Meeting #33

La Jolla, CA

November 4 - 7, 2015

Minutes of the Fall 2015 Alcohol Medical Scholars Program Meeting
Wednesday, November 4, 2015 through Saturday, November 7, 2015
La Jolla, California

Present at the meeting were first-year scholars Priscila Dib, Dorian Lamis, Leslie Lundahl, Randi Schuster, and Daryl Shorter. Also present were second-year scholars Kelly Barth, Marty Plawecki, Joe Schacht, Sarah Pedersen, and Paola Pedrelli. The meeting was chaired by Marc Schuckit, Director, with the help of Marcy Gregg, both from UCSD.

I. Wednesday, November 4, 2015
The group assembled at 7:00 p.m. on Wednesday, November 4th, in the lobby of the Grande Colonial Hotel in La Jolla, California. Introductions were made, and the schedule for the current meeting was discussed. Plans for that evening were challenging, in that the San Diego airport had been closed for five hours during that day because of an emergency, despite which all scholars were able to arrive either that evening or early the next morning.

II. Thursday, November 5, 2015
The group reassembled following breakfast. The morning began with a more detailed description by each of the first- and second-year scholars' background and goals at their medical schools. Marc Schuckit then presented information about how to deliver optimal lectures, a process that is also relevant for writing papers, chapters for books, and grant application. This process is used as the learning tool in AMSP, which produces the benefit of adding alcohol- and drug-related lectures (along with slides and references) that can be used in educating medical students, residents, social workers, and nurses throughout the world.

As demonstrated in the lecture on how to tell your story, posted on the AMSP website, several key elements go into a successful effort. First, the lecturer or writer must modify how ideas are presented by focusing on that specific audience. Second, the role of the writer or presenter is to make information easily accessible to the audience, which means that regarding lectures, the emphasis is placed on the audience and, in effect, the lecturer is the least important person in the room. Third, a successful presentation in writing or as part of a lecture requires that there be a clear flow of logic from the beginning introductory section through presentation of the major activities, on to summarizing what was presented in writing or in the lecture. Optimal slides, figures, and tables are important when they serve the message offered without being distracting.

The second-year scholars shared their experiences with AMSP in the prior year, and the first-year group had the opportunity of asking for clarifications.

Following the morning's discussions, the group next turned to a working lunch, during which issues related to optimizing functioning in an academic atmosphere were discussed. Among the topics during that hour were how to determine whether one's pay is fair, how and when to negotiate for a salary increase, the extra challenges faced by women in academic medicine, approaches to learning when and how to say no when requested to do a task that was beyond the time available for an individual, and how to keep research going during a very difficult time regarding related funding.

The afternoon began with a presentation of his AMSP lecture on pharmacogenetics of alcohol-related treatments by the second-year scholar, Joe Schacht from the Medical University of South Carolina. The material presented gave many opportunities for Marc and the rest of the group to discuss the optimal development of a lecture outline, the fact that the outline must be useful for other individuals who might want to present that same lecture, and the optimal development of slides. After a lengthy discussion of the many assets of the presentation, Marc asked Joe to demonstrate how a 45-minute lecture with 40 slides (which Joe has already developed) can be altered to a 10-minute lecture with 10 slides. That new lecture is to be developed in a process taking less than two hours, and was slated for presentation on Saturday morning, November 7th.

The general meeting adjourned at 3:00 p.m., although Marc met with first-year scholar, Dorian Lamis, to discuss in more detail the initial outline he is developing for his presentation in the spring 2016 AMSP meeting. AMSP participants were on their own that evening for dinner.

III. Friday, November 6th, 2015
The morning session began at 7:30 a.m. with Marc Schuckit meeting with first-year Leslie Lundahl of Wayne State University regarding the development of an outline for her talk to be delivered in the spring 2016 meeting.

