Meeting #31

San Francisco

October 8 - 11, 2014

San Francisco, California
October 8 through October 11, 2014

Present at the meeting were first-year scholars Sarah Pedersen from the University of Pittsburgh, Paola Pedrelli from Massachusetts General Hospital, Martin Plawecki from the University of Indiana in Indianapolis, Bryan Tolliver from the Medical University of South Carolina, and Joe Schacht from the Medical University of South Carolina. Also present were second-year scholars Rob Leeman from Yale University, Myo Myint from Tulane University, Ben Nordstrom of Dartmouth University (Ben delayed his second year due to military service and has rejoined AMSP), and Arthur Westover from the University of Texas Southwestern. Also present were Marianne Guschwan (Associate Director), Marc Schuckit (Director), and Marcy Gregg (Administrator).

I. Wednesday, October 8, 2014
After traveling to San Francisco, the group first met in the lobby of the Grand Hyatt on Union Square Hotel at 6:30 pm to discuss plans for the meeting, the meeting room to be used on October 12th, and a tentative schedule. We then shared a dinner together at the Brindisi Cucina di Mare Restaurant, during which time we discussed developments over the past year.

II. Thursday, October 9, 2014
The meeting began with a detailed description and discussion of the activities for the entire meeting. This included assignment of time slots for lectures from the second-year scholars, scheduling for descriptions of developments related to AMSP for second-year scholars, assignments for first-year scholars" presentations of their plans for activities at their medical school, as well as a range of administrative details.

Marc Schuckit next presented his detailed overview of "How to Tell Your Story." For the scholars Marc reviewed the essential elements of an effective lecture, paper, book chapter, or grant application with an emphasis on the need for a logical flow of ideas developed for a specific audience, with repetition of major points, and a focus on three or four major lessons relevant to that audience. The lecture gave examples from prior lectures, papers, and grant applications and fostered discussions of major issues among first- and second-year scholars. This presentation set the stage for the rest of the meeting as the first-year scholars are beginning to address the process for successful presentations and written communications.

A working lunch was then used for discussions of major issues related to academic development and how to thrive in a medical school environment. This interaction went on for almost an hour and topics included differences across medical schools regarding required hours of clinical activity; mentorship (and being a good mentee); the importance of being assigned to the optimal job description (e.g., research vs. administration vs. teaching); how to clearly establish the way that you are being evaluated by your supervisor (what is it that he or she is looking for when it comes to time to share their evaluation of your work); the importance of impact factors in selecting journals; the range of journals appropriate for alcohol and drug use publications; the manner in which reviewers are chosen by a journal; and a range of related topics.

Following lunch, second-year scholar Rob Leeman presented his full lecture on Alcohol Use Disorders and Impulsivity. This was a superb lecture that included clear slides and a clear development of logic. Many of the points made by Marc in his morning overview of "How to Tell Your Story" were aptly demonstrated in this presentation. Following a brief discussion of minor issues related to specific slides, Marc asked Rob what changes would he envision to alter the lecture into a 20-minute presentation (rather than the original 45 minutes). The entire group then worked together looking at the slide copy to work to delete approximately 50% of the slides. Rob then agreed to use no more than an hour that evening to alter his lecture to meet the new 20-minute deadline and to present the results on Saturday.

The day's activities ended with the report of recent AMSP-related developments at the University of Texas Southwestern by Arthur Westover. Arthur has presented his lecture on stimulants and cardiovascular health at the 8th annual Women and Heart Health Fall Symposium at the Dallas VA Medical Center. It was attended by more than 100 medical professionals. Additionally, Dr. Westover has organized an ongoing lecture series at the psychiatric inpatient unit at Parkland Hospital. In an effort to improve substance use disorder treatment, six faculty (including Dr. Westover) will present two AMSP lectures apiece over the upcoming academic year. This is part of a plan to begin admitting patients with substance use disorders. Dr. Westover also continues to support the Addiction Fellowship trainees through the Addiction Journal Club.

