Meeting #28

New York City

March 27 - 30, 2013



MINUTES OF THE ALCOHOL MEDICAL SCHOLARS PROGRAM MEETING

March 27, 2013 through March 30, 2013

NEW YORK, NY

Attendees: Marc Schuckit (Director), Susan Tapert (Associate Director), Marianne Guschwan (Associate Director); Second-Year Scholars Eric Gunderson, Claire Wilcox, Courtney Bagge; First-Year Scholars Melanie McKean, Shelley Holmer, Gail Basch, Ben Nordstrom, Evan Goulding; and Marcy Gregg (Administrator); as well as Maju Koola and Jodi Gilman (Observers).

WEDNESDAY, March 27

The meeting began at 6:30 pm in the lobby of the Park Lane Hotel in Manhattan. All participants were introduced and the schedule for the next three days was discussed. The meeting moved to an informal dinner with significant others at Remi Restaurant.

THURSDAY, March 28

The day began at 8:00 am with a review of the schedule and decisions about the order of presentations and discussions.

The first presentation was an Overview of How to develop a Lecture, Paper, or Grant Application by Marc Schuckit. The emphasis was on how to better prepare the new group of scholars in September 2013 for the process they were about to begin. Among the suggestions was the need to better explain why the deadlines are so important; the need to review the bullet points immediately before starting the process; and the importance of reminding the Second-Year Scholars of their important roles.

Marc next reviewed these points again by presenting his lecture on DSM-5. The points he made included the key role of keeping the audience in mind and using appropriate but non-distracting slides.

First year Scholar, Evan Golding, next reviewed his AMSP-related accomplishments at Northwestern Medical School. Evan utilized his AMSP training to develop and deliver several lectures: 1) a general lecture on substance use disorders with a focus on alcohol use disorders screening, brief intervention and treatment of withdrawal for physician’s assistants; 2) a lecture on risk factors for and neural systems involved in substance use disorders for psychology students; and 3) a lecture focused on screening and brief intervention for alcohol use disorders for the Healthy Living medical student course. He mentored a psychiatry resident on a senior research project investigating motivations for alcohol and prescription opiate use in those who have professional degrees, and he participated in a medical student education content meeting to discuss integration of substance use disorder topics into the medical student curriculum via the Lifestyle Medicine thread. Evan also met with members of the Northwestern Psychiatry department on several occasions to establish a set of goals for development of the substance use disorders program at Northwestern, including aspects of education, treatment delivery, and research. He continued his work as co-chair for the addiction seminar arranging to have speakers from the Chicago area present their work in diverse areas related to substance use disorders to residents, fellows, and staff each month.

Courtney Bagge, Second Year Scholar, next reviewed her accomplishments over the prior six months at the University of Mississippi. Dr. Bagge used AMSP methods to lecture to psychiatry residents on the “Assessment and Documentation of Suicide Risk” with a special focus on alcohol intoxication, gave a lecture on “Mood Disorders” to second-year medical students, lead a small group interviewing course focusing on substance-disordered patients, provided a lecture on “Acute Alcohol Use” to first-year medical students, and presented at a town hall meeting on “Acute Alcohol Use and Suicidality” for the Atlanta Chapter of the American Foundation of Suicide Prevention. Dr. Bagge mentored psychology undergraduates, early-level graduate students, and psychology and psychiatry residents regarding how to use the AMSP approach to present clinical case conferences, research rounds, and lectures for community providers, as well as to organize manuscripts for publication. She has had active participation by students at all levels of training in her ongoing and expanding alcohol research program, and during the past six months has published five manuscripts. She is the PI on a R21 grant from the NIAAA focusing on a novel methodology in the examination of acute alcohol use and suicide attempts, has a National Institute of Health Clinical Research Loan Repayment Renewal award, and has submitted a large multi-site grant to the Department of Defense that examines acute alcohol use as a warning sign for suicide attempts among veterans. Further, she was recently named an expert in Substance Use Disorders and Suicidality by an NIH research task force. Dr. Bagge also expanded her Mood Disorders Outpatient Clinic to incorporate dual diagnosis of substance use disorders and supervised psychology residents. Finally, she presented research focusing on acute alcohol use at the Association for Behavioral and Cognitive Behavioral Therapies national conference, and additionally, will present symposiums focusing on alcohol involvement (acute alcohol use and alcohol use disorders) at the upcoming Research Society on Alcoholism and the American Association for Suicidology conferences. Dr. Bagge is committed to continue to mentor and involve students at all levels of training when providing alcohol-related education, supervising the treatment of patients with alcohol use disorders, and conducting and publishing alcohol-related research.

