Meeting #2

San Francisco, California

May 3 - 6, 2000



Present at the meeting were Drs. Karen Trocki, Vijay Ramchandani, Eric Raimo, Susan Tapert, Marianne Guschwan, Vania Modesto-Lowe, Marc Schuckit, and Laura Bierut.

I. Wednesday, May 3rd.

The group assembled at the San Francisco Grand Hyatt at 6:00 p.m. Participants had a chance to meet our administrative assistant, Marcy Gregg, and the group set out for the evening's activities which began at Crown Point Press with a tour of the gallery and an exhibition of the process of creating etchings. We were joined for the evening by Ivan and Sarah Diamond, and a dinner for all participants was hosted at Hawthorne Lane. Scholars were briefed regarding the plans for the next day.

II. Thursday, May 4th.

A. The meeting began at 8:00 a.m. with a working breakfast. The goals for the remaining three days of the meeting were established, and the good news regarding funding for the fiscal year 2000/2001 was shared.

B. The first presentation was a review by Marc Schuckit on How to Give a Lecture. This was an update and expansion of the material that had been presented in Hawaii. The lecture along with questions and suggestions lasted approximately an hour and one-half. The suggestion was made that the lecture be repeated at upcoming meetings, and that the next presentation of this material be videotaped. This will give the opportunity for the Scholars to review additional material at their leisure, and also offer them the option of using the tape as a teaching tool in their own institutions. Perhaps the videotape might be attached to the website.

C. The group returned to several housekeeping issues.

1. The next meeting for the Alcohol Medical Scholars Program will begin at 6:00 p.m. on Wed., October 18, 2000 and go through Sat., October 21st in San Diego. Marcy Gregg will make arrangements for housing at a small but lovely hotel, the L'Auberge Del Mar Resort and Spa in Del Mar, California. Some participants might choose to rent a car so they have an opportunity to visit various locations of San Diego County, although car rentals will not be covered by AMSP.

2. The spring meeting in 2001 is tentatively scheduled to begin at 6:00 p.m. on Wed., May 16, 2001 and end at 1:00 p.m., May 19th. This will be the meeting scheduled for a "retreat" in a secluded atmosphere, and is likely to be in Cancun, Mexico.

D. The next item was an update from Laura Bierut regarding the accomplishments and plans from St. Louis.

1. The resources from the Alcohol Medical Scholars Program have allowed Washington University to free-up enough of Laura's time for her to take on a leading role in the reorganization of the medical school curriculum. As a member of the Medical School Education Oversight Committee, she has participated in decisions to add a course on the Practice of Medicine to the first-year curriculum. This will highlight issues relating to ethics, humanitarian aspects of the delivery of care, an overview of care systems, and legal issues. Through her leadership, this course will use issues related to alcoholism as one of the examples of materials to be assimiliated by medical students.

2. Laura is now working with this same group on the implementation (for the year 2001) of the continuation of the Practice of Medicine course to second-year students. This will be an overview based on organ-centered diseases and will be initiated through activities during the psychiatry clerkship. Through her central role, Laura will be certain that alcohol and other substance-related issues have a prominent role in these discussions.

3. Laura has helped to establish sessions of Grand Rounds at Washington University focused on teaching and feedback in clinical care. The emphasis is how to teach during clinical rounds, and some of the ideas as well as much of the input has grown out of the AMSP program.

4. Laura has added two lectures to the second year medical school curriculum including those on comorbidity in substance use disorders and on the differential diagnosis and treatment of delirium (which also includes information on substance use disorders).

5. She has also added third-year medical school small group sessions discussing comorbidities among alcohol and drug-dependent subjects.

6. Much of the teaching regarding alcohol and other substance use disorders has taken place on the inpatient unit of Barnes Hospital. Laura shared with the group the need for trouble shooting of what to do if that unit is either closed or its' efforts cut back. The group discussed the options available in reaching out to other treatment programs for medical student education and/or beginning to focus more on an outpatient model.

E. Marianne Guschwan also presented an update of the accomplishments related to the Alcohol Medical Scholars Program at New York University. Because of obligations associated with a very busy clinical unit, Marianne feels that the educational resources made available from the Alcohol Medical Scholars Program have played a key role in her ability to make inroads in alcohol education. Most of her efforts have involved working with the Director of the Medical School Clerkship, Dr. Manley, as well as interactions with Dr. Marc Galanter. Marianne has created a series of goals of projects to be implemented beginning July of 2000. These include:

1. There are plans for the institution of a one-to-two hour per day for one week rotation on the alcohol detoxification unit for medical students.