III. Friday, October 10, 2014
After a working breakfast discussing issues raised the day before, the day's activities began with the presentation of second-year scholar Ben Nordstrom of his full lecture on Drug Courts. Once again, the lecture was offered to demonstrate how to implement the overall goals of "How to Tell Your Story" as presented the day before. This was an excellent, informative, and well organized lecture that was of great interest to the other scholars. The presentation was followed by a brief discussion of the reasons why specific slides were used, how jargon was avoided, whether all of the information presented on savings of money were needed, and how this presentation required a brief overview of methods (in contrast to most lectures to medical students where scientific methods are not emphasized).

Rob Leeman, second-year scholar from Yale Medical School, next reviewed his recent developments regarding medical school education on alcohol and drugs. Rob used AMSP principles to revisit a lecture he gives annually on nicotine and tobacco dependence to trainees in the Division of Substance Abuse in the Department of Psychiatry. Dr. Leeman remarked on how he has found giving this talk to be much easier with a smaller number of slides, providing less and more focused information on each slide, etc. He has continued to lecture to third-year medical students and physician associate students as part of their Psychiatry clerkship rotation regarding depressants (alcohol and benzodiazepines) and opioids, incorporating several suggestions made at past AMSP meetings, including: beginning the talk by quizzing the students regarding the DSM-5 criteria for substance use disorders; increasing the number of clinical cases; making the lecture more discussion based; keeping focused on the key material they need to know; and offering empirical evidence that shows the impact of medical providers with regard to substance use disorder outcomes. Despite the inherent challenges with this lecture and his inexperience lecturing to this group, he received an overall teaching effectiveness score of 4.08 out of 5, which he found encouraging. At the last meeting, Dr. Leeman reported that he was invited to join as an adjunct faculty member the competing continuation application for the T32 training grant from NIAAA his department holds by co-leading a course on research methods, ethics and statistics. Though the competing continuation is pending, the director of the program would like to move ahead with this course. Dr. Leeman will be meeting shortly with his colleague to develop a plan for this course, which will begin soon.

The morning's presentations led to an informal discussion of the structures of most divisions of psychology in medical school departments. The issues raised emphasized some of the assets and liabilities of working within a medical school environment for both clinicians and basic researchers, the differences among departments regarding degrees of collaboration within psychology divisions, as well as across psychology and psychiatry were also discussed.

Myo Thwin Myint, second-year scholar from Tulane University, next reviewed his AMSP-related developments since the prior AMSP meeting. Myo was invited to present his AMSP lecture to the third-year medical students as well as become involved in innovative flip-classroom teaching to Tulane Heal-X program. This was designed to award MD degrees to post doctoral students in three years. He was also asked to present an overview of substance use in adolescence at the PsychSIGN (Psychiatry Student Interest Group Network) meeting which will occur at the same time as the American Academy of Child and adolescent Psychiatry (AACAP) Annual Meeting in San Diego, CA in October, 2014. Dr. Myint will also co-lead the AACAP Alliance for Learning and innovation, a network of CAP medical educators to create and deliver CAP related contents across the world. Because of his interest in the sexual and gender minorities healthcare, he partnered with the Office of Gender and Sexual Diversity and co-leading the support group for the students with diverse gender expression where the topics will include substance usage. In his role as Associate Residency Director for Triple Board and Child and Adolescent Psychiatry (CAP) Programs, Dr. Myint continues to be involved with Graduate Medical Education (GME) Committees in pediatrics, general psychiatry, and child & adolescent psychiatry, and was recently appointed as the Chair of Clinical Competency Committee for the CAP program. He became the director of a yearlong CAP psychopathology / psychopharmacology course and will be leading the substance use disorders block. In addition, he directs the rotation for medical students and pediatric residents in CAP and coordinates triple board rotation for visiting medical students. Recently, he lectured on how to give effective presentations to residents and medical students using AMSP materials. He expanded his role from distributing publications and accomplishments of the faculty and interesting articles to include Facebook, and plans to continue film nights for the medical students and residents.

The discussion over the working lunch once again focused on development in an academic medical school department. The items discussed included how and when to ask for promotion within the medical school environment; how and when it is appropriate to be named a member of an editorial board for a journal; the importance of setting limits on one's hours and job assignments so that the faculty member does not "burn out" and stop looking forward to coming to work in the morning; problems developing in some medical schools regarding restrictions on how much credit a faculty is given for the money generating activities that they do; as well as various ways to decide whether it was important or appropriate to say no when asked to do something by senior department members.

