Meeting #30

Laguna Beach, CA

April 24 - 27, 2014



Minutes of the AMSP Meeting
April 24, 2014 through April 27, 2014
Laguna Beach, California

Present at the meeting were first-year scholars Arthur Westover, Kelly Barth, Robert Leeman, and Myo Myint. Second-year scholars present at the meeting included Shelley Holmer, Evan Goulding, and Gail Basch, with Melanie McKean having served as a second-year advisor to one of the first-year scholars but due to a family issue was not able to attend. Jessica Skidmore, a repeat invited guest from UCSD also attended; Marc Schuckit was present as director; Marianne Guschwan as associate director, and the administrative assistant for AMSP was also in attendance, Marcy Gregg.

A brief update on recent AMSP activities in other countries. In March 2014, Marc Schuckit spent a month as a visiting professor in Sao Paulo, Brazil, working with an AMSP graduate, Camila Silveira, and the head of her program, Arthur Guerra de Andrade. There, he delivered a series of lectures on alcohol to medical students, residents, and Ph.D. candidates, which was simultaneously broadcast to other medical schools in Brazil. During his time there he met with junior faculty to discuss AMSP major goals, and how the information might apply to Brazil. This included discussions on career development issues, as well as consultations on plans to develop an AMSP for Brazil, to be funded there by local sources. The visit established the basis for ongoing collaborations for at least the next three years, as AMSP grows in Brazil and as part of an effort to enhance alcohol education at major medical schools in that country. A similar AMSP-based program has also been established in Italy by another AMSP graduate, Roberta Agabio. Recently, Dr. Agabio informed Dr. Schuckit that her AMSP spinoff has been successfully integrated into a new lecture series for graduate physicians and psychologists.

Thursday, April 24th
The meeting began one day later than usual because of a last-minute conflict with a National Institutes of Health meeting that was essential for Marc Schuckit to attend. Members of AMSP were able to change their schedules and everyone met in the lobby of the Surf and Sand Hotel for brief networking and discussions of the structure of the meeting. After the initial introductions and discussions, the group continued over dinner at Splashes Restaurant in the hotel.

Friday, April 25th
The participants assembled at 8:30am in the Seahorse Room of the hotel over a working breakfast. The first order of business was to review the structure of the meeting, along with assignments of time slots for first and second year scholars to lecture, as well as reports of developments at their universities.

Marc Schuckit then asked for input regarding how to optimally prepare new scholars for the task of understanding the process for thinking through the development and presentation of materials in lectures, grand rounds, papers, and grant applications. The structure for this discussion was a re-presentation of the lecture entitled "How to Tell Your Story." Many useful suggestions were offered, including the need to emphasize that it is a process for which the new lecture for first year scholars is one mechanism for developing the relevant skills; new scholars need to be aware that because the lectures are representative of the process, they will receive very detailed responses and suggestions from Marc Schuckit regardless of their prior level of skills regarding related topics; new scholars will need to be aware of the fact that the major work occurs in the first several months following their first meeting in the fall; a minimum of an estimated 30 hours spread over those several months will be required to optimally complete the task; however, once the outline is done, the slides are generally fairly straightforward and easy to produce, and there is little (if any) additional work for the remaining several months prior to the spring meeting. Another issue to emphasize is that it is much more difficult to develop lectures that are relatively simple and can be used by others at their universities, compared to developing a full detailed lecture that contains jargon and a structure that uses full sentences.

Following a lengthy discussion, at 10:30 am Evan Goulding, second-year scholar from Northwestern University Medical School, presented his lecture on Motivations for Drinking. The material presented and delivery were excellent, with impressive levels of transitions between sections, great care taken to avoid jargon, an appropriate emphasis on the materials likely to be useful to first-year medical students, and with the use of animation. The lecture was used to discuss several issues regarding slide structure such as when to (and when not to) add brief notation to the slide of a reference of where the specific material came from, and some suggestions were offered regarding how similar material could be delivered in a shorter lecture for another audience when needed.

