Meeting #32

Boston, MA

May 6 - 9, 2015



MINUTES OF THE ALCOHOL MEDICAL SCHOLARS PROGRAM MEETING
MAY 6, 2015 THROUGH MAY 9, 2015

Present at the meeting were first-year scholars Sarah Pedersen, University of Pittsburgh Medical School; Paola Pedrelli, Harvard University/Massachusetts General Hospital; Marty Plawecki, Indiana University School of Medicine; Joe Schacht, Medical University of South Carolina. Also present were second-year scholars Rob Leeman, Yale University School of Medicine; Myo Myint, Tulane University School of Medicine; Ben Nordstrom, Dartmouth University Geisel School of Medicine; and Arthur Westover, University of Texas Southwestern. Also present were Marianne Guschwan, Associate Director; Priscila Dib Goncalves from the University of Sao Paulo; Marc Schuckit, Director; and Marcy Gregg.

Wednesday, May 6, 2015

The meeting began with a greeting of all first- and second-year scholars in the lobby of the Nine Zero Hotel. A discussion was held regarding the agenda for the meeting, along with several assignments for scholars to consider for the next day. The group then continued meeting over dinner at the Via Matti Restaurant.

Thursday, May 7, 2015

The meeting convened at 8:00 a.m. The group reviewed the goals for the next 2 1/2 days, and assignments were made for timings of lectures, as well as reports of accomplishments. The majority of the morning was spent working with Marc Schuckit in a review of the major points regarding "How to Tell Your Story." The emphasis was placed on the key guidelines for lectures, papers, and grant applications of: 1) Recognizing that the audience is the only important entity (and the lecturer/writer is delivering the message to that group); 2) Being certain that the manner in which the material is being presented, as well as the focus of the lecture/paper/grant application/etc. is on an issue relevant to that audience or those readers; and 3) Delivering the message using language appropriate for that audience.. As discussed by one member of the group: "It's not what you teach an audience, it is what they learn."

The noon luncheon discussion of academic issues covered a wide range of topics. These included how to decide which meetings to go to or invitations to accept; assets and liabilities of RO1 versus R21 grants; issues related to changes in journal leadership in our field and reasons for such changes; and a long discussion about how to keep a research program going in times of very tight money.

Joe Schacht, first-year scholar from the Medical University of South Carolina, next presented his full lecture on Pharmacogenetics. This was a well organized, logical and informative lecture that was delivered in an excellent style. The subsequent discussion focused on reviewing details of some examples of excellent slides; suggestions about the most appropriate use of acronyms; and steps that all AMSP lectures can take to be certain that the information is presented in a manner that is easiest for the audience to understand.

Next, Rob Leeman, from Yale University, presented his AMSP related accomplishments at his university. Dr. Leeman has continued to lecture to third-year medical students and physician associate students as part of their Psychiatry clerkship rotation on the topic of depressants such as alcohol and benzodiazepines, as well as on opioids. In prior meetings, fellow scholars and Dr. Schuckit offered a number of very helpful suggestions that he incorporated into this lecture with good results. Overall, Dr. Leeman has made the lecture more discussion and question-and-answer based, and now utilizes only 18-20 slides, about half of those used in the past. This semester, Dr. Leeman began teaching a course for addiction psychiatry fellows, pre- and post-doctoral fellow psychologists. While the course was intended for a wide audience, the students have consisted of only addiction psychiatry fellows, and Rob was able to easily modify the original plan to meet the needs of the actual audience (a major goal of AMSP teaching). Dr. Leeman has also become co-chair of the Collaborative Perspective on Addiction meeting, an annual “mid-year” meeting hosted by Division 50 of the American Psychological Association, where a high proportion of the attendees are students and other trainees. Dr. Leeman noted that at this year’s meeting there were a number of bad habits modeled by senior faculty in various sessions, and plans to include a lecture on “How to Tell Your Story” at next year’s meeting.