Following lunch, Arthur Westover, a second-year scholar from the University of Texas Southwestern, next presented his lecture on Cardiovascular Complications of Stimulant Use (in prescribed doses) as well as misuse in High Doses. As was true of all of the full demonstration lectures from second-year scholars, this was a highly effective and well organized presentation. The lecture was followed by a general discussion of issues related to developing lectures among first-year scholars.

Subsequently, Ben Nordstrom, second-year scholar from Dartmouth University, presented his accomplishments since his prior AMSP meeting. Dr. Nordstrom has remained involved with drug and alcohol education at the fellowship, residency, undergraduate medical, peer and community levels. As director of Dartmouth’s fellowship in addiction psychiatry, Dr. Nordstrom has expanded the program from one trainee a year to two trainees per year. He also initiated a program where Dartmouth’s fellows in pain medicine rotate in the addiction clinic, and the addiction psychiatry fellows rotate in the pain clinic. In addition, Ben provides lectures for Dartmouth’s NIDA T-32 fellowship in addiction research, and oversees and coordinates the addiction psychiatry rotation. He changed the structure of the psychiatry rotation to allow for a longer longitudinal experience in the outpatient clinic of Dartmouth’s Addiction Treatment Program. He also provides lectures on the management of opioid withdrawal, alcohol withdrawal, and the neurobiology of addiction, as well as lectures on addiction and drug and alcohol use disorders for second- and third-year medical students. In addition, in coordination with the Betty Ford Institute and the American Society of Addiction Medicine, he wrote the first three addiction cases for CARE, which is part of iIn-Time’s web-based medical education platform MedU. Finally, Dr. Nordstrom continues to lecture widely on drug and alcohol issues. He is in his third year of a contract with the State of Vermont, where he and his colleagues from Dartmouth conduct learning collaboratives to improve Medication Assisted Treatment for opioid use disorders. Since the last AMSP meeting he served as an attending physician in the Spring of 2013 and provided 15 invited lectures to local, regional, and national audiences. He also used the AMSP method to develop a lecture to be given to the Royal Jordanian Medical Society, and to develop a presentation he gave at the Camp As Saliyah Troom Medical Clinic in Qatar.

The meeting turned to a discussion by first-year scholars regarding the specific topic they had chosen for their AMSP lecture. These included: 1) Joe Schacht will develop a lecture of pharmacogenetics and work with Rob Leeman as his senior scholar; 2) Sarah Pedersen will work on a lecture regarding substance use disorders in African Americans, working with Ben Nordstrom as senior scholar; 3) Marty Plawecki will develop a lecture on ways to monitor abstinence (including use of electronic devices), working with Myo Myint as the second-year scholar; 4) Paola Padrelli will develop a lecture regarding online treatment and prevention efforts, working with senior scholar Arthur Westover; 5) Bryan Tolliver will develop a lecture on substance use disorders as a model of chronic illnesses, working with Marianne Guschwan in a senior scholar role.

The meeting then adjourned for the afternoon, with the group to reassemble at 7:00 pm for a working dinner. The dinner was at Farallon Restaurant, and, while service was very, very slow, the group had a wonderful opportunity to exchange ideas and thoughts regarding the meeting and interactions and networking in the future.

IV. Saturday, October 11, 2014
The day began with a discussion of potential dates for the next AMSP meeting. After some considerations it was decided that the meeting will begin on Wednesday, May 6th, 2015 and end on Saturday, May 9th, 2015 (the day before Mother's Day), and will be held on the East Coast. It is probable that the meeting occur either in Miami or Islamorada, with the possibility of considering Charleston.

Myo Thwin Myint, second-year scholars from Tulane University, next presented his lecture on recognizing, appropriately interacting with, and understanding the course of gender dysphoria, with an emphasis on transgender individuals. This was a highly effective lecture dealing with a sensitive topic rarely taught in medical schools. It was delivered with excellent style and focus, and had effective slides. Myo also demonstrated important aspects of interactions with an audience and manner of handling questions.

