Meeting 35 San Francisco

San Francisco, CA

October 26 - 29, 2016

MINUTES OF THE AMSP MEETING IN SAN FRANCISCO, CA
Wednesday, October 26, 2016 through Saturday, October 29, 2016

Present at the meeting were second-year scholars Randi Schuster, Leslie Lundahl, Daryl Shorter and Dorian Lamis (the fifth second-year scholar has had her meetings and returned to Brazil in September 2016). Also present at the meeting were first-year scholars Susanna Fryer, Hayley Treloar, Danielle Ramo, Reagan Wetherill, and Carla Marienfeld, as well as Marc Schuckit (Director) and Marcy Gregg (Administrator).

I. Wednesday, October 26, 2016
The group met in the lobby of the Grand Hyatt at Union Square and discussed the schedule for the meeting. That evening, the activities continued over a working dinner at Scala’s Bistro.

II. Thursday, October 27, 2016
The group reconvened on Thursday, October 27 at 8:00 a.m. The morning began with an overview of the revised schedule, based on the discussion on Wednesday. This process assigned times for reports on activities related to AMSP at universities for first- and second-year scholars, plans for future meetings, issues related to recruitment, and delivery of the introduction to “How to Tell Your Story”, as well as presentations by second-year scholars.

Most of the morning was spent discussing overall issues of “How to Tell Your Story.” With the help of the second-year scholars, Marc Schuckit presented the overview of how to organize and focus appropriately on a specific audience when telling a story as part of a lecture, grant application, scientific paper, book chapter, or poster at a meeting. In each of these instances, the audience is the key, where the lecturer or writer faces the challenge of presenting his or her story to an audience while using terminology and perspectives likely to be typical for that group. To do this, the material must be very logical, stepping the reader or audience through each of the issues contributing to why the story is important, telling people how the issue was evaluated, and discussing the take-home message or the relevant conclusions. This involved a lively discussion between the first- and second-year scholars as led by Marc Schuckit in his presentation.

A working lunch was then used to discuss issues related to career development. The topics included how to keep research going during difficult financial times; assets/liabilities as well as methods for gaining support from private donors and small foundations; issues related to coping with the workloads that many junior faculty are working under; related challenges in balancing time between teaching, grant writing, and writing papers; the different university “tracks” for administrators versus teachers versus researchers; the appropriate number of papers that one might be expected to publish per year as assistant professors in research tracks; as well as issues related to balancing between home and work responsibilities.

Next, Dorian Lamis, second-year scholar from Emory University in Atlanta presented his accomplishments in his medical school to expand alcohol and drug education. Dr. Lamis met with the director of medical student education and is presenting a lecture on treating substance use disorders to the 3rd-year medical students on their Psychiatry Clerkship every 6 weeks. He also continues to present his lecture on assessing and treating alcohol use and suicidal behaviors to PGY3 medical residents. He presented a slightly adapted version of his AMSP lecture on "Alcohol Use and Suicidal Behavior in College Students" as part of a webinar series at the Washington State College Coalition for Substance Abuse Prevention. He presented Grand Rounds at the Emory University School of Medicine in April using the AMSP format. Dr. Lamis was recently appointed Associate Director of the Psychology Postdoctoral Fellowship at Emory SOM and is incorporating more alcohol/drug education into the curriculum. As part of the Emory Faculty Development Committee, Dr. Lamis suggested bringing in a nationally recognized expert in substance use/addiction to present at Emory Grand Rounds. Dr. Lamis will be a Visiting Professor at Sapienza University in Rome, Italy for 3 months in 2017 and plans to discuss with his sponsor/colleague, Maurizio Pompili MD/PhD, the director of residency training, ways in which alcohol/drug education can be incorporated into the training program.

