Meeting #36 - Hawaii

Mauna Kea Beach Resort, Kohala Coast, HI

April 26 - 29, 2017



MINUTES OF THE ALCOHOL MEDICAL SCHOLARS PROGRAM MEETING
APRIL 26, 2017 – APRIL 29, 20917

I. Wednesday, April 26, 2017
The group convened in the afternoon of Wednesday, April 26th at the Mauna Kea Beach Resort in Kohala, Hawaii. Present at the meeting were second-year scholars Dorian Lamis from Emory University in Atlanta, Leslie Lundahl from Wayne State University in Detroit, Daryl Shorter from Baylor College of Medicine in Houston, and Randi Schuster from Massachusetts General Hospital/Harvard University in Boston. First-year scholars were represented by Hayley Treylor from Brown University in Providence, Carla Marienfeld, originally recruited from Yale University but now at the University of California, San Diego in La Jolla, and Reagan Wetherill from University of Pennsylvania in Philadelphia; along with Marianne Guschwan (Assistant Director), New York University, Marcy Gregg, Administrator, and Marc Schuckit, Director.

The first order of business was getting reacquainted one with another, beginning to network, and reviewing the itinerary for the next several days. It was agreed that meetings Thursday and Friday would be a bit longer than usual so that we could adjourn by 11:00 a.m. on Saturday, April 29th to allow individuals to make their flights back to the mainland. The meeting continued with a working dinner in a restaurant at the hotel.

II. Thursday, April 27, 2017
Much of the morning was spent reviewing the optimal approach for teaching the new scholars who will begin in September 2017 the key lessons in how to tell your story. The discussion centered around the original lecture now delivered again by Marc who stopped regularly along the way to ask for suggestions. In addition to specific advice on how to optimally teach the basic information, additional suggestions included: showing new scholars how to avoid the pitfalls of the auto-correct outline format in most computers. The steps suggested by Reagan Wetherill and Carla Marienfeld include: 1) For a PC open Word, then click on file; 2) click on options; 3) click on proofing; 4) click on AutoCorrect Options; 5) click on AutoFormat as you type or AutoFormat; 6) check or uncheck boxes based on what you want. For Word on Mac: 1) click on the Tools and select AutoCorrect; 2) a new window will pop up and click the “AutoFormat as you Type” tab; 3) clear check boxes (deselect) the follo9wing boxes: under Apply as you type section, deselect “Automatic bulleted lists” and “Authomatic numbered lists”; under Automatically as you type section, deselect “tabs & backspace set left indent.”

Additional suggestions included: 1) having first-year and second-year scholars match up very early in the meeting; 2) then having them begin work on a first draft of the outline before the meeting ends; 3) warn people that last-minute deadlines will not work well in this process of the development of lectures; 4) be sure first-year scholars know Marc is intimately involved with each step for all first-year scholars throughout their process; 5) spend more time in the lecture discussing how to select 4 major points to be emphasized in a lecture; 6) review with scholars how to focus on their four major points.

A working lunch then focused on a series of challenges faced by junior faculty members. These included when and how to begin to look for alternative positions in different medical schools; how to avoid taking on too much; the best ways to prioritize even things one wants to do when they are too busy and need to cut back; and the balance between work and home life.

Following lunch the first presentation was by Dorian Lamis, who modified his original lecture to become a 30-minute lecture to high school seniors regarding the stresses, potential depression suicidal thoughts, and heavy drinking that they might encounter in college. The lecture was excellent, and the group reviewed some alternative steps that might be taken to better fit the fears, as well as strengths of graduating seniors.

Next, Reagan Wetherill, junior scholar from the University of Pennsylvania, demonstrated her lecture on sex differences in nicotine use. This was a fine lecture, well delivered, very logical and easy to follow. A few suggestions were made about the potential importance of speaking loudly, especially when no microphone is available and being sure to write out any names of individuals or other words that might be difficult for the audience to hear and understand.