Gail Basch from Rush University Medical School next presented her accomplishments at her university. Dr. Basch was recently asked by the American Board of Addiction Medicine (ABAM) to apply for an ABAM fellowship program at Rush, a process that is currently underway. This past year she mentored two residents in Addiction Medicine, one continuing into a fellowship and another taking the upcoming ABAM certification. Gail’s efforts have included working to improve resident education through a restructuring of the current syllabus, and has written new developmental milestones for her outpatient specialty clinic. In addition, Dr. Basch has added a narrated two-hour power point lecture on drug and alcohol use disorders for the Psychiatry 3rd year core clerkship education. She continues to work to improve the quality of her teaching regarding alcohol and drug education by incorporating AMSP slides and our website into her presentations. Focusing on medical student education, Dr. Basch is a member of the Rush Addiction Working Group at Rush- a newly formed committee focusing on the vertical integration of alcohol and drug education throughout M1-M4. Over the past year, she has given Grand Rounds presentations on Alcohol Use Disorders, Substance Use Disorders, Substance Use Disorders in the Older Adult, and College Drinking within Rush University and to other hospitals. Gail has also participated in the COPE Region V Summit on Medical Education in Substance Use and Related Disorders, and has been invited to attend the next Medical Education Summit for faculty at schools in HHS Region III (the mid-Atlantic states) in Washington, DC, and has been appointed as the chair of the Curriculum Survey Work Group.

As is traditional in AMSP, the working lunch emphasized issues regarding optimal functioning in an academic environment. Topics that were discussed included how both clinicians and researchers can incorporate teaching within their daily activities; potential opportunities for receiving pay enhancement for such teaching (and the need to carry out interactions with students even when payment is not available); how to budget time regarding emails and phone calls that can occur at home in the evenings and weekends; opportunities for developing grants for teaching and for clinical programs; and an extensive discussion of approaches to revising papers or grants in light of the suggestions made by reviewers.

To begin the afternoon, Robert Leeman from Yale University next presented his lecture on the Relationship of Impulsivity to Subsequent Substance Use Disorders. This was an excellent lecture with an impressive use of clinical cases to enhance the interest of the audience, excellent projection of Rob's voice, material that was very easy to follow, and with excellent slides. Following the lecture, discussions included issues of the need to define all potential jargon (even things as simple as DSM-5, withdrawal and mania); steps that Rob used to slow down his comments so that students had optimal opportunities to assimilate the information; and some suggestions were made regarding small details on slides. A third topic that grew out of the lecture was the need to avoid controversial topics (e.g., are there "behavioral addictions"), unless those topics are essential to the major message of the lecture itself, to avoid a situation where members of the audience react negatively to nonessential information with the result that their thoughts go off on tangents.

Evan Goulding, second-year scholar, next reported on his activities to enhance alcohol and drug education at Northwestern University Medical School. Evan has utilized his AMSP training to revise and deliver to physician assistant students a lecture on alcohol use disorder diagnosis, etiology, and treatment. He has also incorporated multiple existing AMSP lectures into new lectures for psychiatry residents regarding acute intoxication and withdrawal from opioids, stimulants, and cannabis; and a lecture on prescription drug misuse, abuse, and dependence. In addition, Evan delivered 3 general lectures on substance use disorders to medical students and psychiatry residents that he previously developed using his AMSP training. Additional accomplishments included a clinical training session for medical students on brief intervention for at-risk alcohol use; a chapter on screening and brief intervention for at-risk alcohol use for a book on lifestyle medicine in general medical practice; and supervision of an addiction psychiatry fellow in her weekly continuity of care outpatient treatment clinic. Evan continued to participate on the Addiction Medicine program development committee of the Northwestern Psychiatry department, which aims to develop new substance use disorder clinical, research, and training programs. In this context, he served on a search committee for the recruitment of a new faculty member for an endowed professorship in affective and substance use disorders. He also continued his work as co-chair for the addiction seminar for which he arranged 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.