This was followed by the report from Joe Schacht of the Medical University of South Carolina regarding AMSP activities and related future plans. Dr. Schacht was appointed to the Grand Rounds committee in the Department of Psychiatry and Behavioral Sciences at MUSC, and has used his position on this committee to invite experts in addiction research to present their work in his department’s Grand Rounds series. Dr. Schacht has also used his AMSP training to modify the lectures he presents to psychiatry residents at MUSC. He presented John Wryobeck’s AMSP lecture on motivational interviewing to third-year residents, and used the AMSP presentation principles to modify his slides for lectures on the neurobiology of addiction to second-year residents and on neuroimaging to residents in MUSC’s Drug Abuse Research Training (DART) track. Dr. Schacht was also invited to serve as a potential research mentor for future DART residents. Finally, Dr. Schacht was invited to serve as a research preceptor for predoctoral psychology interns in MUSC’s Charleston Consortium internship program, and has mentored an intern who has worked on a study of genetic influences on subjective response to alcohol.

The meeting adjourned at 3:30 p.m. with scholars on their own that evening for dinner.

Friday, May 8, 2015

The meeting was convened at 8:00 a.m. The day began with the report of AMSP-related activities by Ben Nordstrom from Dartmouth University. Ben continues to contribute to addiction education at Dartmouth and in the larger community. As the Director of the Addiction Psychiatry fellowship, he secured funding for a second fellow, and two new Addiction Psychiatry fellows will begin their clinical training this summer. Ben also contributed a lecture for the post-doctoral students at the T-32 funded fellowship in addiction research at Dartmouth, and continued to supervise and lecture Dartmouth psychiatry residents and medical students, providing two addiction lectures to second year medical students, a recurring lecture on addiction to third year medical students on their psychiatry clerkship, and a lecture on managing withdrawal to fourth year medical students. Dr. Nordstrom also completed his work on the Course for Addiction and Recovery Education (CARE), which is offered on the Med U platform as part of a project funded by the Betty Ford Institute and supported by the American Society of Addiction Medicine. About 90% of U.S. medical schools have subscriptions to the Med U services, and CARE is poised to be an important contribution to addiction education for physicians. Finally, Ben continued to provide addiction education to the wider community, providing two lectures to area police organizations, and speaking about addiction topics at four local medical practices. In addition, he led a half-day workshop at a national meeting of addiction counselors and provided a keynote address at the family day of an area substance abuse treatment facility.

Next on the agenda was the report by Paola Pedrelli, a junior scholar from Massachusetts General Hospital (MGH) and Harvard Medical School (HMS) regarding her AMSP-related activities. Paola has discussed her desire to improve medical education in substance use disorders with Dr. Jonathan Alpert, former director of Medical Student Education for HMS, who suggested contacting Dr. Leigh Simmons who serves as a medical student educator and directs the outpatient internal medicine clerkship. She noted that medical students receive the majority of their education on substance-related topics during the inpatient medical service and in the general medicine clinics. Dr. Simmons suggested contacting the directors of training of those services to determine whether such training needs to be expanded in those settings. She noted that there is no formal lecture on substances during her rotation and she does not believe it would be feasible to include one. However, the rotation includes rounds where clinical cases are presented by medical students and Paola offered to serve as an expert when medical students present relevant clinical cases. Paola is also a member of the committee that overview applications for the internship program in clinical psychology at Massachusetts General Hospital (MGH) and uses this role to advocate for recruiting at least one psychology intern interested in substance, with the result that 2015-2016 will be the first year the MGH internship program in clinical Psychology will have such an psychology intern. Since the last AMSP meeting, Paola has given two presentations at national conferences on the association between heavy drinking and depressive symptoms where she included slides from the AMSP webpage and where she applied AMSP principles including having an outline, simple slides, keeping one line per statement and simple figures. Paola was invited to deliver the lecture prepared for AMSP on heavy alcohol use and depressive symptoms to PGY III completing a rotation at MGH transitional age youth clinic.

Following these reports, Sarah Pedersen, first-year scholar from the University of Pittsburgh, presented her lecture on Alcohol Use and Problems in Black Americans. The lecture was notable for the excellent way that the history of the Black population in the United States was woven into the data-based information and the effective way Sarah presented two cases of patients she had seen, which were woven within the fabric of the lecture itself. Both the organization of the material and the slides were very effective.