Second-year scholar, Dorian Lamis, from the Emory University School of Medicine, presented his activities to expand alcohol and drug education at Emory and beyond. Dr. Lamis continues to present a lecture on treating substance use disorders to the 3rd year medical students on their Psychiatry Clerkship every 6 weeks. He will refine his lecture by asking the students for feedback and incorporating their comments and suggestions reported on evaluation forms. He also continues to present his lecture on assessing and treating alcohol use and suicidal behaviors to PGY3 medical residents. He presented Grand Rounds at East Tennessee State University in February using the AMSP format. In his position as Associate Director of the Psychology Postdoctoral Fellowship at Emory SOM, Dr. Lamis has incorporated more alcohol/drug education into the curriculum by lecturing on the topic, as well as recruiting other faculty to present their work related to alcohol and drug abuse. Dr. Lamis continues to mentor and involve students at all levels of training in conducting and publishing research that has an alcohol and drug use component, particularly in patients diagnosed with Bipolar Disorder. Dr. Lamis will be a Visiting Professor at Sapienza University in Rome, Italy for 3 months
from September to December, 2017 and has discussed with his sponsor/colleague, Maurizio Pompili MD/PhD, the possibility of incorporating more alcohol and drug education into the residency curriculum. As director of the medical residency training program, Dr. Pompili is excited to do this and further discussions will take place when Dr. Lamis arrives in Rome. Lastly, Dr. Lamis will present the Italian version of the presentation "How to Tell Your Story" (developed by Roberta Agabio, MD) to psychiatry/psychology trainees and/or faculty at Sapienza University.

Carla Marienfeld, first-year scholar from UCSD, next reviewed the ways she has improved and will continue to work on alcohol and drug use education at her university. The publication of the book she edited on Motivational Interviewing for Clinical Practice provides guidance to clinicians to help their patients change behavior, including addressing substance use disorders. A chapter she wrote in that book is focused on teaching motivational interviewing. Using the presentation and skills she developed through the AMSP, she had adapted this presentation to be delivered in several different formats to several audiences. Most recently, she presented this talk to an audience of about 50 social workers for the UCSD Transitional Case Management Program (TCMP). She prepared a lecture for the general public that was offered through the UCSD health System Focus on Health series using the AMSP talk. She offered the “half and half” on-line and in-person buprenorphine waiver training course to residents of psychiatry, family medicine, and internal medicine programs and to faculty in the Pain Anesthesia program. 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 has developed an elective for 3rd and 4th year residents to work in the new UCSD Addiction Recovery and Treatment Program. She developed a new general course on substance use disorders for the 2nd year psychiatry residents at UCSD. She gave a class on motivational interviewing to the UCSD Child and Adolescent Psychiatry Fellows. She mentored a family medicine resident for individual supervision for addiction treatment. She has prepared 3 workshops, 1 course, and 1 invited lecture for the American Psychiatric Association (APA) Annual Meeting in San Diego. She is in the process of presenting a national Webinar for the (Providers Clinical Support System for Medication Assisted Treatment (PCSS-MAT) and APA network on Motivational Interviewing. 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. Using the teaching skills she learned in the AMSP, 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 meeting then adjourned at 3:15 p.m. with all participants on their own for dinner that evening.

III. Friday, April 28, 2017
The morning began with a 30 minute modified lecture by Randi Schuster, a senior scholar from Harvard University/Massachusetts General Hospital. Her goal was to reach teachers of honors seminars regarding how to teach students about the cognitive dangers associated with cannabis use. The lecture demonstrated a great use of slides, effective pictures incorporated into these slides, and was an example of opportunities individuals have to define all major issues that involve jargon.

Next, Daryl Shorter, second-year scholar from Baylor University, presented his 30-minute alternative lecture for attendees at a public hearing in a small Texas town where there had been a local epidemic of adolescents using opioids. The emphasis was to be on opioid maintenance treatments that were scheduled to be developed in that town. The lecture was excellent with fine examples of definitions of jargon, delivered in a manner that would be appropriate for this specific setting. Daryl also demonstrated excellent summaries as he transitioned from one part of the lecture to another.

