Meeting

Laguna Beach, CA

December 31, 1969



Minutes of the AMSP meeting
Laguna Beach, CA, Surf and Sand Hotel
March 21, 2018 through March 24, 2018

I. Wednesday, March 21, 2018

The meeting began in the late afternoon. Attending were senior scholars Carla Marienfeld, M.D. from UCSD, Hayley Treloar Padovano, Ph.D. from Brown University, and Reagan Wetherill, Ph.D. from the University of Pennsylvania; junior scholars Kara Bagot, M.D. from UCSD, Jennifer Merrill, Ph.D. from Brown University, and David Stiffler, M.D. from New York University; assistant director Marianne Guschwan, M.D. from New York University; director Marc A. Schuckit, M.D. and administrator Marcy Gregg.

After meeting in the hotel lobby to network, update, and review the schedule for the next few days, the group walked to a working dinner at the Broadway restaurant in Laguna Beach. This was an opportunity to continue networking, review and modify the proposed schedule for the current meeting, and to begin to discuss some of the major topics.

II. Thursday, March 22, 2018

Following breakfast, the meeting began at 8:00 a.m. The entire morning was devoted to reviewing major assets and any liabilities for the current approach to teaching at AMSP and planning revisions for the next group of junior scholars. The goal was to recognize our goals in light of the increasing responsibilities that junior faculty members are carrying compared to 20 years ago when AMSP began. As a consequence, it was important to determine how to optimize the information taught while minimizing the time commitments between meetings for first-year scholars.

The first issue was to discuss what about AMSP the current seniors found to be the most important components, with a view to being certain that those continue to be emphasized in the context of any future changes to our program.

Characteristics of AMSP that scholars have found to be most useful include the following:

1. The importance of focusing on a specific audience and learning how to change the lecture based on the audience.

2. The use of the outline which emphasizes an efficient way of keeping track of where an individual is during the lecture and it allows others to give a similar lecture.

3. The development of slides that can be understood through a brief glance while the lecturer explains the information contained in the slide.

4, Networking among first-year scholars, first to second-year scholars, as well as to all scholars to Marc Schuckit and Marianne Guschwan.

5. The importance of summarizing each major subsection of a lecture before the lecturer goes on to the next section.

6. The importance of closing each lecture with a takeaway message that summarizes all of the major points.

7. The opportunity to consider potential changes in the style of delivering a lecture in a way that maximizes the lecturer’s assets and minimizes the lecturer’s liabilities. Examples include individuals for whom their voice does not carry very well insisting on a microphone whenever possible and speaking as loudly as is appropriate. On the other hand, individuals who tend to have booming voices need to be careful to not sound as if they are being dogmatic and they have to moderate their style in a way that makes the audience more comfortable.

The scholars also had excellent suggestions on things that might be done within AMSP to minimize the workload for the first-year scholars. These included the following:

1. Now that the website has more than 70 lectures, we have the opportunity of giving new scholars several options that will help them learn the methods taught by Marc but using less time to do it. This includes selecting an audience other than first-year medical students. That is important because many of the scholars also do continuing education for healthcare deliverers, and scholars have included a range of different types of physicians, as well as clinical psychologists, and researchers. Therefore, this change will make it more likely that the person developing the lecture will be able to use it in their own teaching situations.

2. Slide structure will still need to be kept within useful limits regarding colors, etc. in order to standardize the material offered on the website, this is no longer essential. However, while suggestions can be made regarding whether a particular color or lack of color in the background works optimally, it is important to keep the final background and text colors of those slides up to the person developing the lecture as long as the slides adhere to the AMSP guidelines of clarity, economical use of words, and the ability to be understood at a glance.

3. At the prior AMSP meeting, Marc tried to help scholars who don’t have a lot of experience with lectures by having all scholars do the first rough draft of a two or three page outline during the meeting as part of the meeting procedures. However, it was felt that this exercise was not needed and did not accomplish much for either the person trying to do the outline or for the rest of the participants.

4. There is a need for the first meeting of the first-year scholars to have a clear beginning of a working arrangement between the first and second-year scholars. The group also asked Marc about the procedures for matching first and second-year scholars with his reply that it was based on a balance between the strengths of the second-year scholar and the particular needs of the first-year scholar, along with compatibility regarding the specific topic for the first-year scholar.

The meeting then proceeded to a discussion of guidelines for selection of future scholars. These items included:

1. All scholars appreciated the ideas of mixing both clinically-oriented scholars with research-oriented scholars in the same meeting. Of course, both clinically-oriented and research-oriented scholars share some clinical, administrative, and scholarly activities as part of their responsibilities at their universities. Nonetheless, one group has a greater emphasis on clinical delivery and the other a greater emphasis on research.

