Meeting #41 - Carmel, CA

Carmel, CA

March 20 - 23, 2019

AMSP Meeting, March 20-23, 2019 at Highlands Inn, Carmel, CA

Attending the meeting were Drs. Kara Bagot, Jennifer Merrill, David Stiffler, Marianne Guschwan, Jose Vito, Kathleen Broad, Brook Arterberry, and Elizabeth Aston.

The meeting was chaired by the AMSP Director, Marc Schuckit, with the help of the AMSP Administrator, MaryAnn Klima.

Wednesday, March 20

The initial get together the meeting in the lobby of the Highlands Inn. First and second year scholars were reintroduced, participants had the opportunity to briefly discuss their recent accomplishments, and the meeting progressed to a working dinner at Grasing’s Restaurant in downtown Carmel.

Thursday, March 21

The meeting began with a working breakfast for the entire group. During that time Marc reviewed details of the experiences of the past six months for each of the participants. That led to a more formal discussion of several important topics regarding future activities for AMSP. Primary among them was whether the new modified assignment for two of the first year scholars was a useful learning experience. Both first year scholars and their second year mentors felt that the experience was worthwhile and felt comfortable that they would be able to present their lectures as part of the meeting.

The next item on the agenda was now to set the schedule for the meeting. This involved assigning times for first and second year scholar’s presentations on Thursday, Friday, and Saturday. The first year scholars were to deliver their full 40-minute lecture aimed at first year medical students. The second year scholars were given options of modifying their lecture or, as proposed by one of the second year scholars, the possibility (probably for future meetings) of a second year scholar presenting one of the other lectures rather than the one they developed themselves. Everyone felt this was a fine idea as it gives the opportunity of seeing how their structured interviews can indeed be successfully used by others. An additional issue for the program schedule was to set times for each of the first and second year scholars to discuss how they have worked to expand alcohol and drug education at their schools as well as outline their plans for the next six months (for first year scholars who will be continuing on to their second year) and for the future in their medical schools overall (for second year scholars).

Marc Schuckit then presented his lecture on “How to Tell Your Story”. The lecture was delivered more as a round table discussion giving the opportunity for other members of the group to tell their impressions of what worked well in helping them prepare for their own learning experience, as well as suggestions on things that might be done a bit differently in the future.

The next item for Thursday morning was the presentation of ther AMSP lecture by Kathleen Broad, a junior scholar from the University of Toronto and Western University Schulich School of Medicine and Dentistry. Kathleen took on this task to help her with her teaching of nurses, nurse practitioners, physicians, and other health care deliverers near the Arctic Circle in Canada. As such, she wanted to develop a lecture that standardizes her usual teaching and bring things up to date for that important audience. She also hoped to be able to use the lecture for her interaction with medical students, psychiatric residents, and fellows. The lecture was superb and highly appropriate for the audiences she was considering. The slides were clear, the outline of materials very useful, and the references impressive and up to date. The group was very appreciative.

The group progressed to a working lunch focused on career development challenges. A prominent issue in that discussion was how to establish priorities at work considering that there is so much to do and so little time to do it. This is a challenge faced by almost everyone at every stage of academics, and Marc reviewed some guidelines including: always considering putting family and health (both resting the brain as well as physical health) first. Then, prioritizing issues based on both the importance to one’s own career, as well as level of interest. And, third, a very important step is to learn when and how to say no when asked to take on a task for which they have no time. Fourth, it is essential to understand who is judging you and, therefore, will be instrumental in your next your next promotion or raise and to be certain that you are in agreement with whatever goals they set and are working toward those goals. Finally in Thursday afternoon’s career development discussion, the group discussed how authorship order is established for papers, options on what to do if a more senior person who did not contribute to the paper insists on having their name included, and how to handle situations where other relatively junior faculty believe that the area in which you work “belongs to them”.