Daryl Shorter, second-year scholar from Baylor College of Medicine (BCM), next presented his progress on the advancement of alcohol and drug education at his medical school and in the community. Dr. Shorter drew upon the principles taught in AMSP to (1) adapt a previously given medical student talk on cultural competency in addictions treatment and (2) create a new talk on depression and substance use for a departmental continuing medical education series. He also delivered a talk to the Houston Psychiatric Society on treatment of Opioid Use Disorder which was adapted from his AMSP original lecture, entitled “Buprenorphine.” In his role as course director for the Introduction to Addictions Treatment lecture series for post-graduate year 1 (PGY-1) General Psychiatry residents, Dr. Shorter continued to expand the curriculum with new lectures on motivational interviewing, and in the coming year, he will add a new talk on combating stigma and bias in addictions treatment. Clinically, Dr. Shorter now serves as the course director for a new PGY-2 outpatient rotation in substance use treatment, supervising residents in the completion of a scholarly project related to addictions treatment. Currently, he is working on the completion of a Grand Rounds on iatrogenic stimulant use disorder, applying the AMSP principles for organization and creation of the talk. Dr. Shorter has also stepped into the role of Associate Program Director for the General Psychiatry residency program, and will be utilizing this position to work toward the creation of a unified addictions curriculum across the four years of the training.

Senior scholar, Leslie Lundahl, next presented her accomplishments at Wayne State University. She continues to teach the “Clinical Case Conference” for 3rd- and 4th-year Psychiatry Residents and encourages the residents to focus more on assessment of substance use and to incorporate cognitive behavioral treatment of substance use disorders in their clinical training cases, where appropriate. This case conference series has been expanded to include meetings in which residents have the opportunity to present specific substance use disorder treatment cases to obtain consultation and feedback from their peers. Dr. Lundahl has continued to prepare new lectures using the AMSP style for the other courses she teaches, including “Treatment Approaches for Substance Use Disorders in Adolescents” to 2nd-year psychiatry residents, and “Adolescent Substance Use Disorders” for the Child and Adolescent Psychiatry Fellows. An additional class was added to the latter course to discuss evidence-based treatment approaches for adolescents. Two PGY4 Psychiatry residents have just completed their research rotations in substance abuse and dependence with Dr. Lundahl. One of these residents collaborated with two pre-doctoral psychology students on a project entitled “Neonatal outcomes are associated with length of time in a maternal methadone maintenance treatment program.” Results from this project are being prepared for submission to a peer-reviewed journal. The second resident is currently preparing a case study for publication. Dr. Lundahl will present “How to Tell your Story” developed for AMSP at Grand Rounds at the end of this year.

The group next turned to potential topics for lectures by each of the first-year scholars. Tentative decisions were made with the note that we would return to this important topic on Friday.

The group adjourned at 2:30 p.m., with the notation that each scholar is on their own for dinner that evening.

III. Friday, October 28, 2016
The morning began with a discussion of issues related to lecture development as presented the day before and an update on the schedule for the remainder of the meeting.

Then Randi Schuster, second-year scholar from Massachusetts General Hospital, next gave her lecture developed for AMSP focusing on acute and persistent cognitive effects of cannabis use in adolescents. This fine lecture was then used by Marc to emphasize some points that are important for first-year scholars. This included comments regarding specific issues for the slides that were presented; the need to be certain that any jargon that is used as part of a lecture is appropriate for that audience; a discussion of the best colors to use within slides; ways to enlarge pictures or figures within slides so that they are easier for people in the back of the room to read; the importance of introducing each figure by talking about the x and y axes, as well as summarizing what is presented; the use of a conclusion slide that pulled the entire lecture together; and using a slide telling the audience things they need to remember from the lecture.