On this Saturday morning, the meeting progressed to a report by Joe Schacht, first-year scholar from Medical University of South Carolina regarding the potential plans for the subsequent six months. First, he will use the AMSP approach to revise lectures on motivational interviewing (MI), neuroimaging, and the neurobiology of addiction that he currently gives regularly to psychiatry residents, addiction psychiatry fellows, and psychology interns and post-doctoral fellows at MUSC. Dr. Schacht noted that these lectures would particularly benefit from the AMSP principles of simplifying slides and clearly communicating four major goals for the audience. At Dr. Schuckit’s suggestion, Joe will also consider giving John Wryobeck’s Motivational Interviewing AMSP lecture. Second, Joe plans to engage in clinical teaching on the MUSC inpatient substance use disorders service to addiction psychiatry fellows, psychiatry residents, and 3rd- and 4th-year medical students. This teaching will occur approximately every six weeks (so that students will receive it at least once during their six-week psychiatry rotation) and will involve Dr. Schacht giving a brief (10-15 min) lecture on the main principles of MI and then using this technique to interview a patient during the treatment team’s rounds on the inpatient service. First-year scholar Dr. Brian Tolliver, also of MUSC, is the attending physician for this service, and will facilitate this exercise. Finally, Dr. Schacht will explore opportunities for educational outreach at South Carolina institutions beyond MUSC. Several possibilities for this outreach were discussed, including participation in the MUSC Center for Drug and Alcohol Programs’ educational outreach program to public schools in the Charleston area, trainings on addiction neurobiology and treatment for health care providers at South Carolina hospitals, and involvement with the Doctors Ought to Care (DOC) program.

Rob Leeman, second-year scholar from Yale University, next delivered his 20-minute version of his lecture on Alcohol and Impulsivity. He demonstrated that with 30 minutes of effort he was able to cut from 39 slides to 19 and from 45 minutes to 20. The shorter lecture was effective and made all of the major points in the longer lecture, although while offering less background and less color regarding potential cases. Marc then demonstrated how the 20-minute lecture could be cut to 10 minutes and still have the large majority of the major points covered. This process was a demonstration to both first- and second-year scholars on how one can expand lecture time by case histories if need be when a lecture is going too quickly and can cut back at the very last minute if the lecture time less than originally planned.

Jessica Skidmore, a post-doctoral student working with Marc Schuckit who has been attending AMSP meetings as part of her training, next presented an overview of how to handle problems with computers when one is attempting to develop an outline format. Jessica explained the process, which is relatively straightforward, and offered a handout that first and second-year scholars can refer to as they develop or modify existing lectures.

Bryan Tolliver, a first-year scholar from MUSC, next delivered his thoughts about his plans for the next six months. These included revision of his previously prepared lectures for psychiatry residents and addiction psychiatry fellows using the AMSP format and principles discussed at this meeting. These didactic lectures cover diagnosis and management of comorbid mood disorders and substance use disorders, medication-assisted treatment of opioid dependence, and assessment and treatment of methamphetamine and related stimulant use disorders. In addition, Dr. Tolliver discussed the absence of didactic teaching on the subject of drug courts in the PGY-5 addiction fellowship curriculum at MUSC and plans to implement the excellent lecture on the topic developed and presented at the October AMSP meeting by Dr. Ben Nordstrom of Dartmouth University. Dr. Tolliver also plans to apply the AMSP approach to new curriculum development on comorbidity of mood disorders and substance use disorders. As a first step, he will implement a streamlined format that emphasizes four primary teaching / learning objectives in these lectures and accompanying formal guided reading series. This is likely to be of particular benefit to medical students and second-year residents at MUSC, who will be learning about this complex topic for the first time. Similarly, Dr. Tolliver plans to adapt the straightforward AMSP approach to clinical teaching on the inpatient addiction / dual diagnosis unit where he currently serves as attending psychiatrist. He discussed the particular anticipated merits of using the AMSP format in clinical teaching during morning rounds, where myriad issues arising in the treatment team’s discussions of individual patients’ diagnoses and treatments pose special challenges for organized teaching of trainees at diverse levels of experience.