2. The ideal scholar would be one who demonstrates a level of motivation to learn the skills being taught by AMSP. On the other hand, motivation is difficult to measure as it is a state rather than a consistent trait characteristic.

3. Potential scholars being evaluated for joining the group need a clear understanding of the responsibilities involved in the first year, given as part of a message that takes into consideration the level of understanding that the scholar might or might not have regarding their likely academic responsibilities.
A specific example was given by a relatively junior academic level scholar who did not fully realize the relative responsibilities that he or she would be likely to have in their first major academic year. In this instance, it was difficult for the individual to understand the time commitment involved in light of the time likely to be available.

4. It is important that all potential scholars have contact with prior scholars who can explain the assets and time commitments for junior scholars. The group emphasized the need for the potential scholar to contact either a past scholar or the original person who referred them to AMSP to once more to discuss their obligations of developing a lecture as part of their first year in AMSP.

5. Marc asked for input as to whether his rule of thumb that because the second meeting of the first year requires presentation of a scholarly activity, if a product is not developed for presentation at the second meeting of the first year, there is little reason for that scholar to attend that second meeting. The group agreed that that rule of thumb makes sense, although Marc emphasized that it would be applied with some level of flexibility if, for example, a scholar who developed a health problem, a problem in their family, etc. and who might not be able to fulfill the obligations of AMSP, in which case they might be invited to continue their education the following year.

Under this new approach, a lecture to be posted on the website will no longer be required. If a first-year scholar insists on going through the relatively time-consuming steps to produce such a lecture, Marc will be happy to work with him or her. However, the amount of time required for this project in light of the increasing amount of time pressure for junior faculty members means that only a small minority of scholars are likely to pursue the full lecture option. Rather, the scholar could update existing slides, references, and outline for an existing lecture. Or, the scholar could select a lecture they have already developed and alter it to meet the AMSP guidelines. Marc will also be open to other suggested approaches to a scholarly activity that will benefit the field.

Marc then began a new exercise that he would like to consider for use with all first-year scholars in the future regarding how to avoid using developing a slide from a complex figure or table directly extracted from a paper or book chapter. Rather, the material that is offered in a slide has to be understood fairly quickly, while a table or figure in a paper is to be studied in detail over time. Therefore, Marc handed out a table extracted directly from a recently submitted paper. He then gave background on the fact that this table needed to be changed in a way that was appropriate for a recent 10-minute lecture he gave at the NIAAA, and asked the scholars to recommend how those changes could be made. The discussion went back and forth regarding what to include and what to exclude. With those ideas having been stated, Marc then showed the scholars the final version of the slide that was used in the lecture and explained the changes he made for that specific use.

The next exercise involved thoughts regarding development of the optimal poster at a meeting. Marc returned to the 10 slides used for the 10-minute lecture, returning to the two or three major slides in that lecture and discussing how to select the one (or at most two) major points for the poster. The group used material on a flipchart to develop the outline of how that table could be used as the centerpiece for a poster. Marc emphasized that the goals for a poster involve getting to network with appropriate people and using an eye catching approach that calls attention to a specific aspect of a person’s own work.

Following the tradition of AMSP, the lunch period served as part of the meeting to discuss issues regarding career development and career challenges in an academic environment. The topics covered included the challenges of being in a department where the role of a research or clinical center is being modified or the department is being revamped. The situation can be particularly challenging to junior faculty who may fear that their jobs or specific areas of interest might be deleted, steps that could have a deleterious impact on their careers. The second topic involved challenges in developing a substance disorders clinical program in any university environment. Third, as is often discussed in AMSP meetings, the group turned to specific issues involved in balancing responsibilities at home versus responsibilities at work. Another topic related to how to deal with the need for time off during the later stages of a pregnancy or soon after birth of a child. One of the scholars mentioned that she had planned six weeks off, while others mentioned that by their experiences, 12 weeks could be even more appropriate. Sometimes those additional weeks are covered by working at home.

The afternoon session then began with a presentation of a new lecture developed by Jennifer Merrill, a first-year scholar from Brown University. The lecture was much appreciated and covered information related to alcohol-related blackouts, a topic of particular importance to the growing population of heavy-drinking college students. The slides for this lecture were very clear, the use of animation highly appropriate, and the specific case that was discussed and woven into the lecture was very helpful. The transitions between sections of the lecture were done skillfully and made it easy for the audience to follow. The lecture also demonstrated how numbers can be rounded off (e.g., 13.5% can be listed as 14%) without loss of any real information for the audience while giving them a general feeling of how important a specific change was.