Saturday, April 26th
The morning began at 8:00 am over a working breakfast with the presentation of her lecture on Opioid Use in Dental Practice by Kelly Barth, first-year scholar from the Medical University of South Carolina in Charleston. As is true of all lectures at this meeting, this was a fine presentation that was directed at dental students and was likely to be very useful to them. Following the presentation comments focused on the options for how the terms "addiction" and "dependence" are used; the impressive use of three cases that were woven into the presentation; various minor issues such as the choice of colors in figures (e.g., red does not work very well); Kelly's excellent and consistent use of both generic and trade names for medications; and the minor issue of the need to be certain that pictures used are not distracting and are large enough to be read easily.

After a brief break, the group turned to the lecture on Cardiovascular Consequences of Stimulant Use delivered by first-year scholar, Arthur Westover, from the University of Texas Medical School, Southwestern. Arthur demonstrated a wonderful presence, a great use of anecdotes and humor, an interesting notation of daily life references, such as the New York Times and a long-running television program about amphetamine use (Breaking Bad). With very additional changes, this lecture will be ready for posting on the website.

First-year scholar, Rob Leeman, from Yale University, next presented his activities to expand alcohol and drug education at Yale. Rob uses AMSP principles to 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. This included reducing the number of slides, using larger font, and keeping to 1 line per statement. These principles were particularly valuable as he not only made regular revisions to the lecture, but also included a new section regarding e-cigarettes. Dr. Leeman has begun lecturing to third year medical students as part of their Psychiatry clerkship rotation on the topic of depressants such as alcohol and benzodiazepines, as well as on opioids. He found this task challenging given the large and varied amount of material to cover. His fellow scholars and Dr. Schuckit offered a number of suggestions that he will incorporate the next time he gives that lecture. Dr. Leeman also volunteered to contribute a 15-minute video lecture at Yale to help to supplement the content offered in the clerkship lectures, and in this context Dr. Leeman will likely be tapped to lecture on impulse control disorders. In addition, he volunteered his services to a colleague who coordinates clinical case presentations for addiction psychiatry fellows, offering to work with interested fellows on their overall presentation style, slides and to enhance the quality of the empirical evidence included in these presentations. Rob is also planning to enhance his role as a mentor this next year. Dr. Leeman was gratified by two recent experiences. He was invited to join a new T35 application to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) submitted by his department chair to provide further mentored research experiences for medical students. He was also invited to join as an adjunct faculty member the competing continuation application for the T32 training grant from NIAAA his department holds.

The noontime discussion of academic issues included a review of the criteria for selecting a specific journal for a specific publication; handling negative reviews of papers; how to decide whether to review for a journal; the challenges of striking a balance between offering useful information when you have the role of a reviewer yourself and being too negative; the importance of collaborations for an individual's future development and how to optimize opportunities to collaborate with others; how authorship is selected on an article; as well as who is likely to do the first draft of the paper.

Following a short break, Shelley Holmer, second-year scholar from Duke University, next demonstrated how her 45-minute original lecture could be altered for a 20-minute presentation to high school students and/or their parents. Shelley reported that she was able to carry out these revisions within about one hour, and did not need to develop new slides for the presentation, but was able to modify slides that had been used previously for another audience. She discussed how she decided which of the original 40 slides would be used for the less than 20 slides appropriate for a shorter lecture. This was an excellent demonstration of the ability to modify a lecture originally developed for one audience and with little time and effort, to produce a lecture that was relevant to a very different audience.