Following a short break, Leslie Lundahl, second-year scholar from Wayne State University in Detroit, presented her lecture regarding potential future pharmacological treatments for cannabis use disorders. Once again, this was a fine lecture and gave Marc the opportunity of emphasizing several issues. These included: the potential use of adding a specific case discussion and weaving that case into the presentation; steps that can be taken to expand a lecture when it appears shorter than had been planned or to constrict the lecture to fit a shorter than expected amount of time; different ways of avoiding audience confusion when several slides have the same title; the importance of speaking slowly, an issue especially relevant to presentations to audiences for where English is not the first language; the excellent example of preparing the audience in the first set of slides for the major topics that are presented in the second series of slides (in this instance the need to also have presented the background for FAAH early in the lecture to set the stage for the potential role the substance in pharmacological treatment); and the potential importance of naltrexone in depot form as part of the treatment.

The group next took a short break, after which there was a period of career development discussions during the working lunch. Topics that were covered included how to develop a sequence of grant applications over the years with one 3-5 year epoch leading to the next 3-5 year period; issues related to revising grants or papers based on feedback from committees or reviewers; ways of “marketing” the grant application or submission of papers while taking advantage of areas of interest in the field.

Following lunch, Daryl Shorter, second-year scholar from Baylor University, presented his 45-minute lecture aimed at medical students regarding buprenorphine maintenance programs for opioid-dependent individuals. This was a very effective lecture delivered with a particularly outgoing and engaging style. The presentation was used to demonstrate how slides can be easily modified for fewer words per line; and methods to increase the font size so that individuals in the back of the room can easily read the slides. This was another example of how a lecturer (or writer of a grant application or scientific paper) can become more relevant to the audience by highlighting recent related events. Another strong point of this lecture was the excellent summary given as Daryl moved from one subtopic to another.

Marc then returned to the issue of how a longer lecture can be collapsed to quite a short lecture. The example that was used was based on Randi Schuster’s presentation that morning. In this process the group looked at the slide sorter presentation of Randi’s 40 slides used in her full lecture, and focused on 13 that might be essential for a 15-minute lecture on the same topic. Randi agreed to the task of reviewing those slides on Friday evening and being prepared to do a quick overview of how she would select (and if necessary, modify) no more than 15 slides to present a 15-minute lecture.

The group then returned to a discussion of potential topics for lectures by first-year scholars. The potential topics were then noted as follows: Danielle Ramo was considering developing a clinically-oriented lecture for first-year medical students on vaping as a method of nicotine administration; Susanna Fryer was considering a lecture based on reward processing as it is applied to substance use disorders; Carla Marienfeld proposed a lecture giving an overview of the rationale for and implementation of opioid maintenance treatments; Hayley Treloar considered a lecture focusing on the development of heavy drinking and alcohol-related problems during adolescence; while Reagan Wetherill was considering a lecture on sex differences in nicotine use disorders and their treatment.

The group adjourned at 2:30 p.m. with the plan to reassemble for a working dinner beginning at 7:15 at the nearby E & O Kitchen restaurant.

IV. Saturday, October 29, 2016
The morning began with a review of topics for first-year scholars, as well as a match with a senior scholar who had the most appropriate clinical and/or research interest. The results included:
1. Danielle Ramo, first-year scholar, will deliver a lecture on vaping, and work with second-year scholar Randi Schuster.
2. Carla Marienfeld, first-year scholar, will deliver a lecture on an overview of the treatment of opioid use disorders and will work with second-year scholar Daryl Shorter.
3. Hayley Treloar, first-year scholar, will develop a lecture on the development of heavy drinking and alcohol use disorders during adolescence, working with second-year scholar Dorian Lamis.
4. Reagan Wetherill, first-year scholar, will develop her lecture on sex differences in nicotine use disorders and their treatment, working with second-year scholar Leslie Lundahl.
5. First-year scholar, Susanna Fryer, will develop a lecture on reward processing while working with Marc Schuckit.

Dorian Lamis, second year scholar, next presented his lecture on alcohol and suicide. The fine lecture with excellent projection of his voice and great energy was used by Marc as an opportunity to review several points regarding the development of lectures and slides. These included ways to increase font sizes of slides, possible benefits of showing med students some of the questions used on each specific questionnaires (here a suicide ideation measure, and some fine examples of when it is appropriate to put an abbreviated reference on a specific slide.

