Meeting #29

La Jolla, CA

September 25 - 28, 2013



Minutes of the AMSP Meeting

September 25, 2013 through September 29, 2013

Present at the meeting were first-year scholars Arthur Westover, UT Southwestern, Kelly Barth from the Medical University of South Carolina, Rob Leeman from Yale, Myo Myint from Tulane, and Michelle Bruce from Meharry Medical College. Also present were second-year scholars Shelley Holmer from Duke, Evan Goulding from Northwestern, Melanie McKean from St. Louis University and affiliated programs, and Gail Basch from Rush University in Chicago. Jessica Skidmore was an invited guest from UCSD, Marc Schuckit was AMSP director with Marianne Guschwan as associate director, and the administrative assistant for AMSP was Marcy Gregg.

Wednesday, September 25

The group met in the lobby of the La Jolla Beach and Tennis Club for introductions. The goals of the meeting were presented, along with a tentative schedule of events. After a period of time for getting to know each other and networking, the group continued to meet over dinner at Piatti's restaurant in La Jolla.

Thursday, September 26

The AMSP participants began their meeting at 8:00 a.m. over a working breakfast. Marc Schuckit began the introductions and asked all participants to briefly review their background and to present their work and the universities from which they came. This first section of the meeting progressed to a discussion of the agenda, along with assessment of the time slots for second-year scholars to demonstrate their 45 minute lectures developed for AMSP the prior year, and for their presentation of the accomplishments regarding expanding education on alcohol and drugs at their universities. The first-year scholars were also reminded that on the final day of the meeting they would also present the accomplishments they hope to address during the next six months. Scholars were told about the importance of taking notes on important issues during the next three days, along with the fact that the luncheon periods will be used for discussion of issues related to academic careers. First-year scholars were reminded that by Thursday of the meeting they are expected to have selected the topics for their lectures and that on Friday or Saturday each first-year scholar will be assigned their mentor.

Marc Schuckit then delivered his lecture on how to give a lecture (or how to communicate your ideas to an audience). This presentation and discussion occupied the entire morning, along with a half-hour period following the lunch. Marc handed out a detailed outline of what goes into developing grand rounds, a scientific lecture, a presentation to first-year medical students (the example that is followed for all AMSP lectures posted on the website), with similar approaches being used for a scientific paper or for a grant application. Second-year scholars offered many helpful comments that translated some of the guidelines into actual practice as they experienced during their first year, and first-year scholars asked important questions regarding how the outline and guidelines are likely to apply to their lectures. It is important to note that the September 2013 detailed version of the lecture is now posted on the AMSP website. After the lecture, Marc distributed slide copy to serve as examples for many of the guidelines regarding content of the outline, as well as the slides themselves.

Lunch was served as part of the meeting and was a time when scholars had the opportunity to carry out discussions and ask questions regarding issues in academic medicine. Topics included outlining many of the unique benefits of an academic career; thoughts on determining when (if ever) a young faculty member might decide to leave their current institution (in response to a question raised by a scholar); how to structure ones career when a department is facing major changes in senior personnel; how to adjust the types of jobs a junior faculty member is assigned when the original task does not generate enough financial support to make payroll obligations; the appropriate times and approaches for different types of grant applications (R21, R01, K awards, and post-K applications); and issues relating to developing a balance between home and office life.

Following the lunch Evan Goulding, a second-year scholar from Northwestern University, delivered his lecture on Motivations for Alcohol Use. As was true of the original lecture delivered six months previously, this was an excellent and very effective lecture with appropriate slides. Marc pointed out how well Evan's choice of blue, white, and yellow for the slides worked, as well as how the use of arrows to indicate increases, decreases, and so on helped save important space on the slides themselves. The lecture was so well developed, that Marc asked Evan to work with him in front of the group to demonstrate how a 45-minute lecture with almost 40 slides could be modified for a 5-slide lecture and to a 10-slide lecture lasting five to 10 minutes. The process involved identifying the four or five major points that needed to be made, identifying the key slides relating to those points, and, perhaps, simplifying the message or creating a group of slides that incorporate several aspects of an overarching message in one place. Evan was asked to return to the group on Saturday with a shortened version of the lecture, but to try to limit his efforts to no more than 30 minutes of work. This process demonstrates how much can be accomplished in modifying a lecture in a relatively short period of time.