Arthur Westover, first-year scholar from UT Southwestern, next offered his report of his activities. As an attending psychiatrist in the public county hospital (Parkland) he has met with the medical director of the inpatient unit, and they have initiated plans to begin admitting patients with dual diagnoses (i.e. substance use disorders). He also worked with the director of the Addictions Fellowship and Parkland administrators to bring Addiction Fellows to Parkland for clinical rotations, for which Arthur agreed to be one of the supporting attending physicians. Admitting dual diagnosis patients and having the Addiction Fellows at Parkland will greatly increase medical student exposure to the treatment of substance use disorders. Dr. Westover had introduced the AMSP presentations to medical students and social workers at Parkland as a resource for when they give presentations. He has worked with the director of psychiatric medical education and determined the number of lectures that are given on the topic of substance use disorders. Dr. Westover attends the journal club for the Addiction Fellows, and has agreed to take this over from the current director.

Second-year scholar, Shelley Holmer, next presented her accomplishments at Duke University. In the last two years she has worked toward increasing the amount of time spent on substance use disorder topics in the clinical clerkship curriculum. Currently she is trying to increase the exposure medical students have to patients struggling with these issues. She is working with one residential treatment center in her area to see if it could serve as a clinical site for medical students on their core psychiatry clerkship in future years. Her largest accomplishment since the last meeting has been the establishment of a Residents as Teachers Program at Duke. This course is focused on teaching Psychiatry Residents fundamentals of teaching, with the goal of enhancing medical student education in all areas including drug and alcohol use disorders. Mentorship provided by AMSP made her work on this program possible. This program will be presented at the national meeting for Medical Student Educators in Psychiatry this Spring.

The afternoon ended with a brief discussion of options for the location of our October 8th fall meeting. Participants also discussed options for dinner the current evening (everyone was on their own), and plaques were given to the graduating second-year scholars.

Sunday, April 27th
The session began with a presentation of his lecture on Substance Use Disorders in Transgender Individuals by Myo Myint, a first-year scholar from Tulane University Medical School. This lecture covers a complex and important topic for medical students, and Myo had an excellent presentation style, appropriate use of slides, and excellent organization of the material. Following the lecture, discussions covered the importance of viewing all slides and the lecture hall before giving any lecture (both of which Myo had done); the use of bolded words within slides to make it easier for people to read; how prevention or treatment approaches when offered in a lecture are optimally organized around the most clinically well supported data first, with the more experimental approaches offered last; and some of the liabilities of using a slide format that have artwork as part of the slide, leaving less space for actual information.

Kelly Barth from the Medical University of South Carolina, a first-year scholar, next offered her report of her activities at MUSC. Dr. Barth published a cover article about prescription opioid use disorders in the Spring 2014 edition of MUSC’s medical magazine, (http://www.muschealth.com/pn/index.html), and will give a related state-wide telepresentation on a similar topic. Additional activities have included her delivery of her AMSP lecture entitled “Opioid Use Disorders in Dental Medicine” to 100 first-year dental students; a bi-yearly lecture entitled “Opioid Use Disorders in Behavioral Medicine” given to pre-doctoral psychology interns and psychology attending; her presentation of the “How To Give A Lecture” to the Division of Bio-Behavioral Medicine in the Department of Psychiatry and to pre-doctoral psychology interns and their attendings. Kelly also delivered the AMSP lecture on Spice to addiction fellows, psychiatry residents, third-year medical students, and PharmD students. One of her Addiction Fellows subsequently presented this lecture to other addiction fellows and an attending physician. Dr. Barth was asked to serve on MUSC’s Addiction Initiative Committee and to be co-chair of the South Carolina Translational Research Center’s Pain Research Retreat at MUSC. This year Kelly has published 4 papers and book chapters on substance-related topics.

Following a brief break, Gail Basch, second-year scholars from Rush University Medical School, next presented her 25-minute presentation for parents during the college sons or daughters are part of an entering freshmen class at an undergraduate university. This was a fine modification of an original lecture set up as a 45-minute presentation to first-year medical students, and Gail demonstrated how similar or identical slides could be used for the two lecture formats. This is an important skill for AMSP scholars to acquire.