The afternoon session began with a report of activities regarding enhancing medical school education on alcohol and drugs as delivered by Kathleen Broad. Dr. Kathleen Broad is a consultant psychiatrist for clinics in Pangnirtung and Qikiqtarjuaq, Baffin Island, Nunavut Canada with the NPOP-CAMH program. In this program, she provides addiction and psychiatric clinical consultation and education for mental health nurses at local health centers and provides clinical supervision of senior psychiatry residents. In her role as adjunct professor of psychiatry, Dr. Broad interviewed prospective medical students at Schulich School of Medicine and Dentistry at Western University and clinically supervised medical students and residents. At Huron Perth Healthcare Alliance, Kathleen discussed addiction and psychiatry topics with family physicians at the Consultant Round Table, and presented on Opioid Use Disorder to nursing colleagues via "DocTalks". For the future, Dr. Broad is developing an addiction lecture series for addiction counsellors at Choices for Change Addiction Counselling Centre, will be discussing rural addiction psychiatry at University of Toronto psychiatry residents, and will be lecturing in the AMSP format on Alcohol Use Disorders and other addiction topics at Clinical Round Table, DocTalks and Grand Rounds to nursing and medical colleagues at the Huron Perth Healthcare Alliance.

The next item was a report by second year scholar, David Stiffler, regarding developments in his institution at New York University. Since the last AMSP meeting, Dr. Stiffler has presented on PTSD and Substance Use Disorders at the NYU Annual Psychopharmacology Course and gave the same talk at Psychiatry Grand Rounds at University of Medicine and Dentistry of New Jersey (UMDNJ). Dr. Stiffler gave a presentation at a monthly “Lunch and Learn” to CBS employees on Addiction and Treatment; continued to teach at various levels and presented didactic seminars to Addiction Psychiatry Fellows at NYU and Mt. Sinai; and gave a talk to NYU Child and Adolescent Psychiatry Fellows on Substance Use Disorders in Adolescence. At the Steven A. Cohen Military Family Clinic, David lectured to psychology externs about psychopharmacologic treatment of substances use disorders. In the future, Dr. Stiffler will continue teaching about addiction throughout the NYU and greater academic community using the skills and principles he learned in AMSP. He is scheduled to present on Updates on PTSD and Addiction at the Summer NYU Psychiatry Lecture Series and will present on Trauma and Addiction to PGY-4 residents in the NYU Psychiatry residency program.

The next item was the report by Brooke Arterberry regarding developments in teaching about alcohol and drugs in her institution at Iowa State University. This past 6 months Brooke finalized the implementation of the BASICS program at the university (am approach to mitigating the development of heavy drinking and alcohol problems in students). As Clinical Supervisor of the BASICS program, Dr. Arterberry will continue to provide education regarding alcohol and other drugs to Counseling Psychology graduate assistants and university staff working in Student Wellness, Student Conduct, and Residence Life. Brook also delivered the “How to Tell Your Story” lecture to graduate students in Psychology and will continue to deliver this lecture in future courses. Additionally, she will develop a seminar for Counseling Psychology graduate students regarding college student alcohol and other drug use. In the next year, Dr. Arterberry will develop a course focused on Alcohol and Other Drug Use and treatment approaches for graduate students in the Department of Psychology starting Spring 2020.

After a general discussion of the day’s development and a review of the assignments for Friday and Saturday, the group adjourned at 3:00pm. Scholars were on their own for the rest of the afternoon and for dinner.

Friday, March 22

The group assembled at 8:00am and began with a working breakfast. The day’s goals were reviewed, material from Thursday that needed clarification was discussed, and we prepared for the first new order of business.