Subsequently, Shelley Holmer, second-year scholar from Duke University, presented her accomplishments regarding expanding alcohol and drug education at her medical school. Dr. Holmer has delivered her AMSP lecture on synthetic cannabis to the medical students at Duke, and has increased awareness among medical students and residents about the regular misuse of drugs that are undetected on toxicology screens and the need to ask about them when taking a history. As Director of Undergraduate Medical Education in the Department of Psychiatry at Duke, Dr. Holmer has been actively working to expand the curriculum on substance use disorders for the medical students. She has expanded her lecture for the core psychiatry clerkship on “Taking a Psychiatric History” to include more information on how to skillfully take a substance use disorder history and why this is essential in all specialties. She has also added a lecture to the core clerkship curriculum on substance intoxication and withdrawal syndromes. In addition to her work with Duke medical students, Dr. Holmer works with Duke psychiatry residents as a supervising attending and in her role as Faculty Chair of the Psychotherapy Curriculum Subcommittee, and she advocated for and gained eight hours of motivational interviewing (MI) training for the psychiatry residents. Looking toward the coming year, Dr. Holmer hopes to develop a Residents as Teachers Program, incorporating the pedagogic wisdom she has gained from her experience with the Alcohol Medical Scholars Program. This program would also act as another platform to increase education to medical students about substance use disorders, as this would be one of the topics they are planning to develop for residents to teach students in the program.

Next, Gail Basch, second-year scholar from Rush Medical School, presented her recent accomplishments. Gail teaches the first- and second-year medical students in the weekly Physicianship Class, and contributes to the third-year medical school Core Clerkship Substance Use Disorders class. Recently, Dr. Basch presented her AMSP lecture on "College Drinking” in grand rounds for the Department of Psychiatry, and has been invited to present similar material to the alcohol and drug use focused grand rounds, as well as to the departments of Internal Medicine, Gerontology, and Pediatrics. Under her direction, a new 10-lecture alcohol and drug series for psychiatry residents begins this fall. As Medical Director of the Rush Addiction Medicine Services, Dr.Basch provides AMSP-style weekly teaching sessions, and instructs third-year students on how to develop a presentation utilizing the AMSP method. She continues to work on the overall plan for expanding alcohol and drug services at Rush, while integrating clinical services with research projects. Dr. Basch and her colleagues have submitted a SAMHSA grant proposal for education of staff regarding brief interventions throughout the medical center. Finally, Dr. Basch serves on numerous Rush committees, including those that address psychiatry steering, recruitment, continuing medical education, and the Rush Professional Health Committee.

The meeting adjourned with review of the major points regarding how to tell your story (or give a lecture), and a discussion of the agenda for the Friday and Saturday sessions. On Thursday evening, all scholars were on their own for dinner, and a bit of networking time was taken for scholars to organize their evening plans.

Friday, September 27

The meeting began at 8:00 a.m. over a working breakfast. During this time the first-year scholars were asked for preliminary thoughts about their possible lecture topic. Suggestions were made regarding ideas that might be more versus less appropriate for first-year medical students and issues that might be too narrow or too broad to work well in this type of content.

Shelley Holmer, second-year scholar from Duke University, next presented her lecture on Synthetic Cannabiniods (Spice). This was a very effective lecture with a fine and approachable delivery style that demonstrated that Shelley had full control of the knowledge needed for presenting the material. Scholars commented on the effective use of simple animation of words, as well as Shelley's excellent use of case histories to make the presentation optimally alive to the audience. The comments also highlighted the great challenges involved in avoiding jargon and making the material optimally available to the audience (first-year medical students).

Next, Gail Basch, from Rush University, presented her lecture on College Drinking. Once again, this was a fine lecture that was delivered with great skill and that will serve the AMSP website well. The flow of logic, level of organization, slides and delivery were all excellent.