The day ended with a discussion of cities that might be appropriate for future AMSP meetings. In addition to East Coast cities of New York and Boston, other suggestions were Philadelphia, Charleston, as well as toward the south and midwest, New Orleans and Chicago. The group also discussed how important the dinners in a very relaxing restaurant atmosphere have been for networking, the appropriateness of continuing to have AMSP begin on a Wednesday and end on a Saturday, as well as how important it was to not have the spring meeting on the East Coast where winter storms can still be occurring in March and April (as exemplified by the almost 12 inches of snow this week in New York and Philadelphia). Finally, among the potential locales for the first meeting of the first-year scholars that will be joining the group in the summer of 2018, the group had a relatively strong preference for having that meeting at our traditional meeting place that was the host of the first meeting after the formation of AMSP, Kona, Hawaii.

The meeting adjourned at 2:30 p.m., with each scholar on their own for dinner that evening and the plan to reassemble at 8:00 a.m. on Friday, March 23.

III. Friday, March 23, 2018

Following breakfast, the group reassembled at 8:00 a.m. on Friday, March 23.
The first order of business on Friday morning was a full lecture regarding sex differences in nicotine use disorders and their treatment as developed by the second-year scholar Reagan Wetherill. This is the first time the first-year scholars had the opportunity to hear the full lecture, as Dr. Wetherill’s participation at the prior meeting was precluded by a death in the family and she was not able to attend. The lecture was excellent with a superb development of ideas and progression of thoughts that made the material easily available and clear to the audience. Reflecting the fact that we were reviewing the material developed by a second-year scholar, this lecture was then used to highlight specific aspects of slides that were very effective; any potential changes in slides or outline that might be beneficial for future use; the importance of how Dr. Wetherill clearly defined her topics and avoided jargon unless carefully explained; and the repeated use of a central slide regarding hormonal changes during the menstrual cycle that set the stage for later aspects of appropriate treatment and timing of development of goals during nicotine use disorder treatment.

The session continued with the delivery of the full lecture developed by first-year scholar David Stiffler from New York University. The lecture focused on the treatment of comorbid alcohol use disorders (AUDs) and post-traumatic stress disorder (PTSD). David’s presentation style was engaging and put the audience at their ease. As was true of the other lectures developed at this meeting, his had excellent and clear slides, and easy to follow presentation of ideas, and very useful information for the treatment of each of these disorders, as well as an emphasis on how to approach individuals with both AUDs and PTSD. David and Marc also discussed how well some of the slides had been modified to meet the audience’s needs, a series of steps that also helped identify original challenges in the flow of ideas that were easily corrected in the final version and helped by having reviewed the slides.

The next order of business was to discuss potential dates for the next AMSP meeting, which would be attended by first-year scholars who are assuming their second-year role, as well as five new scholars. The various dates that were considered began in late September and went through October with the decision that the only date that all of the current individuals and several of the new scholars being considered could meet was beginning on October 3, 2018.

The final order of business for Friday morning was the presentation by second-year scholar Hayley Treloar of Brown University of a revision of her excellent full lecture for first-year medical students into a 15-minute lecture given to high school teachers. The topic was alcohol use in adolescents and how their substance use and potential problems with control relate to the rate of brain development. After the fine lecture, Hayley discussed some of the thoughts that went into the selection of and potential modification of some of the existing slides as she changed the audience and the fact that she adhered to the guidelines of this exercise, which was to take no more than 90 minutes (preferably just one hour) to modify the lecture originally developed for one audience for a much shorter lecture developed for a second audience. The goal from the standpoint of AMSP is to demonstrate the steps one can use in such a transition using relatively little time when one is dealing with a well organized lecture to begin with.

After a short break, the group reconvened for a working lunch. Issues that were discussed as they related to career development included the challenges in telemedicine when a lecture is delivered without an audience present in a sterile environment with just the lecturer, the camera person and the camera. Various thoughts were given as to how to imagine an audience and/or to practice first delivering the same material in front of an audience in order to anticipate the needs and questions of the telemedicine audience. Another topic related to assets and liabilities of having a joint appointment in two different departments, with the importance of knowing whether both departments are helping to pay one’s salary and/or give an individual space, as well as the need to make clear to the secondary department what (if anything) the individual can contribute to that second department. A third topic related to the role of an editor of either a newsletter or a journal regarding invited articles that were not optimally written. Various pitfalls of this situation and how such approaches are handled were a major part of the discussion.