Following the lecture, Sarah Pedersen, first-year scholar from the University of Pittsburgh (Pitt), School of Medicine, reviewed her efforts in facilitating substance use disorder training at her school since October 2014. Dr. Pedersen engaged in several activities related to this pursuit. First, she met with the Director of the Addictions course for the residents and the Associate Director of Medical Student Education. During these meetings she reviewed the current addictions training for the medical students and residents at Pitt and developed a plan for increased involvement in these courses and trainings. Related to those discussions, Dr. Pederson discovered that medical students receive a psychiatry course their 1st year and 3rd year, so Dr. Pedersen is going to lead 3 small didactic groups in May 2015. Sarah will also present a lecture on the clinical aspects of Addiction in the upcoming year. 1st-year residents receive an entire course on addiction and Dr. Pedersen is going to prepare and deliver a lecture on screening and diagnosis of SUD, following the AMSP teaching guidelines. Additionally, Dr. Pedersen will also meet with the addictions fellows one time in the next year. Second, Dr. Pedersen was a expert panelist for a journal club presentation on treating comorbid AUD and depression. As part of this role she reviewed the slides of the psychology intern presenter and provided feedback that was based on AMSP lecture style. Finally, Dr. Pedersen met with the Medical Director of Addiction Medicine Services at Western Psychiatric Institute and Clinic. She is working on obtaining a clinical appointment to allow her to directly supervise trainees in the substance use outpatient clinics and is developing a training plan with the Medical Director for staff. In all meetings that Dr. Pedersen held with these Directors she referred to AMSP and the goals of this program.

The next item on the agenda was a discussion by Myo Myint of Tulane University in New Orleans regarding how to modify a lecture on transsexuals aimed at medical students to a format and slide copy appropriate for a fifth grade class. After a detailed discussion, Dr. Myint agreed to present that 15-minute lecture for school children the next day.

The next issue was the presentation of a lecture by first-year scholar Marty Plawecki from the University of Indiana of his lecture on approaches for monitoring abstinence. This very accomplished and effective lecture began with an emphasis on treatment issues, with a segue into the major strength and major portion of the lecture dealing with monitoring devices. Dr. Plawecki had a superb background for discussing these devices, as his original degree was in engineering. After the lecture, a discussion ensued regarding how interesting and unique the alcohol monitoring aspect of the lecture was and how much more Dr. Plawecki might present on that topic. Therefore, Marty agreed to work toward revamping the lecture by markedly expanding information on monitoring devices, while cutting back on some of the initial period of the lecture focusing on overviews of alcohol treatment.

Myo Myint, from Tulane University, then presented his 15-minute lecture on transsexuals in a format now appropriate for 5th grade students. This was an excellent use of illustrations and pictures, and was felt to be a superb potential addition to our Website.

The schedule next segued to a working lunch. The discussion initially continued the focus on transgender individuals, drug courts, and related topics. Additional academically-oriented issues included alternative approaches for clinician- and administrative- scholars to be appropriately promoted in a medical school atmosphere even without an original research program; overall discussions of academic promotion; how to link promotion with higher salaries; and working with donors.

Benjamin Nordstrom, from Dartmouth University, next presented a shortened version of his original lecture on drug courts. This was a superb demonstration on how a 45-minute lecture for one audience can be modified for another group. It was also an important demonstration of how one alters how the same material is modified through the words one uses as he produced a lecture for police academy graduates.

A similar demonstration of modifying a lecture to a different audience was then presented by Arthur Westover, of the University of Texas Southwestern. Here, a lecture that had originally been developed as a 45-minute presentation to medical students regarding cardiovascular dangers associated with the use of prescribed doses of stimulants. Now, the lecture was altered for a large meeting of pediatricians, once again demonstrating the way that material is discussed in greater or lesser depth depending upon the needs of the specific audience.

Following this presentation, Myo Myint, second-year scholar from Tulane University, next discussed AMSP-related events at Tulane University. In the near future, Myo will participate in Tulane's Alcohol Submit with the launch of new university alcohol policy. Recently he used AMSP resources to present grand rounds on synthetic cannabinoids to the Department of Pediatrics, and regarding gender nonconformity to the Division of Child and Adolescent Psychiatry (CAP) . Myo also delivered a substance use disorder lecture block to the CAP fellowship training group as well as adolescent lectures where substance use was a prominent topic. He provided the clerkship lecture on CAP-related topics to the medical students and stressed the substance use in adolescent population. Dr. Myint continued to co-lead the support group for the students with diverse gender expression where the topics have included substance use. In an important recent development, he has accepted the invitation to become the residency training director of both CAP and triple board (pediatrics/psych/CAP) programs starting July 1, 2015. In this role Myo will have the opportunity to impact directly on alcohol and drug education for both medical students and residents/fellows in his department.