The meeting next turned to a report of her progress regarding alcohol and drug education at Wayne State Medical School by Dr Leslie Lundahl. Dr. Lundahl continues to teach the 13-week “Clinical Case Conference” for 3rd and 4th year Psychiatry Residents where she emphasizes that assessment of alcohol and substance use is an important part of diagnostic formulation and encourages the residents to incorporate cognitive behavioral treatment of substance use disorders in their clinical training cases. She also has prepared new lectures using the AMSP style for the other courses including Treatment Approaches for Substance Use Disorders in Adolescents for 2nd year psychiatry residents, and a 3-week series on Adolescent Substance Use Disorders for the Child and Adolescent Psychiatry Fellows. Leslie also presented Dr. Schuckit’s lecture “How to Tell a Story” to 4th year residents preparing their required Grand Rounds presentations, and presented Grand Rounds for the Department of Psychiatry at Wayne State University on Challenges in Adolescent Substance Abuse Treatment. Following this presentation Leslie was asked to teach the Substance Use Disorder module for the 2nd year medical students starting in Fall 2017, and to present her Grand Rounds lecture to Clinical Psychology Interns and Postdoctoral Fellows at The Children’s Hospital of Michigan. Finally, Dr. Lundahl was asked to present an all-day workshop focused on teaching community providers how to assist teens and their families who are struggling with substance use disorders.

Carla Marienfeld, first-year scholar, next presented her full lecture on opioid maintenance treatment. This was an excellent lecture and demonstrated how two similar topics (i.e., Carla’s lecture and Daryl’s lecture) can come at the same topic with different emphases and few, if any, disagreements. The slides were effective, and the delivery was easy to follow. The lecture was then used as an exercise of how to choose slides within an existing lecture for an even shorter lecture. This was also used to and demonstrate how the same information could be delivered on a slide with fewer words, which then makes the slide easier for the audience to understand relatively quickly.

The Friday working lunch centered around issues that affect how comfortable one is within their department. Most of this discussion centered on problems of morale that can develop among junior faculty and from them to residents and graduate students. Differences between how M.D.’s and Ph.D.’s are treated in medical schools were discussed; sex differences and how individuals were treated in universities were an important part of the discussion; and ways of enhancing civility within the workplace were also discussed. Issues also centered on some problems that junior faculty have when they enjoy teaching and research, but work at a veterans hospital that does not give them much flexibility.

Hayley Treloar, junior scholar from Brown University, next presented her first-year lecture regarding mechanisms that can contribute to alcohol use in adolescents. As was true of all the lectures presented at this meeting, Hayley’s lecture was excellent. An outstanding attribute was the way that she tied in a specific adolescent through that period of her life to young adulthood.

Leslie Lundahl, second-year scholar from Wayne State University, then presented a 30-minute version of her lecture modified for first-year graduate students in a pharmacy school. The lecture was highly effective with excellent slides and a manner of presentation appropriate for that specific audience.

The meeting ended at approximately 3:00 p.m., with preparation for discussions at a working dinner that evening. Scholars who were returning home from the meeting on Saturday were advised to check out of the hotel before the Saturday morning session begins at 8:00 a.m.

IV. Saturday, April 29, 2017
The morning began with Marc Schuckit presenting a 10-minute lecture originally delivered to NIAAA staff and members of the Collaborative Study on the Genetics of Alcoholism. The important point was that the short lecture grew out of a relatively complex paper. Marc reviewed the process for deciding what to emphasize (one specific finding) as centered around a key slide, with the six or seven additional slides used to build up to the major point and then summarize the main point.

Hayley Treloar Padovano, Ph.D., first-year scholar, reviewed potential avenues for disseminating AMSP lectures and principles at Brown University. First, Hayley 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. Padovano is scheduled to present a Rounds lecture for the Center for Alcohol and Addiction Studies (CAAS) Rounds series in September, 2017; she will incorporate portions of her AMSP lecture into this presentation. 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. Padovano co-teaches a writing discussion group for postdoctoral fellows at CAAS and will present an adapted version of the “How to Tell Your Story” AMSP lecture as part of this curriculum.