The plans for the next six months were then presented by Paola Pedrelli, a first-year scholar from Massachusetts General Hospital (MGH) and Harvard University Medical School. Dr. Pedrelli currently presents yearly lectures to MGH psychology interns, trainees in the inpatients unit (PGY-I and medical students), and PGY-III in the Transitional Age Youth Clinic at MGH. Her first objective is to improve her current lectures by using the method illustrated in the AMSP program. She plans to work to add another lecture on the co-occurrence of mood disorders and substance use disorders in these settings, and to recruit psychology interns interested in training in substance use disorders at MGH. Paola will introduce the AMSP program and the content of the lectures available on the website to the staff of the Center for Addiction Medicine (CAM) at her institution, a group that includes psychologists and psychiatrists who may use the lectures available in the website when they teach. Finally, she plans to meet with MGH leadership to investigate current opportunities for training in substance use disorders available to medical students. In the context of these meetings she hopes to identify areas in need of further development, and to compile a compendium of the opportunities regarding substance use disorders available to students.

Sarah Pedersen, a first-year scholar from University of Pittsburgh, next presented her thoughts about opportunities to improve alcohol and drug education at her university. First, Dr. Pedersen will have in-person meetings with the Director of the Office of Medical Student Education and the Director of Residency Training at Western Psychiatric Institute and Clinic (WPIC). During these meetings Sarah will discuss the goals of AMSP and discuss what active training elements on addiction are already in place for trainees. Additionally, she will work with these directors to identify gaps in training and expand her involvement based on these needs. Further, Dr. Pedersen will meet with the Medical Director of Addiction Medicine Services at WPIC and arrange to deliver trainings and/or lectures to staff and providers on addiction theory and treatment. She will use AMSP materials and method for these presentations.

The fifth demonstration by first-year scholars regarding potential activities at their medical school was next presented by Martin Plawecki. from Indiana University School of Medicine. Dr. Plawecki's thoughts regarding enhancing alcohol and drug education for medical students, psychiatric residents and fellows, and psychology trainees include looking to augment his participation with the Introduction to Clinical Medicine course to include formal lectures with the medical students while remaining active in the Alcohol and Drug Clinical Training Interviews. He will explore appointment to the Child and Adolescent Psychiatry Resident Education Committee and determine whether any AMSP lectures can and should be offered to the fellows. He will discuss the AMSP program within the Addiction Psychiatry Fellowship and the Indiana University Alcohol Research Center to encourage usage of the educational materials by the addiction, psychology, neuroscience and related faculty.

The next item on the agenda was to establish the timing for activities as the first-year scholars develop their lectures, and the second-year scholars and Marc Schuckit work with the first-year individuals to optimize their presentation and lecture outline and slides to be loaded to the AMSP website. The schedule is as follows:

1. On or before Monday, October 27th, the first-year scholars will send a rough draft of the potential structure of their lectures to the second-year scholars, with a cc to Marc Schuckit.

2. November 10th or before: the literature review should be basically finished with work progressing on modifying the outline. This (a rough guess involving six or more drafts of the outline) should be shared regularly with the senior scholar; the senior should try to get back to the junior scholar within two days, if at all possible; and all such communications should be shared with Marc.

3. December 15th or sooner: the outline should be near its final form, and work should begin to develop references and to insert them in the appropriate place in the outline. This is first done using author and year, but is converted to sequential numbered references to take up less space in the final draft.

4. January 26th, 2015 or sooner: at this point the outline and references should be in very close to final form. At this juncture, Marc becomes the person who is first consulted on drafts, with cc's to the senior scholar (in other words, Marc and the senior scholar switch positions).

5. February 23rd, 2015 or sooner: the outline and references should be finished and it is time to begin working on the slides. These slides are now first shared with the senior scholar (with a cc to Marc), and in the close to final drafts, slides will be handled by Marc as the major advisor and the senior scholar as secondary.

6. March 23rd, 2015 or sooner: the process is finished. All that remains for the outline, references, and slides is practicing the flow of logic and the delivery to prepare for the May 6th, Spring AMSP meeting.

The meeting then adjourned with good thoughts for all to have a rapid and safe flight home.

Layout and design by Brian Klima