The day ended after a several-hour break when the group reconvened for a working dinner at Bistro Du Midi. Issues discussed earlier in the day were revisited, plans for Saturday were discussed, and topics related to planning for the subsequent Fall 2015 meeting were prominent on the agenda.

Saturday, May 9, 2015

The AMSP meeting reconvened at 8:00 a.m. The morning's activities began with a presentation by Paola Pedrelli, first-year scholar from Massachusetts General Hospital, regarding her lecture on drinking and depression in undergraduate students. Paola's fine organization of the material and the important clinical implications of the coexistence of heavy drink and depressive symptoms combined to make an effective, clinically oriented topic based on Dr. Pedrelli's own research. As the meeting was coming to a close that day, Marc used the slides to underscore important topics related to effective slide development, and to discuss how these fit in with topics that are important for scholars and for lecturers overall.

Rob Leeman, second-year scholar from Yale University, next presented his full lecture on impulsivity. The style of presentation was superb and energetic; the material clearly presented; and this was an outstanding demonstration of the effective use of specific cases (in this case Phineas Gage) as a central mechanism for presenting the data. The group discussion here focused on abbreviations, whether one needs to write out any words that are being used that might be misunderstood by the audience, the importance of defining syndromes, along with the overall effective of both the lecture and the delivery itself.

Marty Plawecki, first-year scholar from Indiana University, next presented his report on his AMSP-related activities and progress regarding enhancing alcohol and drug education for medical students, psychiatric residents, fellows, and psychology trainees at Indiana University School of Medicine and for undergraduate and graduate students at the affiliated Indiana University – Purdue University Indianapolis campus. The prior 6 months offered both success and challenges. At the medical student level, Marty continued participation in the Alcohol and Drug Intersession Day, and was nominated to the Grand Rounds selection committee offering the chance to impact the larger Psychiatry department and affiliated students, but was ultimately not selected for this round. He will try again in the future. At the Child and Adolescent Psychiatry education level, he was appointed to the Child and Adolescent Psychiatry Resident Education Committee, giving him another opportunity to optimize medical education on alcohol and drugs. At the university level, he applied for membership to the medical scientist program steering committee, but was ultimately not selected. Martin increased awareness of the AMSP lectures to non-medical school affiliated members of the Indiana University Alcohol Research Center, many of whom provide graduate training and have undergraduate teaching responsibility and explored teaching opportunities.

The final report of activities was given by Arthur Westover, second-year scholar from the University of Texas Southwestern. Dr. Westover has worked to improve treatment of persons with substance use disorders and to improve education on addiction at UT Southwestern Medical Center and Parkland Hospital. He advocated for liberalized admission criteria of persons with co-occurring substance use disorders to the inpatient psychiatry unit at the county hospital. This led to policy clarifications which allowed admission of such patients fitting certain criteria. Dr. Westover worked with the attending physicians on the inpatient unit in developing a lecture series schedule using AMSP lecture materials, where each faculty member would present two lectures from the website. He also encouraged medical students to consider AMSP lectures as source materials for their own required presentations on their third year psychiatry clerkship. While on service, on of the students presented on synthetic cannabis based on a lecture from the AMSP website. Dr. Westover also publicized the existence of the AMSP website to psychiatry faculty. One faculty member at the Dallas VA working in their addiction program later contacted Dr. Westover to say he had found the website very useful in his practice and teaching. Dr. Westover also has continued to work with the addiction fellows at UT Southwestern and the Dallas VA in their addiction journal club, utilizing his research experience to help the fellows better understand topical studies from the addiction field.

The next AMSP meeting (in which the current first-year scholars will become second-year scholars and five new scholars will join our group) will be held in San Diego on November 4th through November 7th, 2015.

As this was the last meeting for the current second-year scholars, they were each given recognition and many thanks for their efforts, and plaques to signify their completion of the AMSP program.

Finally, the group discussed housekeeping issues regarding travel home, supplying appropriate details of expenses to Marcy, and several additional housekeeping issues. The group adjourned with good wishes to all for a safe trip home.

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