Next, Randi Schuster, second-year scholar from the Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), reported on her work to facilitate substance use disorder training at her institution. Since the prior AMSP meeting, Dr. Schuster has given multiple talks using the AMSP lecture format at her institution and in the community about issues related to cannabis legalization and adolescent neurocognition. She has spoken, for instance, at MGH Psychiatry Grand Rounds, Neuropsychology Rounds, and at the annual conference of the Vermont Center on Behavior and Health. She continues to coordinate a junior faculty lecture series for post-baccalaureate research coordinators interested in pursuing a career in medicine. Finally, she plans to meet with the Director of the Clinical Psychology Internship program at the beginning of 2017 to discuss creating a minor rotation in addiction psychology, involving a coordinated lecture series, targeted clinical exposure and supervision, and research.

Our group next established DEADLINES for the process of the development of lectures. These include:
1. By November 6, all first-year scholars will have developed a rough skeleton of an outline on their topic and share that with their second-year scholar and with Marc Schuckit.
2. Between November 6th and January 26th, first-year scholars and second-year scholars will work together to develop a next draft of their outline about every week, sharing the progress through cc’s to Marc Schuckit.
3. By January 26th, 2017, first- and second-year scholars will have taken the outline lecture as far as they can and now turn over the lecture and references for the first year person to work primarily with Marc Schuckit, sharing cc’s with their second year scholar.
4. On February 26th, the outline and references will be totally completed and scholars will begin to work on slides with their second year scholars, with cc’s to Marc. While sketches of potential slides could be kept in mind as the lecture is developing, the slides themselves cannot be adequately created until after the lecture outline is complete.
5. By March 26, 2017, the outline, references, and slides will be complete. That will leave the next month for scholars to tweak their outline and slides for presentation at the next AMSP meeting.

On April 26, 2017, the next meeting commences and during that time (April 26, Wednesday) through April 29, 2017 (Saturday), first-year scholars will present their lectures.

The group next discussed the April meeting in Kona, Hawaii at the Mauna Kea Resort. That meeting will adjourn by 11:00 a.m. on Saturday, April 29, so that scholars who wish to return to the mainland will be able to do so via Los Angeles or San Francisco on flights that leave at 1:30 p.m. and 12:30 p.m., respectively.

Reagan Wetherill, first-year scholar, University of Pennsylvania Perelman School of Medicine,next discussed her plans on improving alcohol and drug education at her institution. Dr. Wetherill currently serves on the Department of Psychiatry Research Trainee event/curriculum planning committee, which focuses on enhancing integration and training across the various Divisions/Centers within the department. She introduced the Alcohol Medical Scholars Program website and resources to the committee and the Director of Education for the Department of Psychiatry. Dr. Wetherill plans to include the “How to Tell Your Story” lecture into the curriculum starting in January 2017. She is also involved in planning didactics for the Center for Studies of Addiction research trainees. As part of this training, Dr. Wetherill will present the “How to Tell Your Story” lecture to postdoctoral/predoctoral trainees and Addiction Psychiatry fellows. She will then assist trainees and fellows in developing and presenting an alcohol- and/or substance-related lecture of their own.

Hayley Treloar, first-year scholar, next presented her plans at Brown University. First, she will seek to increase awareness of the AMSP lectures among the faculty from the Department of Psychiatry of Warren Alpert Medical School of Brown University and from the Department of Behavioral and Social Sciences of the School of Public Health of Brown University, who provide education to undergraduate and graduate students, clinical psychology and medical residents, and postdoctoral fellows. Next, she will include AMSP principles in her lectures as part of the teaching curriculum for her Summer@Brown program course in human development. The Summer@Brown program offers pre-college courses to high school students interested in advancing their education in a variety of disciplines. Additionally, Dr. Treloar plans to give a Rounds lecture utilizing AMSP principles at the weekly Center for Alcohol and Addiction Studies (CAAS) Rounds series. The CAAS Rounds audience includes faculty from the Center, as well as other Public Health and Psychiatry faculty, postdoctoral fellows, and MPH students. Last, Dr. Treloar will inquire about the potential to present AMSP lecture to: (1) clinical psychology residents and postdoctoral fellows as part of their T32 didactic seminar series; (2) MPH students and postdoctoral fellows as a guest lecture for their course on alcohol addiction epidemiology and treatment.

