas of interest.

Susan Tapert then led a discussion on issues related to the development of PowerPoint slides. This half-hour exercise incorporated input from all first- and second-year scholars, and was very effective and enjoyed by all.

The working lunch on Friday returned to issues of career development. In addition to considerations for promotion, funding sources for grants, the relative importance of the source of funding regarding evaluations for promotion, the group also had a useful discussion of the process involved in DSM-5, as well as what is likely to be the final product in May, 2013.

The discussion next focused on the optimal matching between first-year scholars and mentors. For these: Ben Nordstrom will work with Claire Wilcox; Gail Basch will work with Marc Schuckit; Melanie McKean will work with Susan Tapert; the mentor for Evan Goulding will be Courtney Bagge; and Erik Gunderson, the second-year scholar (who could not attend the Kona meeting due to the very recent birth of his son) will work with Shelley Holmer.

The Friday meeting ended with a discussion of the plans for Saturday morning. This will include reports by each of the first-year scholars regarding their plans for enhancing alcohol and drug education at their medical schools. The group is to reconvene on Friday evening for a working dinner at the Brown’s Beach House Restaurant. They will meet in the lobby of the Mauna Kea hotel to proceed to the dinner together.

Saturday, October 27

The group reconvened at 7:00 a.m. to review accomplishments and future directions.

The first order of business was to discuss questions first-year scholars might have regarding the lectures they are developing. Among the issues that arose is the potential that after beginning to organize a lecture, it is possible to discover that the topic is overly broad, has not been well studied in the literature, or that the lecture appears to be inappropriate for first-year medical students. Should that arise, scholars are encouraged to contact Marc and it is no problem to work toward developing a new topic to substitute for the old. The second issue was a question of how much time can be devoted to the development of the lecture, and the answer depends on how much time each person has available to meet the deadlines that are about to be established for phases of development of the lectures. A third issue is the probability that some scholars will begin to consider developing an outline and have problems focusing on what the four key points might be. A step that can be taken to avoid or handle this problem is to always keep in mind (almost like a blinking neon sign) the specific focus of the lecture, and the fact that it is to be delivered to first year medical students. In other words, a subtopic might arise that the scholar thinks is very interesting to follow, but might not be appropriate for the audience and should be considered a road best left for another time—not for this lecture.

The next item of business was to establish deadlines for the stages of development of the lecture:

1. By December 31, 2012, the scholar and mentor should have progressed through five, six, or even more drafts of the lecture and have it developed to the point that both scholar and mentor think is as good as it can be. Prior to December 31, the scholar and mentor should send Marc a copy of all correspondence related to the development of the lecture, along with lecture drafts, so that he can offer advice where needed. After December 31, regarding the lecture outline, the scholar will work primarily with Marc, sending carbon copies of future drafts and comments to their mentor.

2. By January 31, 2013, Marc and the scholar should have reached the close to final version of the outline. During that month, the scholar should continue to work with their mentor in developing the slides (hopefully less than 40).

3. By February 28, 2013, the slides and outline should be complete. This leaves most of March for the scholar to make any last minute changes, practice the lecture, touch up slides, and take any other steps necessary to prepare for presenting the lecture at the meeting in New York, beginning on March 27, 2013.

At the March meeting, the first-year scholars will present their 45-minute lectures as if lecturing to first year medical students. Also at that meeting, second-year scholars (Claire Wilcox, Courtney Bagge, and Erik Gunderson) will be asked to present a shorter version of their own lecture demonstrating how the original lecture can be modified for a separate audience. Marc will work with all the second-year scholars several weeks before the March meeting to establish what that alternative lecture might be (it must be one with which the second-year scholar is comfortable).

The meeting ended with each of the first-year scholars presenting their tentative plans for expanding alcohol and drug education at their medical schools over the six months between the fall 2012 and the spring 2013 meetings.

Ben Nordstrom of Dartmouth University first presented his goals. Dr. Nordstrom plans on using information from the Alcohol Medical Scholars program to modify the substance use disorders curriculum at the undergraduate, graduate, and post-graduate educational levels at Dartmouth. He will meet with Dr. Matthew Duncan, who directs an undergraduate course on alcohol use and alcoholism, in order to review the curriculum and see what, if any, improvements can be made. Dr. Nordstrom will also apply the lessons he learned at AMSP to modify a lecture entitled "Introduction to Substance Use Disorders" to second-year medical students in their Scientific Basis of Psychiatry course (this lecture is also cross-listed in the second-year Psychopharmacology class). In addition, Ben will use lectures from the AMSP series to create specific curricula for the third-year and fourth-year medical students on “Addiction Psychiatry” rotations. He will similarly create curricula for second-year psychiatry residents on their compulsory two-month substance use disorders psychiatry rotation. He will use AMSP lectures for presentations to third-year medicine residents and pain (anesthesias) fellows rotating through the “Addiction Treatment Program.”

