Meeting #37 - La Jolla

Grande Colonial Hotel

September 13 - 16, 2017



I. Wednesday, September 13, 2017
The meeting began in the late afternoon in the Grande Colonial Hotel lobby. Present at the meeting were first-year scholars Soraya Asadi from Loyola Stritch Medical School in Chicago, Eraka Bath from UCLA Medical School , David Stiffler from NYU Medical School, Kara Bagot recently from Yale and now at UCSD Medical School, and Jennifer Merrill from Brown University Medical School. Also present were second-year scholars Hayley Treloar Padovano from Brown University Medical School and Carla Marienfeld from UCSD Medical School, as well as Marianne Guschwan, Associate Director from NYU Medical School, Marcy Gregg, AMSP Administrator, and Marc Schuckit, Director. Second-year scholar, Reagan Wetherill was participating “from a distance” as she had a death in the family and was attending a funeral that day, although Reagan will take on the role of a second-year scholar.

The group became acquainted with each other and with everyone’s current goals at their medical school, and the informal meeting then progressed to a working dinner at George’s at the Cove restaurant nearby.

II. Thursday, September 14, 2017
As is the tradition for the first meeting for junior scholars, the first morning of the meeting focused on issues related to “how to tell your story.” Readers interested in the slides used in this process should look at the slides on the AMSP website for the lecture “How to Tell your Story.

Marc Schuckit reviewed one of the major goals during the first six months of joining AMSP, that is developing a lecture (or some similar communication) on a topic related to alcohol or drugs to be listed on the AMSP website and used by interested teachers in medical schools and elsewhere across the world. Marc began by discussing some of the major suggestions for improving education on how to tell your story as received from the current second-year scholars when they were participating in their first-year.

The group then methodically worked through the series of slides Marc had prepared about the guidelines for developing lectures for medical students and other health deliverer lectures, presentations at medical grand rounds, papers, posters, and grant applications. The essential step in each case is: remembering that the audience is key and the lecturer or writer is only the vehicle through which information is imparted to the audience. Therefore, at all points in a lecture or paper, one has to say what might this mean to the audience?

The second major tenet of this projection of information to be delivered to an audience is to focus on approximately four major points. If too many major points are presented in a grant application or a paper or a lecture, it becomes very difficult for the audience (sitting in an audience or reading a paper or application) to follow the information in a logical manner and to remember the major points. It can be tempting to try to fit in additional major points because they interest the speaker or the writer, even if they are not relevant to the audience, or because the person preparing the lecture or the paper spent a lot of time on the issue even though the material is irrelevant for that topic or that audience. However, including those additional points interferes with the key messages being delivered.

Therefore, every step of producing the paper or lecture requires that the author ask himself or herself the questions of : “what does this mean to the audience?”, as well as the question of “how does this section or paragraph fit into the major points I want to make?”

Next, Marc stressed the importance of being certain that what is delivered to the audience (in front of a lecturer or reading a paper or a grant application) represents the current findings in the literature as best as possible. Therefore, he presented a plan for reviewing the literature where one begins by remembering who the audience is and what the four major points are likely to be. Then, one can select a recent review article or a recent paper with a relatively extensive introduction and/or discussion (the places where their literature review is likely to be up to date), and create a series of files (either on paper or in a computer) that center on topics that might be covered as part of the lecture or paper, etc. Each paper from the literature that is used now needs to be skimmed for potential relevance by reading the title and abstract (probably the two most important parts of any paper), and then go into the results to determine what the paper covered, followed by a careful review of the introduction and discussion to identify information that might be of use to the specific paper or lecture being developed. After one has covered the X number of (perhaps 15) topic areas and done the review in reference to the specific audience, it is possible to organize the topic areas in a logical order as they might be given in writing or a lecture. From that organization, it becomes apparent subtopics that were reviewed might not fit in the outline and should be set aside. It also becomes apparent which areas have not been covered in this rapid literature review, which leads to searching for additional sources of information.

Marc then gave a handout (now developed into a separate set of slides) that demonstrates how one begins to create an outline from these topic areas. First, he reviewed the outline format where information begins with the most important heaadings (as shown in Roman numerals that denote major sections), to less key information that relates to the Roman numerals but now given as a capital letter (A, B, C, etc.); to information that supports the capital letter as indicated by Arabic numerals (1, 2, 3, etc.); to information related to lower case letters (a, b, c, etc.), on to even lesser important information (1’, 2’, 3’, etc.) and so on. This outline generally includes the four or so major points as Roman numerals, but there will be additional Roman numerals that don’t address the major points. Examples of those additional numerals include Roman numeral I. Introduction and (perhaps) for the conclusion. Other sections need to be developed as segues between the major points that are the focus of that lecture for that audience.