2. Marianne is working with Dr. Galanter regarding helping to train fellows in substance use disorders how to give lectures. They will also be introduced to the lectures and slide copy developed through the Alcohol Medical Scholars Program and presented on our website.

3. Marianne is working to be certain that alcohol and other drug education is incorporated in the revamping of the medical school curriculum at NYU which is now changing to a more organ-based approach. The group suggested that rather than reaching out to all components of the reorganization, Marianne might identify one particular educational unit (perhaps behavioral medicine or psychiatry) and contact the director of that unit to be certain he or she knows that teaching materials on alcoholism and other drug dependencies are available, and that Marianne would like to help.

4. Dr. Guschwan has already taken steps to develop one-and-one-half hour workshops at the American Academy of Addiction Psychiatry meeting in Phoenix, and at the 2001 meeting of the American Psychiatric Association in New Orleans. The workshops will be directed at residents and fellows in fields related to alcohol and drug dependence, and will focus on how to give a lecture, how to review the literature, the development of slides, etc. Marianne will be working with Susan Tapert to develop these applications, and Marc Schuckit has volunteered to help with editing and making suggestions regarding filling out the forms for application.

5. A group of medical students at NYU have been developing information on harm reduction relating to the substance use disorders. Dr. Guschwan is planning to reach out to these students, perhaps sponsoring a dinner that will give them a chance to discuss some of their efforts.

6. There are plans to incorporate a lecture on detoxification procedures as part of the series of lectures for medical students and fellows relating to recognizing and treating alcohol and drug problems while on call.

7. Finally, the discussion turned to the assets and liabilities of incorporating mandatory AA meetings into the rotations by family practice/internal medicine residents, as well as the possibility of tieing in some of our materials with a group from Hazelden in New York.

F. The next order of business on Thursday morning was the presentation of the lecture by Laura Bierut regarding "Brief Interventions for Heavy Drinking." Laura shared hand-outs that demonstrated 17 slides, gave an outline of the talk, and presented appropriate references. The group was impressed with the material, and hopes that the lecture will be ready to add to the website by mid-July of 2000. A number of suggestions were made in an effort to make this excellent lecture even more effective.

G. At the suggestion of Eric Raimo, the next issue was a discussion of a clear cut mission statement that can be added to the website. Various drafts of the potential material were presented, and Marcy Gregg took on the task of developing these into a potential statement to be shared with the scholars on Friday.

H. The group established the time-frame for the six lectures to be presented over the next two days of the meeting. Friday will focus on lectures on spirituality, the developmental paths involved in substance use disorders, and alcohol and drug problems among special populations. Saturday will involve three additional lectures developed by scholars including medical consequences of alcohol and drug related disorders, pharmacological treatments, and pharmacology.

I. The meeting ended with an informal discussion of issues relevant to career development including trying to develop lectures and to keep up with the literature. Among the points made were that nonresearchers who are developing lectures for medical students or other populations should take optimal advantage of review articles. The group outlined a number of journals that offer excellent materials that have usually been appropriately reviewed for publication. These included various echelons of journals ranging from Science/Nature/New England Journal of Medicine, to additional fine journals such as JAMA/The American Journal of Public Health/Archives of General Psychiatry/The Journal of Consulting and Clinical Psychology/The Journal of Abnormal Psychology, on to excellent journals focused on the substance use areas including The Journal of Studies on Alcohol/Alcoholism: Clinical and Experimental Research/ and Addiction. There are also a few nonfereed journals with excellent reputations including Alcohol Health and Research World.

J. The group adjourned at approximately 2:00 p.m. with plans to resume the meeting at 8:00 a.m. on Friday, May 5th.

III. Friday, May 5th.

A. Some housekeeping issues.

1. Several Scholars have received awards which are at least indirectly related to their AMSP participation. Laura Bierut will receive a teaching award at the upcoming American Psychiatric Association meeting in Chicago, while Vania Modesto-Lowe has been given a promotion and will become the Director of the Addictions Training Fellowship at the University of Connecticut. Congratulations to them both!

2. Marianne Guschwan announced that her workshop on spirituality (the topic presented here) has been accepted and slated for presentation at the American Psychiatric Association meeting later this month.