First year scholar, Elizabeth Aston, next presented her fine lecture regarding medical benefits of cannabis. In developing this lecture Liz had worked through several different approaches and then began developing what she felt was the best approach to her lecture. Her talk reviewed the key elements of cannabis, presented medical uses with convincing controlled data, then carefully proceeded to inform the audience that of the remaining potential uses were backed by theory and many were backed by open trials, but none had a double-blind controlled trial data. This was a very effective and informative lecture with very clear slides and outline, and an impressive group of references. Following this lecture, as an exercise in seeing how easy it is to modify the talk for a shorter lecture and/or for a different audience, Marc asked Liz if she would take 1 hour or less that night to develop a lecture for graduate students (as opposed to medical students), and to limit herself to 15 minutes using 15 slides. Liz agreed to the challenge and offered to deliver that new lecture Saturday morning.

Following this, Kara Bagot, second year scholar, presented her first-year lecture but now modified for second year psychiatric residents rather than medical students. This was an important and somewhat challenging change because, as opposed to the medical students, the residents already understand the basics of psychiatry, and have already been introduced to issues relating to alcohol and drugs in adults. The lecture was highly effective, and demonstrated an ability of a scholar to modify a lecture for one audience, and then give it to a very different audience, and not have to spend much time making the changes.

Marc next handed out materials that could be useful to both first and second year scholars. The first was an overview of activities that all scholars can have in an effort to expand medical information to medical, psychology, and other health care deliverer on education on drugs. The second was a reminder about the guidelines for both developing slides and developing a lecture.

Jose Vito, from an NYU clinical service, a first year scholar, next presented his lecture. In this instance Jose updated an existing lecture from our website and modified it to represent more of his own thoughts. This abbreviated assignment was developed because many of the scholars currently do not have the time to develop a full lecture, but still would benefit from an assignment where they can apply the approaches to “Telling Your Story” presented as part of AMSP. Jose had several challenges in this process, including the fact that as a first lecturer giving a modification of a previous topic, he was not certain of how much of the lecture he was free to change. A useful discussion ensued, Jose shared the changes that he made from the prior lecture and the reasons why, and was asked to explain which slides he changed and the reasons.

Following this exercise, Jennifer Merrill, second year scholar, asked that rather than deliver her first year lecture, she wanted to give a new lecture that she is currently developing, and was eager to hear suggestions regarding slides. The entire group was enthusiastic about this approach, and Jennifer proceeded to give the lecture in an abbreviated format leaving most of the time to discuss what were very effective slides that could potentially consider some modest changes based on the AMSP approach. Our discussion proceeded slide by slide and at no time was there any slide that was not fitting for the lecture itself.

This was followed by the report of activities by second year scholar Kara Bagot from University of California, San Diego. Kara continued to develop and expand child and adolescent psychiatry fellowship substance use didactics, using the AMSP format in delivering lectures to the child psychiatry fellows during a month-long lecture series. These didactics are in conjunction with field education in community adolescent substance use treatment. She has developed lectures for third year medical students rotating on Psychiatry and adult psychiatry residents in the AMSP format to improve understanding of the substance use disorders. Kara also mentors undergraduates, graduate and medical students, postdoctoral fellows and child and adolescent psychiatry fellows on substance use education and research. Further, she has given Pediatric Grand Rounds at Rady Children’s Hospital on adolescent substance use disorders to education pediatric residents and faculty. Kara is also a member of the Opiate Use Task Force at Rady Children’s Hospital to influence opioid prescribing practices among physicians and increase parent education on opiate safety, administration and disposal. She is also increasing substance use education among allied health professionals, by providing rounds to nurses in community adolescent substance use centers regarding consequences and treatment of various substance of use. In the future, she will continue to work with Dr. Neal Swerdlow, the research track adult psychiatry residency program director, to develop a child and adolescent and adult psychiatry research track with a focus on recruiting trainees dedicated to improving adolescent addiction outcomes. Kara will also add to, and improve child psychiatry fellow substance use didactic lectures in the AMSP format.

After discussing the day’s activities, and Saturday’s schedule, the group adjourned for several hours. Participants reassembled in the lobby of the hotel for a working dinner at Carmel Bouchee’ Restaurant in downtown Carmel.