Marc then went on to the discussion of how to develop optimally effective slides. These must be: easy for people in the the back of the room to read; should have no more than 7 or 8 lines on the slide (not including the title) in order to make the slide easy to understand; never involve tables or figures taken directly from book chapters or papers (they are too complex to present and need to be changed into cartoons that focus on the major points being demonstrated); and must (of course!) relate directly or indirectly to the major points being made and be created in a structure appropriate for that audience. It is also essential in these slides to avoid jargon whenever possible, and to carefully define any jargon or abbreviations that cannot be avoided.

Also included in the morning’s discussion was the description by each first-year scholar of their areas of work as either clinician scholars or as researchers. Then, each first-year participant was asked to suggest ideas of what they might use as the focus of their lecture. From that discussion (as well as some subsequent discussions among the scholars and issues shared with Marc) the following topics were chosen: Soraya Asadi will develop a lecture regarding the role and problems associated with hepatitis C in individuals with alcohol use disorders; Eraka Bath is planning to develop a lecture regarding the use of technology in treatment settings (e.g., automatic reminder calls for sobriety among individuals who have finished treatment); David Stiffler will develop a lecture on PTSD and alcohol use disorders, expanding upon a prior lecture listed on the website; Jennifer Merrill will develop a lecture regarding alcohol-related blackouts among adolescents and young adults; and Kara Bagot will develop a lecture on data-based treatment approaches for adolescents with cannabis use disorders.

The group next moved to a working lunch where problems related to academic issues were discussed. The items raised by scholars included the differences among universities regarding the meaning of tenure and various academic tracks (e.g., a research track versus a clinical track versus a teacher/administrator track), as well as the benefits and liabilities of each. Marc reminded everyone that each of these tracks are important for career development, and it is essential that anyone in an academic line know the track that they are in and how they will be judged. Additional topics included carrying out research on limited moneys, balancing home and work, selecting a journal, and dealing with reviews for articles and grant applications.

The afternoon returned to potential issues related to development of AMSP lectures.

In addition, Carla Marienfeld, from UCSD presented her accomplishments related to alcohol and drug education at her medical school. Carla has given lectures on motivational interviewing to the Child and Adolescent Psychiatry Fellows. She is preparing a course for the American Society of Addiction Medicine annual meeting on Motivational Interviewing using slides formatted with the AMSP program techniques. Using the presentation and skills she developed through the AMSP, she had adapted her presentation on Agonist Maintenance Treatment to be delivered in several different formats to several audiences. She continues to find many uses for adapting this lecture, including to community groups, medical students, residents, and physicians who come to her clinic for remediation. She will soon offer the “half and half” on-line and in-person buprenorphine waiver training course to residents of psychiatry, ob/gyn, family medicine, and internal medicine. 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 refined an elective for 3rd and 4th year residents to work in the UCSD Addiction Recovery and Treatment Program, including using lectures using the AMSP style. She teaches general course on substance use disorders for the 2nd year psychiatry residents at UCSD. She mentors a family medicine/psychiatry resident for individual supervision for addiction treatment as part of his rotation in her clinic. She has prepared 4 workshops, 1 symposium, and 2 invited lectures for the American Academy of Addiction Psychiatry and the Academy of Psychosomatic Medicine. She is still 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 teaches 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 adjourned at 3:00 p.m. Suggestions were made for places for dinner with each scholar being on their own that evening. The agenda for the next day was briefly discussed. This included the goal of having a skeletal outline of the potential lecture by each first-year scholar developed in the course of the meeting. As an optimal educational tool, Marc suggested that this be done as a group effort and that each person can leave the meeting with a rough outline in hand.

III. Friday, September 15, 2017
The meeting began with a review of how first-year and second-year scholars will match up. The prior group of first year scholars suggested that it is important to establish such coupling as early in the meeting as possible. This step could foster optimal development of a relationship between a first- and second-year scholar when they begin working together early in the meeting. The following combinations were determined: David Stiffler will work with Marc Schuckit; Soraya Asadi will work with Marianne Guschwan; Eraka Bath will work with Hayley Treloar Padovano; Kara Bagot will work with Carla Marienfeld; and Jennifer Merrill will work with Reagan Wetherill.