3. Several topics were selected for presentation at the next AMSP meeting including an overview of the development of Powerpoint slides and the appropriate use of the LCD projector, an overview of the appropriate use of Procite and Endnotes, a session dealing with how to teach motivational interviewing, a lecture on how to write a good research or review article and on adaptation of John Greden's lecture on career development. The first and last of these will be given by Susan Tapert, and the Endnotes/Procite by Karen Trocki.

B. The AMSP lecture on "Spirituality and Alcoholics Anonymous" was then presented by Marianne Guschwan. Marianne presented the entire lecture and slide copy. This is an excellent overview of topics that are important for teaching of medical students and other personnel. With some minor changes, this will be incorporated onto the AMSP website by July 15, 2000.

C. Marc Schuckit circulated a copy of the outline, slide copy, and explanation of slides that he developed for an alternative lecture on the genetics of alcoholism to be presented at the upcoming Research Society on Alcoholism meeting. He asked that, if at all possible, the Scholars preparing lecture material for the website follow the basic format of this outline.

D. The group returned to a discussion of our mission statement. We agreed that this will (at least temporarily) be as follows:

"The mission of the Alcohol Medical Scholars Program is to promote optimal education in medical schools regarding the identification and care of people with alcohol use disorders and other substance-related problems."

E. Karen Trocki presented a lecture on "Developmental Factors in Substance Use Disorders Prevention and Treatment." This fine lecture complements additional topics from AMSP and will be incorporated into the website by July 15th. It is an overview of the interplay between various aspects of biological background and areas of life functioning as they combine to promote exposure to drinking and use of other substances as well as associated problems.

F. The update on developments at the University of Connecticut was presented by Vania Modesto-Lowe. Vania emphasized that the money and resources given to her through the AMSP have helped her achieve higher levels of prominence and influence within her department. During the time between this and the prior AMSP meeting, Dr. Modesto-Lowe achieved the following steps:

1. She met with the medical school clinical rotation coordinator and the person in charge of the didactic series of lectures. Vania was able to establish a one-hour per week lecture on comorbidity issues in substance use disorders as part of the medical school rotation on psychiatry. This was instituted approximately three months ago and is due to continue.

2. She has developed a six-week lecture series for PGY2 residents covering pharmacology, motivational interviewing, etc. and focusing on substance-related problems.

3. The addiction fellow is now slated to give one Grand Rounds per year on substance-related issues.

4. Steps have been taken to help the fellow regarding teaching residents about alcohol and drug issues.

5. During the interval, Dr. Modesto-Lowe has carried out one Grand Rounds at a community hospital, and has two more scheduled.

6. A number of problems have arisen regarding medical students rotation on her unit relating to financial and political problems at the hospital. Similar issues have arisen regarding psychiatric resident rotations on substance use disorder programs. The group discussed various options that might be available to her, and Marc Schuckit agreed to continue to work with her on these issues.

7. In the future, Dr. Modesto-Lowe hopes to be able to implement the lecture on how to give a lecture, and to deliver it to fellows and residents, and plans to develop a series of videos regarding clinical cases.

8. An additional problem has arisen regarding the possibility that the unit on which Dr. Modesto-Lowe works might be moved from the hospital to a prison setting. It was suggested that she get in touch with Dr. David Deitch in San Diego, as he has established similar programs in California and might be of help.

G. Susan Tapert delivered her lecture on "Alcohol Related Problems in Special Populations (Women and Youth). This was another example of a fine lecture, and the group had some modest suggestions. As with the other lectures, it is hope this will be fully incorporated into the website by July 15th at the latest.

H. The group turned to a discussion of the selection of new scholars.

1. An invitation will be submitted to Dr. Villier of Howard University.

2. Similarly, an invitation will go to Dr. Christopher Welsh at the University of Maryland, who is now on their faculty.

3. Marc Schuckit will contact Marilyn King of the American Psychiatric Association regarding potentially interested candidates from the APA Minorities Program. An additional potential resource for nominations is Patty Ordorica who works in addiction psychiatry at the Tampa, Florida VA. While she is relatively senior, she may have additional individuals to recommend. At the same time, potential candidates for the two remaining slots will be sought through a telephone call to Barbara Mason at the University of Florida and (by Karen Trocki) to Raul Caetano at the University of Texas. Eric Raimo will also contact a colleague, Dr. Srinivan Pilloy, at McLean Hospital.

I. The group than turned to issues related to career development. Marc Schuckit and Karen Trocki had the opportunity to discuss career paths. The discussion also touched upon time management (the importance of saying no), tips for optimal hiring of research assistants, and the need to determine what activities are most highly valued by each department.