Saturday, March 23

The group assembled for a working breakfast and a discussion of what will be accomplished on Saturday.

The day began with Brooke Arterberry’s presentation, first year scholar, from Iowa State University, of a modification and update of a lecture originally posted on our website. During the lecture Brooke pointed out that she would have benefitted from more information about what was expected regarding a modification. Important questions that arose included whether it is acceptable to make major changes in the lecture itself (the answer is yes-indeed it is preferred), and was it possible to make major changes in the slides and/or add or subtract any information (again, the answer was an enthusiastic yes). Despite these questions, Brooke’s lecture was effective, and pulled in some information directly relevant to Iowa State. In response to Brooke’s important questions, the group reviewed the slides and topic areas, one by one, with suggestions of modest changes that would make a good lecture even better. Brooke will work with these and incorporate any that she thinks is appropriate before forwarding the lecture to Marc to be loaded on the website.

Next, Elizabeth Aston, first year scholar from Brown University, presented her modified lecture. Her goal was to complete the lecture within 15 minutes with using 15 slides (she modified that slightly to 17 slides). The modified lecture was as effective as the full lecture. Liz told us that those changes from the major lecture took her 20 minutes to do, and reviewed what she deleted order to cut back on the lecture. The deletions included the case history that had been described in the longer lecture, and several of the major points after deciding which goals and major points were most appropriate for the new audience).

Jennifer Merrill, second year scholar, next delivered her report on activities at her medical school. In the past six months, Jennifer Merrill from the Center for Alcohol and Addiction Studies at Brown University engaged in the following: (1) She continued to revise some of her lectures for her Summer at Brown course (The Mind, Brain and Behavior), using AMSP principles; (2) As chair of the Rounds Committee at CAAS, she invited former scholar Paola Pedrelli to give a task as a part of this series; (3) Jennifer has spread the word about the AMSP program, including the availability of lectures on the website; (4) Jennifer has assisted her PhD and Master’s students in using AMSP principles as they develop and deliver research presentations; (5) 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. She advertised and encouraged Brown students and residents to attend; (6) Dr Merrill wrote an article for Boston University’s Public Health Post describing her research on blackouts for a lay audience. Jennifer’s plans for the future include the following: (A) She is waiting to hear from Brown University Alcohol and Other Drug Committee regarding a staff/faculty based survey of knowledge on and needs regarding addressing substance use on campus. If there is interest among Brown faculty and staff, Jennifer will develop and deliver an AMSP style lecture on identifying and addressing substance use problems among students; (B) She will continue to assist her PhD and Master’s students in using AMSP principles as they develop and deliver research presentations; (C) She will continue to practice outlining and modifying existing lectures (to be delivered to a Summer at Brown Introduction to Psychology class) using the AMSP principles, with an ultimate goal of redoing all lectures for that course using these principles; (D) Jennifer is on the schedule to present the “How to Tell your Story” AMSP lecture to the Public Health graduate student journal club; (E) Jennifer will work with Elizabeth Aston to present the “How to Tell your Story” AMSP lecture to the postdoc writing group at the Center for Alcohol and Addiction Studies; and (F) In her role on the Research Society on Alcoholism Education Committee, Jennifer will make efforts to increase substance use education not only among RSA members but also the broader population of healthcare deliverers.