The next order of business was the presentation of a lecture on opioid maintenance treatment delivered by second-year scholar Carla Marienfeld. This was very useful information and the presentation was perfect. Carla was engaging, in control, informative, and very approachable. The lecture was then used as a discussion of several issues related to things that could be of importance to first-year scholars. These included: 1) working to make sure that the font used in the slides was as large as appropriate; 2) demonstrating how specific lines in slides can be deleted and/or words deleted in order to make slide material points fit on one line; 3) showing the effective use of up, down, and sideways arrows to replace some words in the presentation; 4) slides that demonstrated the AMSP general rule of presenting both generic and trade names the first time a medication is presented, after which only generic names are used; 5) the excellent use of segues between major points; and 6) summarizing the prior points throughout the lecture. Carla was then tasked with demonstrating to first-year scholars how her 40-minute lecture can be presented as a 15-minute lecture, but to the same type of audience. Carla agreed to make those changes and to present the shortened lecture (an important exercise in dealing with being flexible when the amount of time allotted could change), and will do so on Saturday morning.

Soraya Asadi, first-year scholar, then worked with Marc and other members of the group in developing her initial outline for her lecture on hepatitis C. She began by establishing the four major points she was likely to focus on within the lecture. She then went on to Roman numeral I and made four points with several bits of additional information in this outline of her introduction to her lecture (that section should not take more than five minutes), ending with an item capital E relating to this lecture covers. Section Roman numeral II was then outlined as well as it relates to definitions and epidemiology of substance use disorders. In this first draft of a skeleton of an outline, section Roman numeral III will describe hepatitis C and its treatment, and so on until a basic outline with major points but only some detail relating to minor points were developed.

The next order of business was the report on recent developments at her university as presented by Hayley Treloar Padovano a second-year scholar from Brown University Medical School. First, she sought 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. She also disseminated the link to the website via the American Psychological Association Division 50 mailing list. Next, she included 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 October, 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.

The group then broke for an informal working lunch where issues related to academic development were again discussed. The items discussed included a discussion of the steps used in evaluating someone for promotion; the usual number of publications per year and how that differs depending upon the academic line a person is in (e.g., research versus clinical); handling rejections of papers and knowing how to revise; as well as the discussion of how to handle unacceptable editing by a journal or book editor in the final steps of production of a manuscript.

The afternoon began with the presentation by Hayley Treloar Padovano, second-year scholar, of her lecture on the development of alcohol problems during adolescence. This demonstrated a superb lecture with a great presentation style, and the discussion that followed by was used by Marc to highlight issues relevant to first-year scholars. Marc pointed out the excellent use of colors in the slides with most of the information presented in white, yellow, and a blue background. Marc emphasized that red usually does not work well in slides – and that all slides in a lecture need to be viewed with projection by a PowerPoint projector before the actual lecture is given in order to spot colors that might clash, vibrate, or bleed. This well organized lecture also stood out in demonstrating: 1) the approach used to clearly define every major concept and to avoid jargon whenever possible; 2) how slides referring to brain areas could be done very simply without much detail because this lecture was not about brain imaging, but rather about alcohol and effects on adolescent brains; 3) the importance of summarizing material as one goes from one major section to another; 4) how material presented in one lecture might be useful to another lecture (i.e., Eraka’s developing lecture on new developments in technology); 5) how a very complex topic went through many drafts until Hayley had the version that was easiest for the audience to understand (making material accessible to that audience); 6) how quotes are sometimes required in lectures (even though in general they don’t work well – they did work very well here).

The group worked with first-year scholar Jennifer Merrill regarding an initial outline for her lecture on alcohol-related blackouts. As with Soraya and Eraka, we first established the four major points; reminded ourselves of who the audience is; and then launched into the sections Roman numeral I through Roman numeral VI.

The next order of business was for David Stiffler, first-year scholar, to develop his initial outline regarding post-traumatic stress disorder and alcohol use disorders. As was true for all of the lectures, this process took between 30 minutes and 45 minutes. In each step of the discussion David asked himself how any new section related to the topic and the specific audience.