J. The group then proceeded to an update of developments from Indiana University Medical Center. Vijay Ramchandani reported many assets to him through his participation in the program. He related the following accomplishments:

1. Vijay has completed a review of all of the alcohol and drug-related material being presented to medical students at IU. He is working closely with Dr. Chris Selzer in producing additional material to be incorporated into the curriculum.

2. The efforts in impacting on the curriculum accomplished to date include:

a. Incorporation of alcohol-related material into the doctor-patient relationship course.

b. An expansion of the information offered on alcohol and other substances as part of the Year 2 Pharmacology course. It is estimated that the alteration in this course will begin in the Spring of 2001.

c. The addition of three hours dedicated to substance use disorders as part of the medical school Year 2 Psychiatry course.

d. Ongoing work to incorporate rotations related to substance use disorders into Year 3 of the curriculum.

e. A one-month chemical dependency elective giving information on methadone, inpatient consultation, smoking cessation, etc. has been established for the Year 4 medical students.

3. Dr. Ramchandani is also working to be certain that the AMSP efforts are tied in closely to the alcohol education programs established as part of a grant given to IU from a local family.

4. He is serving as a focal point for recruiting of additional teachers into substance use disorders areas. These include a person working with Lily, as well as Dr. Lucy King and others.

5. Vijay is working on developing a knowledge based series of goals for what medical students need to learn regarding alcohol and other drugs. Laura Bierut suggested several additional resources for him to look at including those developed by the American Psychiatric Association and the American Association of Medical Colleges.

6. Additional potential opportunities for Indiana University will come through attempts to incorporate a lecture on the genetics of alcoholism into the medical genetics course, efforts to be certain that the fetal alcohol syndrome is covered as part of OB-Gyn, attempts to incorporate information on brief intervention techniques in the family medicine course, and expansion of efforts to optimize information on alcohol and drug use disorders through journal clubs.

7. Dr. Ramchandani is still working on expanding the web-base learning approach, looking into the possibility of establishing an elective.

8. Furthermore, he is working with Sean O'Connor and T.-K. Li regarding implementation of a small grant from the Indiana Department of Health aimed at increasing knowledge regarding alcohol and other drugs among policy makers in the State of Indiana.

9. Vijay is also looking to how to best tie into the addiction fellowship which is about to begin at IU.

IV. Saturday, May 6th.

A. Some housekeeping issues

1. It was requested that Marc Schuckit develop a lecture and slide copy for some of the future AMSP meetings focusing on the importance of personality disorders in substance use disorders.

2. Marcy Gregg will look into finding a book published by Nolo Press regarding how to copyright material. We hope to institute this soon in regard to our website lectures.

3. Karen Trocki shared information regarding the lecture series to be offered in June, 2000 at the Research Society on Alcoholism. Members of AMSP were encouraged to attend.

4. Marc Schuckit will follow through by gathering an update on the progress made at the University of Washington through contact with Marty Hoiness. Marc will also talk with Marty about expanding some of his preliminary notes on his lecture on issues for substance use disorders among gay communities.

5. Susan Tapert will work with Marc on the possibility of incorporating videotapes relating to patient interviews on the AMSP website. Laura Bierut will continue her survey to determine whether any such videos are available, and if not, Marc will look into the possibility of developing some as teaching tools within AMSP.

B. Vijay Ramchandani presented his lecture on the "Pharmacology and Neurobiology of Alcohol." This was well received and was felt to be very close to a form that can be posted on the website. Some minor suggestions were made, and it is hoped to be completed by July 15th.

C. Susan Tapert, Eric Raimo, and Marc Schuckit presented an update of AMSP developments at UCSD. These included:

1. An elective course aimed at first and second year medical students has been successfully implemented. This involves ten one-hour sessions held once each week based on the topic material which has already been shared with members of the AMSP. This course had 11 individuals enrolled this year, and will be repeated every spring. The elective course will include an evaluation of the course by the medical students, as well as suggestions on how the material might be improved. In addition, as part of the elective, students will be asked their opinions about the fund of knowledge that should be part of medical school courses on alcohol and drugs.

2. One major Grand Rounds has already been carried out regarding dual diagnoses, a second is scheduled for the VA Hospital regarding genetics of alcoholism, and issues related to substance-use disorders have been incorporated in journal clubs.

3. The San Diego component of the AMSP is working closely with the San Diego Summer School of Alcohol Studies. We hope to post information regarding this and potential scholarships on the website. A note about scholarships will be shared with AMSP members immediately after the meeting.