A working lunch then began with a discussion of Issues Related to Flourishing in Academic Medicine. These included: how to avoid becoming over committed; getting credit for work done; when to include (or not) other members of grants in a paper; the role of a corresponding author; assets and liabilities of working with the VA and with pharmaceutical companies, and related topics.

Evan Goulding, First Year Scholar, next presented his lecture on Motivations for Alcohol Use. This lecture was effective and on an excellent level for first-year medical students, with clear and effective slides. As an exercise at showing how lectures can be modified to shorter time frames by focusing on the 4 or so main points, the entire group than worked with Evan on decreasing the lecture to 30 minutes and < 30 slides; then to 10 minutes and 10 slides.
The day adjourned at 3:00 pm, with scholars being on their own for dinner that evening.

FRIDAY, March 29

The meeting reconvened at 8:00 am with the report by Claire Wilcox, second Year Scholar regarding her accomplishments at the University of New Mexico Medical School. Dr. Wilcox has done a variety of things as a result of her experience with AMSP to improve medical education in recognition and treatment of substance use disorders at the University of New Mexico. First, as a lecturer to residents, pharmacy students, psychologists, and social workers, she has revised many of her talks (cannabis use disorders, assessment and treatment of individuals with co-occurring substance use and psychiatric disorders, alcohol use disorders treatment, impaired decision-making in substance use disorders, neurobiology of substance use disorders, motivational interviewing training, GABA and anxiety) using skills learned at AMSP and using slides/talks on the AMSP website. In addition, as the addictions fellowship didactics coordinator, she has referred colleagues to the AMSP website for assigned lectures. Her AMSP experience has also improved her presentation style in other lectures and trainings (for example, regarding motivational interviewing), as well as the clarity of her writing in research papers, grants, and review articles. Specifically, she has implemented tools used to write a review article this year on ‘Cognitive Control in Alcohol Use Disorders’ (which is closely related to the topic of the talk she developed for AMSP). She is also a mentor and/or supervisor for a number of medical students and psychiatry residents, and has gained advice from Dr. Schuckit during these meetings about mentoring, which has helped her ability to provide better mentoring advice. During an ongoing 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, she will encourage faculty to access the AMSP website. She is a member of the IRB committee, she is funded on an R21 and K23, and she reviews articles for many journals, and skills used at AMSP have come in handy in many critiquing and writing projects associated with these other activities.

Ben Nordstrom. First Year Scholar from Dartmouth, then gave his lecture on Drug Courts. The lecture worked very well and was delivered with an easy and enticing style. A few suggestions were made about several slides, and these were incorporated into the lecture itself.

Next, Shelley Holmer, First Year Scholar, gave her lecture on Spice (Synthetic Cannabinols). This was very challenging because of the lack of solid data in the literature, but the lecture was as evidenced based as possible and very effective. A few suggestions were offered regarding avoiding jargon and some things that could be added to the slides to spice up the presentation a bit (pun intended). This is a very important addition to the AMSP Website.

Gail Basch next gave her report on her accomplishments at Rush Medical School. Dr. Basch has used the AMSP approach with: first- and second-year medical students during their ongoing physicianship course weekly throughout the academic year; third-year students as they rotate through their core psychiatry clerkship; third- and fourth-year students as they rotate through the Rush Addiction Medicine Program; and residents during individual supervision time. Two of Rush’s graduating PGY4’s will go on to careers in Addiction Medicine, both having been supervised weekly by Dr. Basch this past year. Dr. Basch serves on the Department of Psychiatry’s residency recruitment committee, CME Committee, Professional Assistance Committee and gives the yearly incoming physician health and wellness orientation for all interns and fellows beginning at Rush. She recently participated in a career development track for medical students interested in psychiatry, sitting on a panel and discussing her career and particular interests. As director of the Rush Addiction Medicine program, Dr. Basch works closely with her department chair in determining the future course of alcohol and drug-related education and treatment As a result of Rush University Medical Center public relations being made aware that Dr. Basch is an AMSP scholar, she has been called upon for various media interviews as an expert in the field.