The afternoon’s work ended with a brief review of the activity over the last five months for the AMSP website. Briefly, using data extracted by the web mistress for AMSP, Marcy Gregg, Marc reviewed some of the major findings. During this five months, there were 2,133 page views and 1,033 total visits. The latter is generally taken to indicate that about 10,000 hits occurred at the website. During this time there were 285 downloads of the slides and/or outlines. Regarding the topics, the lectures most commonly visited included Potential Pharmacotherapies for Cannabis Use Disorders, Acute Alcohol Intoxication, Motivational Interviewing, and Agonist Maintenance Treatment. Over the five months, visits were made from46 countries, with the most common users (in order from most to less) coming from the United States, Italy, China, Canada, Germany, India, South Korea, Brazil, the United Kingdom, and Mexico.

The meeting adjourned at about 3:00 p.m. Scholars have the afternoon off and are to reassemble for a working dinner in the lobby of the hotel at 7:10 p.m. The dinner was held at a nearby informal Italian restaurant, Piazza 1909. It was a thoroughly enjoyable dinner, and everyone looked forward to meeting together again on Saturday morning.

IV. Saturday, September 16, 2017
The meeting began at 8:00 a.m. with Kara Bagot, first-year scholar from UCSD, working with the group in an exercise to develop the first draft of her outline for her lecture on the treatment of cannabis use disorder in adolescents. As was true for all of these first-year outlines, the discussion progressed by first establishing the four or five major points, remembering that the audience is first-year medical students, and working our way through sections Roman numeral I to section Roman numeral VI.

The next order of business was for Carla Marienfeld to deliver the 15-minute version of her lecture regarding opioid maintenance treatment. Ideally, the 15-minute lecture would have no more than 15 slides but that number is flexible, and this presentation was delivered in an excellent manner. The 21 slides used here all made sense, but the group next turned to how the lecture might be delivered in 15 minutes with < 15 slides. Therefore, as a group we worked on some information that could be deleted (about four slides), other information which could be simplified and key information of old slides could be combined; and a goal of 15 slides was easily reached. Then Marc continued in this line by asking what if we only had a 10-minute lecture and only had 10 slides? If that occurred, which slides would be likely to remain? Thus, this was an excellent opportunity to discuss how timeframes can be changed without a great deal of work.

Eraka Bath, first-year scholar from UCLA Medical School, next worked with the group in a 30-40 minute session regarding her outline for her lecture on the use of technology in clinical and research settings regarding substance use disorders. As was true of all such exercises, we established the four major points, reminded ourselves of the audience, and worked our way through the lecture , which in this instance will probably involve five or six Roman numerals.

Kara Bagot, first-year scholar, next presented some thoughts on how she might improve alcohol and drug education at her medical school. Kara is fortunate to work in a psychiatry department currently expanding its alcohol and drug program. She is also in an excellent position to play a key role in any new programs as her background is in child and adolescent psychiatry that focuses on the age group highly vulnerable to substance use and related adverse effects. Therefore, Kara hope to develop an alcohol and drug education curriculum for residents in the adolescent and child program and for child and adolescent fellows. She will also consider developing a substance use disorder special interest group for the child program, with the hopes interested students might meet together once or twice a month. Kara will also work closely with Kara Marienfeld regarding the developing outpatient alcohol and drug program, especially related to education opportunities in the program for medical students, residents and fellows.

Subsequently, Jennifer Merrill, first-year scholar, offered some thoughts on activities to improve alcohol and drug education at her medical school over at least the next six months. Jennifer Merrill, Ph.D., first-year scholar, reviewed potential avenues for disseminating AMSP lectures and principles at Brown University. First, Jennifer will include AMSP principles in a lecture to postdoctoral fellows in the Center for Alcohol and Addiction Studies (CAAS) on the topic of College Drinking. Second, she will look into who is in charge of alcohol education for Clinical Psychology Trainees and Medical Students, in order to survey the department on what kinds of education is currently provided and give additional suggestions. As chair of the Rounds Committee at CAAS, she will look for opportunities to provide weekly speakers with suggestions for using the guidelines put forth in the “How to Tell your Story” AMSP lecture. Finally, she will work with Dr. Hayley Treloar Padovano (second-year scholar) to consider starting a journal or movie club for graduate students, on topics relevant to drugs and alcohol.