Evan Goulding, from Northwestern, next presented his accomplishments regarding expansion of alcohol and drug education at his medical school. Utilizing his AMSP training, he develop several lectures for the new medical school curriculum at Northwestern: 1) a lecture on substance use epidemiology, risk factors, and impact for first-year medical students in their Health and Society lecture series, 2) a lecture on substance use disorders diagnosis, etiology, and treatment for second-year medical students in their Scientific Basis of Medicine lecture series, and 3) a general lecture on substance use disorders and their treatment for first-year psychiatry residents. Dr Goulding also participated in the development of small group training sessions for second-year medical students using clinical cases and interactive role play to teach brief intervention techniques for alcohol and other substance use, and has continued his mentoring work with a senior psychiatry resident to develop her research project into a poster presentation for the American Society for Addiction Medicine meeting. Evan used AMSP methods to develop a grand rounds presentation on home cage behavioral monitoring and mouse models of substance use disorders, continued to participate in the Addiction Medicine Program committee of the Northwestern Psychiatry department, which aims to develop new substance use disorder clinical, research, and training programs, and he works 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.

The working lunch discussion covered issues related to optimizing functioning in an academic environment that included: challenges in transitioning from a resident position to faculty at the same university (relating how to demonstrate to individuals who used to be your mentors that you are now on a faculty level), the importance of grants regarding promotion to associate professor; issues relating to optimal efficiency at work; thoughts regarding selection of a journal optimal for a particular topic; challenges related to the need to regularly publish papers to demonstrate progress on a grant and optimize the chances that the next stage of the work will be well received by a review committee; as well as additional related issues.

After lunch, Melanie McKean, second-year scholar from St. Louis University, discussed her accomplishments at St. Louis University and related institutions. In the interval since the prior meeting, Dr. McKean transitioned to Saint Louis Behavioral Medicine Institute (SLBMI), an academic affiliate of Saint Louis University, and continued her academic duties from her new institution. Prior to this transition, she continued regular interactions on the Psychiatry Consultation-Liaison Service with medical students and residents regarding substance use disorders, and presented "How to Present a Lecture" to the psychiatry residents as part of their weekly didactics. In addition, Dr. McKean was also the recipient of the Faculty Teaching Award, presented by the psychiatry residents at their annual graduation ceremony. In her new position, Melanie continues to supervise two residents on a weekly basis, and recently completed teaching the Psychiatry Resident In-Service Training Exam (PRITE) course. She will be presenting her AMSP lecture, "Alcohol Use in Pregnancy" at least twice this semester to MS3's, as part of their OB/GYN rotation didactics, and is presenting it to the MS1 & MS2 members of the American Medical Women's Association student group in October. In August, Dr. McKean presented "Anxiety, Depression, and Disease Management" at the VA Centers for Excellence's "Balanced Care for People with MS" allied health program, and in October, she will be presenting as part of the Maternal Fetal Medicine fellows didactics, "Psychiatric Illness in Pregnancy and Postpartum." For all her presentations, she has utilized strategies learned by her involvement in AMSP, with presentations covering alcohol and other substance use disorders in the specialized populations. Melanie has continued to publicize her involvement in AMSP and to encourage her colleagues at Saint Louis University and SLBMI to utilize the website.

The day ended with a discussion of potential matchups between first-year scholars and mentors, as well as the need to make a final decision regarding the lecture topic. Those items will be a major part of the Saturday session. The group then discussed the dinner plans that evening, as well as the Saturday agenda.

The AMSP members reassembled in the early evening for a brief discussion of the progress of the meeting. The group then met again for a working dinner at the Marine Room restaurant in the hotel.

Saturday, September 28

Following a working breakfast, the official meeting began with the presentation of the lecture on Alcohol Use in Pregnancy by Melanie McKean of St. Louis University. This was an important topic and Melanie presented the material clearly and with excellent slides. The information was of such high interest to the group, that Melanie had to deal with many questions during the presentation, which resulted in the challenge of minimizing some of the information in order to stay within the time frame. The discussion of the lecture involved several issues relating to the slides (e.g., Marc's preference that animations come straight in with a key press rather than fading in more slowly), as well as a general discussion of questions that might have arisen from first-year scholars regarding PowerPoint.

The morning session was used for a series of reports from the first-year scholars regarding their plans for expanding alcohol and drug education at their medical schools.