The full group session began at 8:00 a.m. with a lecture presented by Priscila Dib, first-year scholar from Sao Paulo, Brazil, regarding alcohol-related blackouts. Because Priscila had joined AMSP with an unusual beginning date (reflecting her Brazilian supported travel to the U.S. to work in Marc Schuckit's laboratory), this was the first of the first-year scholars' talks (the other presentations will occur at the spring 2016 meeting.) The alcohol-related blackout lecture was excellent with superb slides, easy to follow logic, and a delivery that placed the audience at their ease. Priscila's presentation will be loaded onto the AMSP website within the week.

The morning's activity then progressed to a presentation of the recent accomplishments of the second-year scholar, Sarah Pedersen, from the University of Pittsburgh (Pitt), School of Medicine. Her activities related to addiction training since May 2015 include involvement in several different endeavors related to the goal of increasing addiction training at Pitt Medical School. First, she facilitated three small group didactic classes to first-year medical students. Additionally, she gave a talk on career development to postdoctoral scholars at Pitt. Dr. Pedersen delivered a talk to first-year psychiatry residents on the screening and diagnosis of substance use disorders, and utilized the AMSP lecturing style. Finally, Dr. Pedersen was an expert panelist on a journal club presentation to psychiatry residents. The topic was on motivational interviewing, change talk and brain activation. Dr. Pedersen is scheduled to give three different lectures to psychiatry residents and fellows over the next few months, is scheduled to work with medical students on learning motivational interviewing, and will continue to work to obtain a clinical appointment that will permit her to do clinical work in addiction facilities.

Marty Plawecki, second-year scholar from the University of Indiana, presented his progress regarding enhancing alcohol and drug education for medical students, psychiatric residents and 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. At the medical student level, he continues participation in the Alcohol and Drug Intersession Day and has continued to engage with the departmental liaisons for the medical student education reform process. He has taken advantage of additional opportunities to influence the reform through interaction with the Indiana Alcohol Research Center. Martin continues to serve on the Child and Adolescent Psychiatry Resident Education Committee. His activity in the education of fellows has increased and he used the AMSP methodology to develop several lectures given to the group. Although he was initially denied, he was selected to participate with the Medical Scientist Program Steering Committee. Martin continued to increase awareness of the AMSP lectures to faculty of the Purdue School of Science, who provide education to both undergraduate and graduate students. He also continues his efforts for getting an expanded appointment and teaching opportunities.

The next item on the agenda was to discuss the timing and place for the Spring 2016 meeting. The dates that were acceptable to all participants focused on beginning on Wednesday, March 16, 2016 and ending on Saturday, March 19, 2016. The place will be on the East Coast, probably somewhere in the Miami area, or in either San Francisco or Los Angeles..

The morning's activities progressed to a presentation of the lecture on treatment of pain in dental practices, by Kelly Barth, second-year scholar from the Medical University of South Carolina. This was also a very effective lecture with excellent information that would easily be of use to a medical student audience as well. The slides were very effective and there was a lively discussion about assets and liabilities of several of those slides that might be changed, although their current format is quite effective.

The noontime discussion of academic-related topics took place over lunch from approximately 11:30 am to 12:45 pm. The items discussed included how to ask for a promotion, assets and liabilities of being a member of editorial boards for journals, optimal reviewing of submissions to journals, potential guidelines regarding assigning co-authorship or the appropriate place in the list of authors, approaches to optimal follow-up studies, and ways to deal with situations in which an individual feels overwhelmed.

The afternoon began with a revised presentation of his lecture on devices used to monitor abstinence as delivered by Marty Plawecki of the University of Indiana. The modifications included incorporation of a few additional monitoring devices, and the lecture was highly effective. Once again, the material was used as a reminder to first-year scholars about some of the mechanisms that go into the development of lectures and papers.