4. Marc Schuckit will work with the Director of the Medical School Clerkship regarding the possibility that students from other units might be able to attend the rounds held each week on the Alcohol and Drug Treatment Program.

D. Susan Tapert presented information about the development and expansion of the AMSP website which is based at UCSD. Additional monies will be spent in order to develop a dedicated computer and a dedicated web address so that individuals will be able to contact the website more easily. The group will try to establish a way to determine the number of people who visit the website, and will ask anyone who downloads any of the lectures or additional material to supply information about how this material will be used, while also giving their own e-mail address. Steps will be taken to be certain the website is appropriately linked to the RSA and NIAAA websites, as well as others. The current website will also be linked to the new address. It was also suggested that any of the slide copy developed for AMSP and listed on the website should give credit to the Alcohol Medical Scholars Program (fully spelled out) in the lower right hand corner.

E. Eric Raimo delivered the lecture on "Medical Consequences of Alcohol Dependence." As was true of all the lectures, this was well developed and will only require a modest amount of work before it is appropriate for adding onto the website by July 15, 2000. The discussion incorporated a variety of issues related to how to best frame the material, achieve optimal internal coherence, relate to all the other lectures in the optimal manner, and avoid too much overlap with additional lectures. This particular lecture can be expanded through pictures (for example, individuals with fetal alcohol syndrome), as well as possibly some slides relating to tissue damage (for example, liver damage).

F. Vania Modesto-Lowe presented her lecture on "The Use of Pharmacological Agents in the Treatment of Alcohol Dependence. This lecture requires very few changes, and is almost ready for website loading. It complements the other materials being presented.

G. Marty Hoiness forwarded his update on progress at the University of Washington.

1. Marty has spent a significant amount of time developing and organizing an addiction program for women. The program is centered in an inner city mental health center and serves women with both substance and psychiatric disorders. Psychiatric residents are now rotating through the program and finding it very educational. He is now working with the dean's office to make this rotation an elective for fourth year medical students.

2. A 10-week nonclinical elective is in the works for first and second year medical students. Hopefully the elective will be offered for the first time during the winter quarter. The elective will be on alcohol and substance abuse-related topics. It will consist of a half-hour didactic and then a half-hour discussion with a patient pertinent to the weeks topic.

3. Beginning in July, a new rotation will be offered in the intensive outpatient addiction's program at Harborview Hospital. The rotation will include group activities as well as medication management of the patients. As part of the rotation, students will participate in motivational interviewing of trauma patients who are suspected to have an alcohol problem. For the first six months this rotation will be offered only to residents, but it is hoped that medical students will be able to use the rotation as part of their third-year psychiatry rotation.

4. The medical school is now developing standardized patients to test third-year medical students. Marty is helping to develop a standardized patient who has both depression and alcohol abuse.

5. Clerks on their psychiatry rotation must now attend an AA meeting and complete a chemical dependency screen on one of their patients. They are also encouraged to attend CD groups on the inpatient units and have a didactic from the CD counselors.

6. A lecture on substance use is part of the core lectures for the third-year medical students.

7. Third-year clerks must spend two half days in an outpatient clinic. They are now able to spend time in a MICA program.

H. Some closing thoughts.

1. Marc Schuckit congratulated everybody on the excellent job they did in producing this series of lectures.

2. The entire group shared their gratitude to Marcy Gregg for her work in organizing the meeting. Thanks to her, everything functioned without problems.

3. Marc again highlighted the impressive accomplishments at each of the centers. When one considers how difficult it is to incorporate material into established curricula, the quality of the progress is particularly impressive.

4. Participants were reminded that the group will get together on a telephone conference call in approximately three months (mid-August). The specific date and time will be established by Marcy Gregg.

5. Our next face-to-face meeting will be in San Diego beginning at approximately 6:00 p.m. at the L'Auberge Del Mar Resort and Spa (tentative place) on Wednesday, October 18, 2000. We will adjourn at approximately 1:00 p.m. on Saturday, October 21, 2000.

6. The next meeting will incorporate the four new scholars. At the August, 2000 conference call we will choose a minimum of six established lectures to be presented to the new scholars at the October, 2000 meeting. The new group of Scholars will also be presented an overview of our accomplishments, and challenged to develop four new lectures as well as to identify goals for their own institutions. The meeting will begin with a lecture on how to teach.

7. The meeting adjourned and all participants were wished a safe and swift trip home.

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