The working lunch included career development issues of: roles of co-authors on grants; volunteering to help a colleague on research and how to get credit for this; balancing grant writing and paper writing times; meanings of “polysubstance dependence”; what criteria can be used to know if it is time to move from one job to another; working with “head hunters”; etc.

Melanie McKean, First Year Scholar from St. Louis University, next presented her report of activities. She was invited to speak at St. Anthony’s Medical Center (in St. Louis) for their 2012 Memorial Lecture on “How to Manage Stress as a Healthcare Provider”, and wrote a 2-part review article entitled "Psychiatric Care in Pregnancy and Postpartum" for Psychopharmacology Review. Dr. McKean has regular interactions on the Consultation Service with medical students and residents regarding substance use disorders, and has reached out to students linked to OB/GYN as well as a range of student interest groups regarding substance use disorders and women’s health topics. She has also been invited to speak during MS3 OB/GYN rotation didactics. Melanie mentors 3 residents on a monthly basis, as well as 2 others on a weekly basis, and she has been assisting some with development of presentations, utilizing AMSP methods and directing them to the AMSP website for some topics. She is hoping to present a formal lecture on How to Present a Lecture later this spring. In addition, she has been mentoring 2-3 MS3’s for their monthly psychiatric presentations, as well as some MS3’s & MS4’s regarding career planning. In collaboration with another physician, she has worked on treatment algorithms for substance use/intoxication when patients present to the ER, and plans to present lectures to educate Internal Medicine residents on topics including the treatment of substance use disorders, as well as decision-making capacity, delirium, initiation of antidepressants, etc. Melanie has been asked to speak at an upcoming Multiple Sclerosis Society symposium (August 2013) on psychological health/psychiatric issues with MS and will utilize AMSP strategies, as well as discuss substance-related issues with MS. Melanie has publicized her involvement in AMSP and encouraged her colleagues to utilize the website and has noticed how much involvement in AMSP has changed her interactions with medical students and residents, as well as patient care.

Courtney Bagge, Second Year Scholar, next gave her short version of her lecture on Suicide and Alcohol. This was particularly challenging because of the difference in educational level between med students and such volunteers, and Courtney did a wonderful job. Some suggestions were made regarding organization of the material and the final product was very impressive.

Eric Gunderson, Second Year Scholar, next presented the short version of his lecture on treating chronic pain while minimizing the risk for dependence, but as modified for nurses. Again, this was effective and important, as well as a fine example of how flexible lectures can be for different audiences without investment of a great deal of time.

Ben Nordstrom, First Year Scholar, offered a report of his recent accomplishments at Dartmouth. For undergraduate medical education, Dr. Nordstrom gave a lecture entitled “Introduction to Addictions” to second-year medical students, has lectured on “The History of Opioid Dependence” for third-year medical students, and has a regular lecture on “Illicit Drugs” that he delivers to third-year students on their psychiatry rotation. Dr. Nordstrom provided a lecture on “Illicit Drugs” to Dartmouth-Hitchcock Medical Center internal medicine residents, where he also lectured on “Neurocircuitry of Addiction” and has used Alcohol Medical Scholars techniques for lecturing at the post-training level, has twice given lectures at all-day Continuing Medical Education seminars, provided a grand rounds as an invited speaker at Riverview Psychiatric Center in Augusta, Maine and provided a lecture on personality disorders to the Crisis Intervention Team of the Lebanon New Hampshire Police Department. He is routinely using AMSP techniques in lectures he provides as part of an ongoing collaboration between the Dartmouth Psychiatric Research Center and the State of Vermont’s Department of Health’s Department of Vermont Health Access and the Blueprint for Health. He and his colleague are running a series of Learning Collaboratives for medication-assisted therapy to improve the treatment of opioid dependence across the state of Vermont and is lecturing to buprenorphine providers across the state on a number of topics designed to reduce practice variation and improve quality of care for office-based opioid therapy. Finally, Ben has also partnered with the Betty Ford Institute and Dr. Thomas McLellan, Director of the Treatment Research Institute at Penn, to develop a curriculum for addiction education in medical schools across the country, while working others to develop lecture and case-based content that will be available to all U.S. medical schools to improve addiction education.