Joe Schacht of the Medical University of South Carolina next presented his report of activities related to alcohol and drug university to which he has contributed. Dr. Schacht was recently invited to participate in MUSC’s first-year medical student curriculum by assisting with brain dissection labs. He has used this opportunity to help students learn aspects of neuroanatomy related to addiction (e.g., identifying brain areas associated with the rewarding effects of alcohol and drugs or that are affected by Korsakoff’s amnesia). Dr. Schacht has continued his teaching in the MUSC psychiatry residency program, and recently lectured on motivational interviewing to third-year psychiatry residents using slides he modified according to the AMSP presentation principles. Dr. Schacht has also influenced alcohol and drug education at MUSC through his participation on two committees in the Department of Psychiatry and Behavioral Sciences. As a member of the Grand Rounds Committee, he has invited experts in addiction research, including Drs. Andrea King of the University of Chicago and Lara Ray of the University of California, Los Angeles, to speak in the psychiatry Grand Rounds series. Further, as a member of the Addiction Sciences Division’s Media and Outreach Committee, Dr. Schacht has helped to invite addiction scientists to present their research to patients engaged in a relapse prevention group in an intensive outpatient clinical program. He will present his own research to this group in early 2016.

The last item of the day was to review the next day's schedule and questions individuals might have regarding the materials that had been presented that day.

The meeting adjourned at 2:30 p.m., following which Marc Schuckit met with first-year scholar Daryl Shorter from the Baylor College of Medicine regarding his talk.

The group reconvened at 7:00 p.m. in the lobby of the Grande Colonial Hotel to discuss the accomplishments of the day. The meeting continued over a working dinner.

IV. Saturday, November 7, 2015
At 7:30 a.m. Marc Schuckit met with Randi Schuster regarding her initial outline for her spring 2016 lecture.

The meeting for the full group began at 8:00 a.m. with the presentation of a modified lecture by Sarah Pedersen, second-year scholar from the University of Pittsburgh. Sarah's task was to modify her original 45-minute excellent lecture on drinking in Black Americans, imagining she had only 20 minutes (and less than 20 slides) to present the key lessons to a local NAACP meeting. Using less than two hours, after reviewing her prior outline and slides, Sarah was able to develop a superb and logical, and easy to follow lecture that was highly appropriate for the audience. The group then discussed with her the steps she took in this process that are relevant to first-year scholars.

Next, Paola Pedrelli from the MGH service in Boston presented a modification from 40 minutes to 20 minutes and from medical students to computer programmers of her lecture regarding alcohol and depression on college campuses. Once again, this was a superb demonstration of how lectures can be modified for different audiences with a relatively short period of work (in this case two hours).

The next order of business was to finalize the assignments of first- and second-year scholars as the first-year participants develop their lectures. Thus: 1) first-year scholar Daryl Shorter will develop a lecture on buprenorphine by working with second-year scholar Kelly Barth, who had already developed a lecture on opioids; 2) Randi Schuster, first-year scholar, who will be developing a lecture on cognitive impairments related to marijuana use in adolescents while partnered with Sarah Pedersen who had developed a lecture on a wide range of topics related to alcohol use in Black Americans; 3) Dorian Lamis, a first-year scholar developing a lecture on alcohol and suicide, will be partnered with second-year scholar Paola Pedrelli, who had developed a lecture on depression and alcohol in college students; and 4) the lecture to be developed on pharmacological treatments for marijuana use disorders by first-year scholar Leslie Lundahl, who will be partnered with second-year scholar Joe Schacht, who had developed a lecture on pharmacogenetics, as well as Marty Plawecki, who had a lecture developed on monitoring abstinence.

The group then returned to discussion of the due dates for first- and second-year scholars in developing the new lectures. These include:

1. Monday, November 16th -- the first rough draft of the outline originally developed in a very rough form during the AMSP meeting will be due to the second-year scholars and to Marc Schuckit.

2. Monday, November 23rd -- is the due date for the next draft of the outline that will be expected to have had some details filled in, as well as some references noted.

3. Monday, January 11th -- after multiple drafts carried out by first-year scholars working with second-year scholars and Marc Schuckit, is the absolute latest deadline for having developed the full lecture with references. It is on this date that Marc Schuckit will take over working with first-year scholars on finalizing their lectures.

4. Monday, January 25th -- is the date when first-year scholars will turn back to their second-year scholars (with ccs to Marc Schuckit) regarding developing slides for their lecture.

5. Monday, February 22nd -- will be the date when all lecture outlines, references, and slides will be in their almost ready for presentation form.

6. Wednesday, March 16th, 2016 -- is the beginning of the spring meeting and the time when all four of the new first-year scholar lectures will be presented (first-year scholar, Priscila Dib, has already developed and presented her lecture at the current meeting).