Reagan Wetherill, first-year scholar from the University of Pennsylvania Perelman School of Medicine, next discussed her plans for improving alcohol and drug education at her institution. Dr. Wetherill 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. Dr. Wetherill presented the “How to Tell Your Story” lecture to the Department of Psychiatry Research trainees. She is also involved in planning didactics for the Center for Studies of Addiction research trainees. As part of this training, Dr. Wetherill presented and will continue to present the “How to Tell Your Story” lecture to postdoctoral/predoctoral trainees and Addiction Psychiatry fellows. Using the skills learned from the Alcohol Medical Scholars Program, Dr. Wetherill has modified her Sex Differences in Nicotine Use presentation and has presented the modified talk at Columbia University as part of their seminar series and will modify the talk for two upcoming Grand Rounds at the University of Vermont and the University of Connecticut. She has also used skills she has learned from AMSP to modify a colleague’s presentation on Addiction as a Brain Disease as the Keynote Address at the 10th Annual Conference on Primary Care and Child/Adolescent Psychiatry: Teens and Substance Abuse. She also used AMSP skills to modify the Keynote Address talk, which will be presented to the community the evening before the conference. She will then assist trainees and fellows in developing and presenting an alcohol- and/or substance-related lecture of their own.

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. Since the last meeting, Dr. Shorter gave his AMSP-adapted talk on cultural competency in addictions treatment as well as a departmental grand rounds entitled, "The Ups and Downs of Uppers: Iatrogenic Stimulant Addiction in America." Additionally, Dr. Shorter adapted the "How to Tell Your Story" lecture into a talk on "large group teaching" and delivered it to the residency Clinician Educator Track. Dr. Shorter also convened the first Addictions faculty workgroup, creating a space to discuss with Addiction fellows and faculty opportunities for innovation in substance use disorders education across all levels of learners, ranging from undergraduate medical students to fellows. Dr. Shorter continues his work as Associate Program Director for the General Psychiatry residency program and Program Director for the Addiction Psychiatry fellowship.

Next on the agenda was discussion by Randi Schuster, second-year scholar from the Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), 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, twice at MGH Neuropsychology Rounds about assessment and treatment of adolescent cannabis use. She has also spoken several times in community forums about the potential repercussions of creating a legal cannabis market in Massachusetts. Finally, she plans to continue discussions with the Director of the Clinical Psychology Internship program to create a minor rotation in addiction psychology, involving a coordinated lecture series, targeted clinical exposure and supervision, and research.

Dr. Susanna Fryer, a first-year scholar from UCSF added her report. Working in collaboration with other UCSF faculty involved in research and clinical training, she has formed a working group for postdoctoral fellowship governance for UCSF-affiliated SFVAMC postdoctoral research fellowships. In addition to other activities, this group is advocating for a substance specialty track both within the scholarly project program for psychology interns (pre-doctoral) as well as seeking to establish an addiction-focused postdoctoral research fellowship (for psychologists and physicians), which is currently lacking at the SFVAMC site of UCSF. 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. Lastly, Dr. Fryer is the primary mentor for an incoming research fellow through the VA's Mental Illness Research, Education and Clinical Centers (MIRECC) who will work on a research project related to cannabis use and psychosis.

Marc Schuckit next discussed the functioning of the AMSP website. During the year ending March 31, 2017, there were 7286 total page views involving 4102 sessions for 3265 visitors. This involved 1100 PowerPoint downloads. The visitors came from 91 countries, among which the top nine included the United States, the United Kingdom, Canada, Russia, Brazil, Italy, India, China, and the Philippines.

When the group was asked ways to improve the website, Marianne Guschwan suggested that at the next meeting, which will be in San Diego, Marc might consider videotaping his presentation on how to tell your story. To follow up on this, Marc and Marcy will contact Gil, who is in charge of videotaping educational sessions at that university.

On another topic, Marc also suggested the importance of the new group considering developing a new lecture on alcohol poisoning, especially in universities. Furthermore, Marc will be contacting graduate scholars about the possibilities of getting together over breakfast at the Research Society on Alcoholism in June 2017.

The meeting then adjourned mid-morning for individuals to be able to travel to the airport for their flight home on Saturday.

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