After lunch on Friday, Carla Marienfeld, a second-year scholar originally from Yale and recently at UCSD, asked our group to test out a new approach to teaching about some of the major AMSP goals. Her idea was to present and discuss slides that she developed but might not have worked as well as she might like. The lecture was a general discussion about the recognition and treatment of substance use disorders for third-year medical students, but that she tried to develop in a manner that could be modified fairly easily for other audiences. The lecture primarily grew out of her activities before AMSP and she wanted to go through the process of how she might alter slides and some of the challenges and thoughts she had as she takes this earlier lecture and modifies it. This was very useful for the audience. The patterns that needed to be changed for these very solid slides included: 1) To increase the font size to a minimum of 32 in order to have slides that can be read in the back of the room; 2) In order to do that, the number of words used in the slide needed to be decreased with plenty of examples of how that could be done; 3) To also enhance readability, the number of lines of information offered needed to be decreased and the lines spread as best one could from near the top to near the bottom of the slide; 4) The importance of a skillful use of abbreviations; and 5) The easy correction of decreasing words that are implied by either the general topic.

After this very useful exercise the group then discussed potential scholars to be recruited for the several spots open for fall of 2018. This topic was important and related to some of the discussion that had occurred on Thursday morning.

The meeting adjourned at 2:30 p.m. Marc met individually with some members of AMSP and AMSP participants were reminded of the working dinner that evening.

Therefore, the group reassembled in the lobby of the Surf and Sand Hotel at 7:15 p.m. and proceeded to the first floor where the working dinner was carried out at Splashes restaurant.

IV. Saturday, March 24, 2018

The group reassembled for a working breakfast at 8:00 a.m. on Saturday morning, March 24th. The accomplishments of the meeting to date were reviewed and plans for the next meeting were discussed.

The meeting then turned to the presentation of a lecture on cannabis treatment in adolescents by Kara Bagot, first-year scholar from UCSD. This lecture demonstrated the importance of clear slides, the very appropriate progression from describing jargon and the specific drug forms to regions of the brain that are affected and onto approaches for treatment. The delivery of the lecture was very effective and the group turned to whether any of the specific slides might be modified in light of the five steps mentioned above regarding Carla’s lecture. With both first and second-year scholars leading the series of suggestions for improving already effective slides, much of the rest of the morning was used as a summary of the major important points developed throughout this meeting.

The next order of business was the presentation by each scholar of the accomplishments regarding the advancement of education on alcohol and drugs to healthcare deliverers at their institutions. These included:

Reagan Wetherill, second-year scholar, University of Pennsylvania Perelman School of Medicine, 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 integrated the “How to Tell Your Story” lecture into the curriculum and plans to give the lecture annually. She is also involved in planning didactics for the Center for Studies of Addiction research trainees. As part of this training, Dr. Wetherill presented the “How to Tell Your Story” lecture to postdoctoral/predoctoral trainees and Addiction Psychiatry fellows. Dr. Wetherill is also Director of the Center for Studies of Addiction Seminar Series and hosted previous AMSP scholars to present their AMSP lectures to her Center’s faculty, postdoctoral/predoctoral students, psychiatry residents and fellows, as well as research staff. Using the AMSP guidelines, Dr. Wetherill developed a lecture on Cannabis for MS1s Brain & Behavior course.

Carla Marienfeld, second year scholar, next reviewed the ways she has improved alcohol and drug use education at her university, University of California San Diego. She is doing education for inpatient based services to initiate patients with opioid use disorders on medication treatments to increase likelihood they will follow up with referral to treatment, and has improved her lectures on motivational interviewing to the Child and Adolescent Psychiatry Fellows. In addition, Carla is presenting 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 including to community groups, medical students, residents, and physicians who come to her clinic for remediation. She will again offer the 4.5 hour “half and half” on-line and in-person buprenorphine waiver training course to residents and faculty that allows those who complete the course to apply for the DEA waiver to prescribe buprenorphine. She continues a clinical selective for 3rd and 4th year residents to work in the UCSD Addiction Recovery and Treatment Program, including using lectures using the AMSP style; teaches general course on substance use disorders for the 2nd year psychiatry residents; and mentors a family medicine/psychiatry resident for individual supervision for addiction treatment as part of his rotation in her clinic. She has prepared 2 workshops and courses for the American Psychiatric Association and 1 course for the American Society of Addiction Medicine. She has prepared the curriculum for the ACGME Addiction Psychiatry Fellowship application she submitted this spring, 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.