Evan Goulding at Northwestern University reviewed his potential goals for the upcoming six months. He will utilize the AMSP training in developing: a lecture for first year medical students and physician’s assistants on substance use disorders with a focus on the continuum of problems with use and the utility of early brief intervention in primary care settings; a lecture for first year medical students on substance use for a course on behavioral determinants of healthy living; and a lecture on animal models of substance abuse for psychiatry residents and on initiation of use and progression to dependence for child and adolescent psychiatry residents. He will begin supervising an “addiction psychiatry” fellow in a new continuity of care clinic based out of the faculty practice. He will continue to co-chair the monthly substance use disorder seminar at Northwestern recruiting basic and clinical researchers from the Chicago area to discuss their work in an informal setting. Evan will work with members of his department to develop an outline for development of the substance use disorders program at Northwestern. Finally, he will meet with the chair of his department to explore the possibility of surveying the Northwestern medical campus to determining the state of existing training at the downtown campus.

Shelley Holmer, a first-year scholar, is a faculty member in the Department of Psychiatry at Duke University Medical Center. In her role as Director of Undergraduate Medical Education, she manages and oversees all Duke medical student activities in the Psychiatry Department. Over the next six months Dr. Holmer will review all areas where the students currently get both didactic and clinical training in the area of substance use disorders and identify areas that can be improved upon. Changes already identified include adding a lecture to the psychiatry clerkship on Substance Intoxication and Withdrawal Syndromes, and reviewing the need for updates in the current core lecture on Substance User Disorders: Diagnosis and Treatment. She will also make substance use disorders a topic for the medical Student Psychiatry Interest Group noon lecture series, as well as the Psychiatry and Cinema group attended by both medical students and psychiatry residents. In addition to increasing medical student training and exposure to this topic, Dr. Holmer will inventory the areas where Duke Psychiatry residents get training in substance use disorders. In her position on the duke Psychiatry Residency Curriculum Committee, she will work towards increasing and improving training in this area.

Melanie McKean of St. Louis University School of Medicine then reviewed her potential goals for the upcoming six months. She hopes to gain knowledge of the curriculum involving substance use disorders and treatment currently offered to SLU medical students, and provide guidance to the faculty administering those lectures, including directing them to the AMSP website. Melanie will also work to take a more active role in the education of the psychiatry residents by providing lectures to them as part of their didactics programs, and giving mini-lectures to residents and medical students rotating on the consult-liaison service. As her AMSP lecture on Alcohol Use Disorders in Pregnancy is developed, she is hoping to present it not only to the Psychiatry division, but also to the departments of OB/GYN and Family Medicine. One of Melanie's current roles at SLU is providing psychiatric care at the SLU Student Health and Counseling Center on the undergraduate campus; she is hoping to collaborate further with the counselors there that provide more in-depth treatment to undergraduate students with substance use disorders, as well as be involved in their outreach and education program to all students at SLU. Melanie hopes to be able to collaborate with one of the research projects at SLU involving treatment of pregnant and postpartum women and alcohol use disorders, funded by a Prenatal Mental Health Grant. She is planning to notify university PR of her involvement in AMSP, and utilize many of the aforementioned opportunities to direct healthcare providers to the AMSP website.

Gail Basch of Rush University will use the new skills learned at the AMSP meeting to enhance her teaching style, presentations, speaking opportunities, and career development, with continued focus on drug and alcohol education at Rush University Medical School. Dr. Basch will utilize her new skills as she teaches the M1- M2 Physicianship Class, as well as the Core Clerkship M3 Substance Use Disorder. She also plans on presenting “How to give a Lecture” presentation to appropriate students, residents and fellows. She hopes her AMSP lecture that is in development will be modified to fit venues such as in-service and community lectures, media-related requests, and education of organizations such as TASC, Inc (Treatment Alternatives for a Safe Community) and the Robert Crown Heroin Prevention Project as well as for use in her role as Medical Director of the Rush Addiction Medicine Services. Ahead of her are the tasks of organizing the four year curriculum for residents in Alcohol and Drug Education, supervising the Chief Resident, constructing the vision for expanding Alcohol and Drug Services, integrating clinical services with active research projects, and interfacing with departments in order to improve treatment services. Dr. Basch hopes to impact on alcohol and drug education at Rush through her service on the Rush Psychiatry Steering Committee, the Rush Psychiatry Recruitment Committee, and rush Psychiatry Continuing Medical Education Committee, and the Rush Professional Health Committee.

The meeting adjourned with all scholars having chosen mentors, the schedule of goals for the development of the lecture established, and all members wishing everyone a safe and comfortable trip home.

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