Next, David Stiffler, first-year scholar, offered his thoughts about activities that might make sense at his university medical school for improving alcohol and drug education over the next six months. Dr. Stiffler plans to update yearly didactic seminars he leads at NYU using AMSP principles, including talks on substance use disorders in adolescence for NYU child and adolescent psychiatry fellows and pregnancy to fourth year psychiatry residents as part of a reproductive psychiatry elective. Additionally, Dr. Stiffler will be leading a didactic seminars on substance use disorders in trauma and post-traumatic stress disorder and veteran populations to psychiatry fellows at NYU, Mt. Sinai and Columbia. As part of a new trauma curriculum in the NYU psychiatry residency training program, Dr. Stiffler will be leading seminars on trauma and addiction. Finally, Dr. Stiffler will be giving web-based seminars to the Cohen Veteran Network Community, including a talk on Principles of Psychopharmacology for Non-Prescribers, which includes information about the psychopharmacologic treatment of substance use disorders.

Finally, regarding the series of plans from first-year scholars, Eraka Bath related her thoughts about developing steps to enhance alcohol and drug education at her medical school. First, Eraka will seek to increase awareness of the AMSP lectures among the faculty in the Division of Child and Adolescent Psychiatry, in the Department of Psychiatry, and the David Geffen School of Medicine. As a clinical psychiatrist to the Behavioral Wellness Center, a clinic specializing in mental health treatment for medical students, residents and fellows, she will work with the administrative staff to develop in-service talks and training on wellness and substance use education and prevention. Eraka is also teaching in the School of Social Welfare for the 2018 Winter and Spring Quarters in Child and Adult Psychopathology and will include material from the AMSP resources within these lecture series which will be attended by social welfare graduate students. Next, she will include AMSP principles in her lectures as part of the teaching curriculum for her lecture series on youth in the juvenile justice system, the majority of who suffer from substance use related problems. Dr. Bath is the recipient of a career development award from the National Institutes of Drug Abuse and will be presenting her research on at risk adolescents and substance use disorder at the American Academy of child adolescent psychiatry in October 2017. Dr. Bath was also invited to give a lecture at the UCLA Dept. of Psychiatry Grand Rounds in April 2018 and will use the talk she is developing on Technology in the AMSP Scholars program.


As time was running out for our meeting, the group next turned to a series of deadlines that first- and second-year scholars will try to over the subsequent six months or so until our next meeting:

A. EVERY TWO WEEKS beginning today, first-year scholars will work with second-year scholars to flesh out and improve the outline for their lecture. This will involve going back to the literature on many of the issues in order to develop subsequent drafts every two weeks as the development of the lecture continues. Communications regarding developments of next stages of outlines between first- and second-year scholars need to be copied to Marc who will join in the conversation if he has any additional suggestions.

B. The goal of A is to HAVE DEVELOPED THE LECTURE OUTLINE (NOT SLIDES YET!) BY JANUARY 1ST, 2018.

C. AT THAT POINT, FOR A MONTH MARC WILL ASSUME THE ROLE OF SENIOR SCHOLAR FOR ALL FIVE LECTURES. The goal here will be to get the lecture into close to final form. All communications between Marc and first-year scholars will be copied to the second-year scholar.

D. ON FEBRUARY 1, 2018, THE PROCESS OF DEVELOPING THE LECTURE OUTLINE AND REFERENCES SHOULD BE COMPLETED. At that point, the first-year scholar will return to the second-year scholar to DEVELOP NO MORE THAN 40 SLIDES FOR A 45-MINUTE LECTURE. Once again, all communication between first- and second-year scholars should be copied to Marc, who will join in and make suggestions where appropriate.

D. THE ENTIRE PROCESS OF OUTLINE, REFERENCE AND SLIDES SHOULD BE COMPLETED BY MARCH 1, 2018.

This process was developed with the DATE OF THE NEXT MEETING IN MIND. The next AMSP meeting will be Wednesday, March 21, 2018, beginning at 5:00 p.m., ending on Saturday, March 24, 2018 at noon, and probably to be held at the Surf and Sand Hotel in Laguna Beach.

The meeting ended at noon with a reminder of the goals, informal plans between first- and second-year scholars on the manner in which they will meet the deadlines; a reminder by Marc of the need to give him copies of plans for the next six months and to do so within the next week; also a reminder that all first-year scholars should be presenting their initial outline and send it to Marc by one week from the end of the meeting; and well wishes for a safe and swift trip home.

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