Robert Leeman of Yale School of Medicine reported on potential contributions he will make to medical education at his university. First, he will revise a lecture on nicotine and tobacco dependence that he gives annually to trainees in the Division of Substance Abuse in the Department of Psychiatry based on AMSP principles. In addition to regular revisions he makes every year, this lecture is in need of a new section regarding e-cigarettes; thus, the AMSP approach will be very helpful as he makes these changes. Dr. Leeman will be in contact with the Principal Investigator of the training grant for the Division’s Addiction Psychiatry fellowship and offer to help Fellows enhance the research content of case conference presentations they give during the Division’s weekly seminar for trainees. For up to 2-3 Fellows with a particular interest in research, this involvement may expand into collaboration on a focused review of the literature or small empirical research project, results of which could be presented at the annual meeting of the Research Society on Alcoholism or another relevant meeting. Dr. Leeman will also consult with his department chair and other leaders in medical student education in his and other departments regarding the content of medical student education in alcohol and drug use disorders. Given Yale’s strength in the addictions, he expects that overall the content will be solid; however, he will consult with these leaders in order to assess what, if any, gaps exist in medical education regarding alcohol and drugs so that he might help address those needs. He will also examine the list of elective courses offered to trainees and other members of the Psychiatry Department and pursue offering a course relevant to his areas of expertise (e.g., adolescent and young adult alcohol/drug use disorders; self-control difficulties and addiction; cognitive aspects of addiction) that is not currently being addressed by the course offerings.

Kelly Barth of the Medical University of South Carolina reviewed her potential goals for the upcoming six months. In her role as Director of the Inpatient Substance Abuse Services at MUSC, Dr. Barth lectures to rotating teams of students every six weeks, including 3rd- and 4th-year medical students, pharmacists, nurses, psychiatry residents, and addiction fellows. She will add a lecture to the current curriculum obtained from her peers at AMSP, entitled "Synthetic Marijuana." She will educate each of the three Addiction Fellows in the tenants of "How To Give a Lecture," and then have them demonstrate the lecture on Synthetic Marijuana. As the Director of the Combined Internal Medicine and Psychiatry Residency Training Program, Dr. Barth will be involved with the Graduate Medical Education (GME) Committees at an institutional level, as well as with student interest groups. She will present a lecture about opioid use disorders for the Internal Medicine Residency Noon Conference to a mixed group of 3rd-year medical students and PGY 1, 2, and 3 internal medicine and med-psych residents. She will also participate as a faculty member in MUSC's Alcohol Awareness Week, using information from the AMSP website to educate medical students about at-risk drinking. Lastly, Dr. Barth is developing a lecture about Opioid Use Disorders in Dentistry for AMSP that she will present to a class of first-year dental students in March 2014.

Myo Thwin Myint, first-year scholar from Tulane, next reviewed his potential goals for the upcoming six months. In his role as Associate Residency Director for Triple Board and Child and Adolescent Psychiatry Programs, he is involved with Graduate Medical Education (GME) Committees in pediatrics, general psychiatry, and child and adolescent psychiatry. Over the next six months Dr. Myint will contact the faculty member in charge of medical students in the psychiatry department to learn what the students who are interested in psychiatry (particularly in substance use disorders) are doing outside of their curriculum requirements. Because Tulane students are required to provide community service, if no such program exists, he will help develop a Doctors Ought To Care (DOC) program to give students the opportunity to visit local schools to discuss issues related to substance use. He will partner with student interest groups offering noontime lunch lectures/discussions related to substance use disorders. Myo will also identify himself as one of the AMSP scholars and discuss how he might contribute to undergraduate medical education in general. In addition, he will work to establish a film night program for medical students and residents to discuss substance-related issues in cinema. Through GME Committees, Dr. Myint will educate participants about the AMSP program and lectures on its website to utilize in order to enhance learning about substance use disorders. Finally, Myo will use past relevant lectures to educate other health care providers in the clinics as in-service sessions.

Michelle Bruce, first-year scholar from Maharry University, presented her plans for expanding alcohol and drug education for the next six months. Michelle plans to offer grand rounds for the Department of Internal Medicine regarding her topic (substance problems in medical students), and for student health staff. She will also expand the information on alcohol and drugs given to medical students, and hopes to use the AMSP approach to teach about the use of Brief Interventions regarding alcohol and drugs use and problems for interventions with Maharry students.