Hayley Treloar Padovano, Ph.D., second-year scholar, next reviewed ways she has disseminated AMSP lectures and principles at Brown University and to wider audiences. 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, Hayley included AMSP principles in her lectures as part of the teaching curriculum for her Summer@Brown program course for advanced high school students. 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 presented a portion of her lecture for Brown faculty and postdoctoral fellows, as well as Dr. George Koob, Director of the National Institute on Alcohol Abuse and Alcoholism, upon his visit to Brown University; she also presented a portion of her lecture for the Collaborative Perspectives on Addiction conference in March, 2018, which is sponsored by the Society for Addiction Psychology. Last, Dr. Padovano co-teaches a writing discussion group for postdoctoral fellows and junior faculty members at the Center for Alcohol and Addiction Studies at Brown and will present an adapted version of the “How to Tell Your Story” AMSP lecture as part of this curriculum.

Kara Bagot, first-year scholar from UC San Diego Department of Psychiatry plans on further developing the child and adolescent psychiatry fellowship substance use didactics, and using the AMSP format in delivering lectures to the child psychiatry fellows. She will also adapt her current lectures for the medical students and adult psychiatry residents to the AMSP format to improve understanding of the concepts discussed. Further, in collaboration with Dr. Carla Marienfeld, an associate professor at UC San Diego, and second-year scholar, Kara will co-direct didactics for the addiction psychiatry fellowship that is currently being developed. Kara also mentors medical students, and child and adolescent psychiatry fellows on substance use education and research.

Dr. David Stiffler, junior scholar from NYU medical school next gave his report of activities. Since the last AMSP meeting, Dr. Stiffler has given AMSP-inspired talks on trauma and substance use disorders to addiction psychiatry fellows at NYU, Columbia and Mt. Sinai. At NYU, Dr. Stiffler gave a talk about adolescent substance use disorders to Child and Adolescent psychiatry fellows. He spoke on a panel about the opioid epidemic at the Cohen Veterans Care Summit in Washington D.C. He has given a talk to psychology externs at the Steven A. Cohen Military Family Clinic at NYU about the treatment of substance use disorders. Dr. Stiffler gave a webinar talk to the Cohen Veteran Network where he spoke to non-prescribers about principles of psychopharmacology, including the treatment of substance use disorders, that would be relevant to clinicians working with veterans or veteran family members. At Adelphi University, Dr. Stiffler gave a talk to clinical psychology candidates about important issues to consider when working with patients with substance use disorders. Finally, Dr. Stiffler has taken on the role of Associate Editor for the American Academy of Addiction Psychiatry Newsletter, and his first article will be about PTSD and addiction.

Next, Jennifer Merrill, first-year scholar from Brown, presented her accomplishments regarding increasing alcohol and drug education at her university. Jennifer included AMSP principles in a lecture to postdoctoral fellows in the Center for Alcohol and Addiction Studies (CAAS) on the topic of College Drinking using some of a prior scholar’s AMSP slides on this topic as well as some of the slides she herself developed during AMSP on the topic of blackouts specifically. She also joined the Alcohol and Other Drug Committee at Brown University, where she chairs a subcommittee focused on enhancing faculty and staff abilities to recognize and address substance use issues among students. Jen is also in the process of researching how other universities assist faculty and staff with these issues, and a working on a needs assessment that includes assessment of faculty/staff willingness to attend a lecture on substance misuse topics. She is co-chairing the 2019 Collaborative Perspectives on Addiction conference, and advocated for this conference to be held in Providence, RI so that Brown University students and residents will be able to benefit from further education on alcohol and drugs. Jennifer will develop and deliver an AMSP style lecture on identifying and addressing substance use problems among students. Jen 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; she is chair of the Rounds Committee at CAAS where she will look for opportunities to provide weekly speakers of that series, and/or postdoctoral fellows, with suggestions for using the guidelines put forth in the “How to Tell your Story” AMSP lecture, and will invite former scholar Paola Pedrelli to give a talk as a part of this series. Jennifer will assist PhD student in using AMSP principles as she develops and delivers research presentations; will practice outlining and modifying existing lectures to be delivered to a Summer at Brown Introduction to Psychology class, and, in her role as co-chair of the Collaborative Perspectives on Addiction conference, she will advertise and encourage Brown students and residents to attend.

With all the major goals of the meeting having been addressed, the group prepared for adjournment at 11:00 a.m., a time required for scholars who wished to return to their East Coast homes without arriving too late in the evening. During this final session, plaques regarding participation in AMSP were delivered to the second-year scholars; much appreciation to Marcy Gregg for her very hard work in organizing this meeting was presented; discussions were shared regarding future networking among members of AMSP; and plans for shared breakfast with graduated scholars at meetings such as the Research Society on Alcoholism, the International Society of Biomedical Research on Alcoholism, and CPDD meetings were established. The meeting adjourned with thoughts for the next official get-together for current first (and newly becoming) second-year scholars, as well as next year’s first-year scholars on October 3, 2018.

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