Danielle Ramo, first-year scholar from the UC San Francisco Department of Psychiatry and Weil Institute for Neurosciences, presented her plans for improving alcohol and drug education at her institution. She shared her role as director of the tobacco cessation curriculum for medical student education at UCSF. In her role as an AMSP scholar, Dr. Ramo plans to use this position and her overall role in her department to better understand the existing curriculum related to substance use disorders more broadly. She will also begin to use the AMSP format in her lectures on tobacco cessation for medical students this year, and plans to speak to the Child and Adolescent Psychiatry Fellows about Adolescent Substance Use Disorders in two didactic lectures this spring. She will adapt her current talks to the AMSP format to make them easier for the audience to follow. Dr. Ramo will also give a talk at the Child Grand Rounds in the department that covers two topics, one of which is that of her AMSP lecture (electronic nicotine delivery systems). She will use the practice and design of the talk she is adapting for AMSP in that seminar. Finally, Dr. Ramo plans to volunteer to give a lecture this year in the NIDA-funded T32 Substance Abuse Treatment and Services Research Training Program seminar. Likely topics would focus on cannabis use or the lecture she is preparing for the AMSP (e-cigarettes).

Susanna Fryer from UCSF, first-year scholar, next reviewed her plans for the University of California related programs in San Francisco. Her ideas for strengthening alcohol/substance-related education at University of California, San Francisco (UCSF) medical school include working with a more senior faculty colleague to develop a "scholarly project" program for psychology trainees that arranges for mentorship and career development didactics, as well as matching with a faculty mentor to undertake a scholarly project. Specifically, AMSP lectures could likely be incorporated for at least some of the didactic portion of this program, and she will also advocate for a substance specialty track within the scholarly project program. Additionally, she will work to incorporate substance use disorders didactics into general psychiatry outpatient services seminar for trainees, and, more generally, will share the AMSP lectures with faculty across UCSF sites.

Finally, regarding reports, Carla Marienfeld, first-year scholar originally from Yale and recently having moved to UCSD, presented her plans for expansion of alcohol and drug-related teaching programs at UCSD Medical School. She plans to offer the “half and half” on-line and in-person buprenorphine waiver training course to residents of psychiatry, family medicine, and internal medicine programs. This course offers 4.5 hours of in-person interactive didactics that allows those who complete the course to apply for the DEA waiver to prescribe buprenorphine. She is also planning the curriculum for the ACGME Addiction Psychiatry Fellowship application she is preparing, and she plans to use the AMSP training about how to give a lecture as a talk. She then plans to have the fellows elect to develop their own lecture or use one of the existing AMSP lectures to give a talk on a chosen topic. Finally, she plans to work with third year medical students who are finishing their psychiatry clerkships to review the evaluation of patients for co-occurring disorders (both a psychiatric and substance use disorder) and to consider substance use on their differential diagnoses list when doing a patient formulation.

The scholars next suggested that it might be helpful to first-year scholars if Marc worked with one of them in front of the group while they developed a skeletal outline for his/her lecture. Carla Marienfeld offered to take the lead on this topic. Carla and Marc then demonstrated how an outline might be developed, as well as the give and take with people having some differences of opinion and some agreements on what would best be covered and where within the lecture it might best be presented. This was a very useful exercise.

The meeting adjourned at 11:00 a.m. on Saturday, after Marc had distributed to second-year scholars the outline of their responsibilities, and to first-year scholars the books “Educating Yourself on Alcohol and Drugs” and “Drug and Alcohol Abuse, 6th Edition.