Arthur Westover from UT Southwestern Medical Center, then presented his goals to expand drug and alcohol awareness education for his university over the next six months. Dr. Westover plans to take an inventory of the current medical student curriculum to determine the extent to which substance use disorders are covered. This will include formal didactic lectures to first- and second-year medical students, as well as lectures for third-year medical students during the psychiatric clerkship. He will also take a similar inventory of the psychiatry residency training curriculum, and will seek to expand teaching on substance use disorder topics on psychiatry clinical rotations. Arthur will present the AMSP website resources to attendings on ER, inpatient, and consult/liaison services and encourage their use as teaching aids. Additionally, third-year medical students are required to make a presentation on a psychiatric topic during their psychiatry clerkship and Dr. Westover will make students aware of AMSP as a resource for their presentations and papers, thus hopefully increasing the number of students who choose a SUD-themed topic. Arthur will also meet with the addiction fellows and determine to what extent AMSP materials can be useful in their responsibilities. He plans to meet with a representative administrator of the county hospital to determine what future plans there are regarding SUD resources and what help he may be able to provide. Lastly, Dr. Westover is in the preliminary stages of expanding his research to an alcohol use disorder topic, and thus AMSP promises to be a valuable tool as he goes forward.

Next, the first-year scholars discussed their topics and Marc discussed with each the most appropriate mentors. These included:

1. Arthur Westover will develop a lecture on medical complications of stimulant use, and will work with Marianne Guschwan as his primary mentor, along with additional mentoring by Marc Schuckit.

2. Michelle Bruce will develop a lecture on substance use and problems in medical students, with Marc Schuckit as primary mentor and Gail Basch as secondary mentor.

3. Rob Leeman is developing a lecture on impulsivity and substance use disorders with the primary mentor of Evan Goulding and secondary by Marc Schuckit.

4. Myo Myint will develop a lecture on transgender conditions, associated stresses, and substance use and problems with Marc Schuckit as primary mentor and Melanie McKean as secondary mentor.

5. Kelly Barth will develop a lecture on opioid use and misuse among dental patients with Shelley Holmer as primary mentor and Marc Schuckit as secondary.

The group also reviewed the timetable for developing drafts of lectures and slides. This year the first-year scholars will be working under a short time frame in order to help Marc meet some of his obligations that begin in mid-December. Perhaps working on drafts quickly rather than spreading them out over a long period of time might make the process more efficient and enjoyable. The deadlines that were established included:

1. By Monday, September 30th, all scholars will attempt to have a very rough outline of what their lecture might cover to their primary mentor and to Marc.

2;. By October 7, 2013, a first draft of the lecture with modifications from the initial thoughts, as well as beginning to fill in some details regarding the broad topic areas is to be completed.

3. By October 17, the second draft of the lecture is due. This is to have a modest expansion of the amount of information offered, but also will contain a clear description of the four major points to be made.

4. By October 27th, the third draft with greater detail than the prior drafts will have been developed and sent to both the primary mentor and Marc Schuckit.

5. The fourth draft of the outline (if a fourth draft is needed) is due on November 6th.

6. On November 15th, a close to final outline following the AMSP style and including ~30 references will be finished, although additional revisions will be carried out as needed. However, at this point the lecture should be close to an appropriate format for delivery to an audience.

7. By December 15th, drafts of slides (no more than 40 for any of the lectures) will have been developed and finalized.

This schedule will facilitate a period of time when Marc Schuckit is not available for mentoring (December 20, 2013 through January 30, 2014) because of additional obligations. During that time as well as the time leading up to the April 2014 meeting, first-year scholars will continue to modify and improve their slides and lecture outline by practicing and delivering to whatever audiences are available to them at their own universities.

The meeting adjourned with a reminder to scholars that our next meeting is scheduled to begin by 5:00 p.m. Wednesday, April 23rd, and will probably be held in Laguna Beach, California. In April all first-year scholars will present their full 45-minute lecture, while second-year scholars will be given assignments before the meeting to consider the challenge of modifying their lecture to a shorter time frame and a different audience (similar to the exercise carried out by Evan Goulding at the current meeting).


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