Next, Kelly Barth, second-year scholar from the Medical University of South Carolina, presented her activities at MUSC over the prior six months. Dr. Barth presented Critical Care Grand Rounds entitled, “Prevention and Management of Alcohol Withdrawal in the Intensive Care Unit.” She has also received a two-year grant to educate MUSC students (pharmacy, medicine, nursing) about safe opioid prescribing and opioid use disorders in pain management. She has served as a consultant for the South Carolina Opioid Safety Initiative, a project that educates primary care physicians about safe opioid prescribing for pain. Additional activities have included her role as a mentor and lecturer for MUSC’s Drug and Alcohol Research Tract, where she has mentored two med-psych residents in a project aimed at prevention of restraint use in hospitalized patients through identification of heavy drinking. Finally, she continues to deliver her AMSP lecture entitled “Opioid Use Disorders in Dental Medicine” annually to first-year dental students and a bi-yearly lecture entitled “Opioid Use Disorders in Behavioral Medicine” to pre-doctoral psychology interns and post-doctoral fellows.

Paola Pedrelli, second-year scholar from Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), next reviewed her activities at her medical school over the prior six months. Dr. Pedrelli discussed her desire to improve medical education in substance use disorders at HMS with Donna Greenberg who directs the education of medical students at MGH. Dr. Greenberg outlined the fact that Harvard Medical School is undergoing a major reform and its curriculum has been revised significantly. Students for the first time will begin clinical rotation in the second rather than third year of medical school. The school is also changing its pedagogical style which has become more experiential. Given the fact that the new curriculum has just been implemented with this year's class, the possibilities for expansion are still a bit unclear. Dr Greenberg noted that she can envision Dr. Pedrelli helping by providing an elective in addiction or by enhancing the medical students' experience while completing their rotation at MGH addiction or at MGH inpatient unit. Dr. Schuckit offered to share his syllabus for an elective he offered at UCSD. Dr. Greenberg also noted that the governor of Massachusetts asked for a report outlining medical students’ education in addiction and Dr. Greenberg proposed to share it with Dr. Pedrelli so she could identify possible areas to enhance. Paola continues to be a member of the committee that reviews applications for the internship program in clinical psychology at MGH and will continue to uses this role to advocate for recruiting at least one psychology intern interested in addiction. Since the last AMSP meeting, Paola has given one presentation at a national conference on the association between heavy drinking and depressive symptoms where she included slides from the AMSP webpage and applied AMSP principles. Paola has delivered a lecture prepared according to the AMSP style on heavy alcohol use and depressive symptoms to PGY III completing a rotation at a MGH transitional age youth clinic. Dr. Pedrelli will also give a lecture December 9th, 2015 to MGH Addiction fellows outlining the resources available on the AMSP website and will present “How to Tell Your Story”.

The days' activities ended with lists by all first-year scholars of their potential activities at their universities.

First year scholar, Priscila Dib from Brazil, reviewed her plans to expand substance use education at the University of São Paulo. In the future, Priscila intends to translate to Portuguese the presentation “How to Tell Your Story” and give this talk in the Addiction Seminars reviewing the major points. This will supplement Dr. Schuckit’s presentation in São Paulo in March 2014, which is attended by six second-year psychiatry residents, six fellows from the multidisciplinary residency in Alcohol and Substance Use Disorders for non-medical professional, psychologists, clinical psychiatrists, and open to the general public. In addition, Priscila intends to present the “How to Tell Your Story” in the Psychiatric Grand Rounds and raise awareness of the available lectures on the AMSP website. Those rounds are attended by all psychiatric residents, psychiatry department faculty, and clinical staff (i.e. nurses, psychologists, social workers, occupational therapists) from the Institute of Psychiatry. Priscila also will use her AMSP training to modify the alcohol and drug lectures she presents to trainees in neuropsychology, in the Addiction Seminar and the specialization course of alcohol and substance use disorders for medical and mental health professionals.