The discussion next turned to suggestions for optimizing the use of the AMSP website. Our most recent report included ~5,000 visits of individuals from 84 countries, including, most prominently, the U.S., Canada, India, Singapore, the U.K., the Netherlands, Brazil, Australia, and Italy. This included almost 4,000 unique visitors, with most individuals viewing two pages or more. The most commonly viewed lectures included alcohol intoxication, college drinking, spice, drinking motives, alcohol withdrawal, craving, alcoholism treatment, and so on. Among suggestions that were made for enhancing the viewers to the website include asking current and former scholars whether they had ideas of organizations to which AMSP might link; adding a profile page for all current and past scholars; linking the AMSP website to medical school websites; working with Hostgater to optimize the visibility of our web page; working with Listserv; linking to the Association of Medical School Directors; linking to Residency Training Directors; writing a letter to the editor for major alcohol and drug journals about the AMSP website and what is available there; current lectures when possible; and additional potentially important ideas.

Myo Myint, first-year scholar from Tulane University School of Medicine, next offered an overview of his accomplishments to promote alcohol and drug education at Tulane. Partnering with the Division Chair of Child and Adolescent Psychiatry, he created the first ever film night for the medical students and residents and is planning to do more of these sessions in the near future. In his role as Associate Residency Director for Triple Board and Child and Adolescent Psychiatry Programs, Dr. Myint is involved with Graduate Medical Education (GME) Committees in pediatrics, general psychiatry, and child & adolescent psychiatry. He now organizes the grand rounds for the division and has been identified as faculty who distributes publications from the faculty as well as other interesting articles. As planned, Dr. Myint contacted the Director of Medical Student Education in Psychiatry and offered to provide lectures on substance use disorders and other psychiatric topics and identified himself as one of the AMSP scholars. Because of his interest in the sexual and gender minorities healthcare, he met with the Director of the Office of Gender and Sexual Diversity and discussed ways to partner and provide education on important health related topics including substance use. As a step toward developing a Doctors Ought To Care (DOC)-yype outreach program, he has reached out to the faculty advisor of Psychiatry Interest Group and will continue to follow up to give students the opportunity to visit local schools to discuss issues related to substance use as well as to offer noontime lunch lecture/discussion related to substance use disorders. Dr. Myint represented Tulane at the Southeast Consortium of Child and Adolescent Psychiatry Training Program and discussed ways to collaborate within the region. Finally, he will continue to find ways to use past relevant AMSP lectures to educate students and other health care providers.

Melanie McKean, second-year scholar from Saint Louis University, who was not in attendance at the meeting, sent an update of her activities. She continues to work full-time at Saint Louis Behavioral Medicine Institute, an academic affiliate of Saint Louis University, and continues in her role as an Adjunct Faculty member for Saint Louis University. She has presented her AMSP lecture, "Alcohol Use in Pregnancy" as part of the MS3 OB/GYN rotation didactics. In addition, she presented her lecture to MS1 & MS2 members of the American Medical Women's Association student group in October 2013. She presented "Psychiatric Illness in Pregnancy and Postpartum" as part of the didactics for the Maternal Fetal Medicine fellows at Saint Louis University, which included discussion of the management of substance use disorders in pregnancy and postpartum. She continues to supervise two Saint Louis University psychiatry residents, and utilizes knowledge she has acquired from her involvement in AMSP on a daily basis while screening for substance use disorders, as well as treatment of patients with substance use disorders alongside mood, anxiety, and/or eating disorder comorbidities. She will continue to direct colleagues to the AMSP website and utilize the skills she has learned as a scholar, in her preparation of future lectures and publications.

The meeting adjourned before noon, with good wishes for everyone's safe trip home. The first-year scholars will now be assuming a second-year scholar role, and we are all looking forward to meeting the new scholars at the October 8th meeting.









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