Jose Vito, junior scholar from NYU Langone School of Medicine, next gave his report. He continues to serve on the Educational Committee at the NYU School of Medicine at the Psychiatric Residency Program. Since the last AMSP meeting, Dr. Vito has given AMSP-inspired talks on addiction with the NYU medical students and addiction leadership roles as a member of the Scientific Program at the American Academy of Addition Psychiatry (AAAP) at the annual meeting in December 2018. Serving on the Continuing of Medical Education and Life Long Learning (CMELL) at the American Psychiatric Association (APA), he introduced the Alcohol Medical Scholars Program website and resources to the committee. Regarding future activities, he will be one of the panel speakers at the NYU Medical Student Interest Group on April 10, 2019 regarding Synthetic Cannabinoids based on his modification of the existing AMSP lecture. He will also give talks to the National Psychiatry Interest Medical Students at the American Psychiatric Association (APA) annual meeting in May 2019. In addition, he is scheduled to deliver an AMSP style lecture on Cannabis in the Youth with the Child Fellows at the New York regional of the American Academy of Child and Adolescent Psychiatry (AACAP). Jose serves He on the Addiction Committee of the New York County Psychiatric Society, a District Branch of the American Psychiatric Association, where he hopes to create an AMSP-inspired talk and podcasts to educate substance use disorders to APA members and the general public.

The group next turned to issues related to AMSP recruitment. Marc reviewed the criteria for selection of AMSP participants, and members of the current group had several individuals that they were considering and asked relevant questions. Those with suggested participants for AMSP will contact Marc within the next two weeks, two of the slots have already been filled and there are openings for three more.

The discussion next turned to potential dates and places for the fall 2019 meeting of AMSP. This will be the first meeting for the five new scholars, and the first meeting of the second year for those going on to year two. Four potential dates might work for the current scholars, including Wednesday-Saturday morning for September 18-21, September 25-28, October 2-5, and October 16-19 (although that last date might not be optimal for several) . Following the usual approach in AMPS the next meeting would preferentially be on the east coast and among the places being considered being Manhattan, Charleston, and Boston. Current members noted that they would have a preference for returning to the west coast with, according to Marc, potential venues being San Diego and Laguna Beach.

Elizabeth Aston, first year scholar from Brown University, nest reviewed her activities to improve alcohol and drug education at her university. Liz continued mentoring students in the AMSP guidelines in her writing group with postdoctoral students. She gave a brief “How to give a lecture” presentation, and plans to work with Jennifer Merrill to give this kind of presentation to the new postdocs in the coming year. Elizabeth is also the co-chair of the Center for Alcohol and Addiction Studies Rounds Committee where, in her role as co-chair, she helps to bring relevant speakers to talk about research topics pertaining to substance use and substance use disorders. Elizabeth will plan to present on her current research during CAAS Rounds, implementing AMSP guidelines and principles. Elizabeth also developed and delivered an AMSP style lecture on the behavioral economics of marijuana to postdoctoral students in the Center for Alcohol and Addiction Studies (CAAS) as part of their Etiology of Substance Use Disorders course. She teaches an Introduction to Neuroscience course to high school students each summer as part of Summer@Brown and plans to restyle her existing lectures using the ASMP principals. She is also part of the 2019 Collaborative Perspectives on Addiction conference planning committee, and as part of this commitment, encouraged Brown University medical residents and students to participate and attend the meeting, wherein much research will focus on assessment, prevention, and intervention for alcohol and other substance use. Elizabeth will serve as co-chair of the Collaborative Perspectives on Addiction meeting for 2020. In this role, she will be able to bring many clinicians and researchers to the meeting wherein much work relevant to assessment, prevention, and intervention for alcohol and other substance use will be presented. She plans to work with AAA in the coming year to develop a program for adolescents on marijuana and driving. Elizabeth has also been asked to give a talk on medical marijuana at Rhode Island Hospital which will occur later in the year. Finally, she will look for other opportunities to present on use of marijuana for both medical and recreational purposes at national meetings, including at conferences and as part of invited talks, using the AMSP guidelines.

The final official order of business was the awarding of plaques to second year scholars to commemorate their two years of activities with AMSP. The group also expressed their appreciation to MaryAnn Klima for organizing the meeting, and Marc Schuckit was rewarded with hugs from all before they left.

The meeting ended at 11:45 in the morning so that individuals flying home that night could make their flights. This also gave the opportunity for those who are staying overnight to have a beautiful day for sightseeing.

Layout and design by Brian Klima