Dorian Lamis, Ph.D., a first-year scholar from Emory University School of Medicine, presented his thoughts about opportunities to improve alcohol and drug education at his university. First, Dr. Lamis will revise previously prepared lectures for psychiatry residents using the AMSP format. Second, he will present the AMSP website resources to attendings on ER, inpatient, and consult/liaison services and encourage their use as teaching aids. Third, Dr. Lamis will look into potentially developing a Doctors Ought To Care (DOC) program to give Emory students the opportunity to visit local schools to discuss issues related to alcohol and other substance use. Fourth, he will meet with the directors of the postdoctoral fellowship and
residency training programs to discuss integrating alcohol/drug education into the curriculum. In these meetings, he will discuss the goals of AMSP and learn what active training elements on addiction are already in place for trainees. He will then identify gaps in training and expand his involvement based on these needs. Lastly, Dr. Lamis will meet with the Medical Directors of the inpatient and outpatient services at both Emory and Grady hospitals to arrange to deliver
trainings and/or lectures to staff and providers on addiction theory and treatment using AMSP materials and methods for these presentations.

Dr. Leslie Lundahl, first-year scholar from Wayne State Medical School in Detroit, next discussed her plans for enhancing education about substance use problems at her school. Leslie currently teaches a psychotherapy course to third- and fourth-year psychiatry residents, and lectures on treatment approaches for adolescent substance use disorders to second-year psychiatry residents and residents in the Child and Adolescent Psychiatry Fellowship program. She plans to update the slides she currently uses in these lectures to reflect the AMSP style and improve the quality of her presentations. Dr. Lundahl will also meet with the Vice Chair for Education in the Department of Psychiatry and Behavioral Neurosciences to discuss presenting Dr. Schuckit’s “How to Tell Your Story” to faculty, residents, students, and trainees. To better understand where training could be improved, Dr. Lundahl will discuss with the Vice Chair the existing alcohol and drug education curriculum for medical students and residents. Finally, Dr. Lundahl will meet with a colleague in the Department of Family Medicine who directs a traveling clinic to offer training in screening and assessment of alcohol and substance use disorders.

Daryl Shorter, a first-year scholar from Baylor College of Medicine, next discussed his thoughts on improving alcohol and drug education at his institution. Dr. Shorter currently serves as the course director for the Introduction to Addictions Treatment lecture series for post-graduate year 1 (PGY-1) General Psychiatry residents. This academic year (2015-2016), the lecture series was expanded from eight (8) one-hour lectures to ten (10), with the additional topics of motivational interviewing and substance use disorder diagnosis to be addressed. Dr. Shorter's first objective is to re-imagine the course, utilizing the principles stressed in AMSP, in order to tailor the lecture offerings more specifically to the audience and improve the presentation/slide content. Dr. Shorter will also adapt previous AMSP lectures from the website, such as Motivational Interviewing, in order to further enhance the quality of these didactics. Additionally, Dr. Shorter will sponsor a brown-bag lunch with other faculty members from the Addiction Psychiatry division as well as the PGY-5 Addiction Psychiatry fellow in order to introduce the "How To Tell Your Story" lecture and format.

Next on the agenda was a discussion by Randi Schuster, first-year scholar from the Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), on her upcoming plans to facilitate substance use disorder training at her institution. She noted the possibility of presenting lectures to first-year residents at MGH, as well as to the MGH/HMS Addiction Grand Rounds on issues pertinent to substance use assessment and treatment including recognition of withdrawal and common comorbidities. Additionally, as the newly appointed Director of Neuropsychology at the Center for Addiction Medicine, Dr. Schuster proposed developing a comprehensive infrastructure for training and supervision on neuropsychological assessment among substance using populations. She plans to establish a journal club for newly accepted medical students and graduate students to foster a discussion on current, thematically-arranged issues in the field of substance use. Finally, Dr. Schuster will meet with Dr. Todd Griswold, the director of Medical Education for HMS, to discuss the possibility of incorporating medical students in the development and presentation of substance-use focused in-service days for Boston-area high school students, faculty and parents.

The meeting adjourned at noon with good wishes to all on their trip home.

Layout and design by Brian Klima