The meeting continued in the evening as a working dinner at Abboccato Restaurant. This was an enjoyable way to review the day and the tasks scheduled for Saturday.

SATURDAY, March 30

The group reconvened at 8am with the presentation by First Year Scholar, Gail Basch, of her lecture on College Drinking. This lecture had a strong data base and is an important topic. The discussion was used as a basis for reviewing the roles of the Second Year Scholars in helping the new scholars in September. The group worked as a team in reviewing the material slide by slide, making changes as we went along.

Next, First Year Scholar, Melanie McKean delivered her lecture onAlcohol Use in Pregnancy. The slides were excellent, the text of the outline was appropriately detailed, and the delivery warm and inviting. A few minor changes were suggested.

Claire Wilcox, Second Year Scholar, next delivered her shortened lecture on how bad choices contribute to developing and maintaining substance use problems, but now as aimed at a freshman college group in their introductory course on alcohol and drugs. The lecture worked very well, and was used for a discussion of how to handle a lecture when time was running out but there was still material to be covered.

Shelley Holmer, First Year Scholar, next reviewed her recent accomplishments at Duke Medical School. In the last six months, Shelley worked toward her goal of surveying the current curriculum and looking for areas where medical student education on substance use disorders could be enhanced. She found that in the core clinical clerkship students get minimal exposure to patients whose presenting diagnosis is a substance use disorder. Her medical school currently has one lecture during the clerkship on Alcohol Abuse and Dependence. Dr. Holmer has developed a second lecture on Substance Intoxication and Withdrawal Syndromes, and will be adding it to the core curriculum in the next academic year. In addition, she has expanded her lecture on The Diagnostic Interview to discuss how to best ask about substance use in a more in-depth way that avoids stigma. Outside of the core lecture series, she plans to present her lecture entitled Synthetic Cannabinoids to the Medical Student Psychiatry Interest Group noon lecture series and hopes to make this a case presentation. Dr. Holmer has also reviewed the curriculum of the Psychiatry Residency Training Program at Duke. The Residents there have a more robust exposure to substance use disorders both in their clinical rotations and in their didactics. As a member of the Curriculum Committee for Residency training, Dr. Holmer has advocated for more Motivational Interviewing Training for the residency to help them address substance problems, and this will be added to the curriculum in the next academic year. Also there will be a new Chief Residency position at a local treatment program for substance use disorders who may find the AMSP Web site helpful as she develops curriculum for her new position. Dr. Holmer has volunteered to work with the resident on this.

Eric Gunderson, Second Year Scholar, next reviewed his recent accomplishments at University of Virginia (UVA), Charlottsville, Department of Psychiatry & Neurobehavioral Sciences. Dr. Gunderson’s efforts targeted all levels of physician training, including medical students, house staff, and practicing physicians. For medical students, he used the AMSP approach to guide his substance use lecture and outline development for a Team-Based Learning course on substance use disorders. For medical house staff, Dr. Gunderson utilized AMSP techniques to administer small group lectures on alcohol screening and intervention in primary care, as well as deliver a case-based lecture on risk management during opioid analgesic prescribing. He delivered a similar curriculum to Addiction Psychiatry Fellows at Columbia University College of Physicians and Surgeons, where Dr. Gunderson maintains an Adjunct Research Scientist appointment, using content that overlapped with the lecture he prepared for the AMSP. Later in the spring, he will be presenting the opioid risk management lecture to nursing staff at UVA, and will continue working with the hospital’s online training on opioid prescribing using AMSP techniques as well. AMSP lecture preparation and delivery strategies were utilized when preparing a research talk on designer drug use delivered at an annual meeting for the American Society Addiction Medicine (ASAM) in the spring and also for the UVA Department of Medicine's mid-Atlantic meeting on Advances in Clinical Medicine. Dr. Gunderson continues his role as a Physician Clinical Support System (PCSS) national mentor on the use of buprenorphine treatment for opioid dependence. He presented an online webinar lecture for the PCSS on clinical practice models of buprenorphine induction, the process by which the medication is initiated. AMSP techniques were essential for development and organization of the lecture.

The remaining issues involved: handing out bullet points regarding being a second-year scholar; thanking the graduating second-year scholars for all their help and hard work; and wishing everyone well and a safe trip home. The meeting adjourned at 12 noon.

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