Meeting #42 - La Jolla, CA

La Jolla, CA

October 2 - 5, 2019

Minutes of the Alcohol Medical Scholars Program (AMSP) meeting in San Diego, CA beginning Wednesday, Oct. 2 and ending Saturday, Oct. 5.

Present at the meeting were Drs.: Elizabeth Aston, second year scholar from Social Sciences at Brown University; Kathleen Broad, second year scholar from Schulich School of Medicine and Dentistry in London, Ontario, Canada; as well as first year scholars Neeral Sheth from Rush Medical School, Alan N. Francis from Massachusetts General Hospital, Rachel Gunn from Brown University, Alejandro Meruelo from UCSD, Adina Fischer from Standford Unversity, and Javier Ballester from University of Utah Medical School. Two additional attendees who were not able to make this meeting were Marc Schuckit’s AMSP assistant, Jennifer Merrill from Brown University, and Brooke Arterberry from the University of Iowa – each of whom will be taking part on roles as second year scholars. Also present were Marc Schuckit (director) and MaryAnn Klima from Marc’s office

Wednesday, October 2, 2019

The group convened in the lobby of the Grande Colonial Inn in La Jolla for an informal meeting. Here, members of AMSP introduced themselves and had the opportunity to network in an informal environment. The group then briefly adjourned as they walked to dinner at Piazza 1909 where we had a private room and the opportunity to continue discussions as well as highlight materials for the next day’s program.

Thursday, October 3, 2019

After breakfast on their own, the group reconvened at 8:00am in the Parlor Room of the Colonial Inn. Individuals were asked to reintroduce themselves and give a brief overview of their activities at their medical schools. Those engaged in research were also invited to give a brief description of their research activities and publications.

The next order of business and the major topic of the morning was Dr. Schuckit’s leading of a seminar regarding how to tell a story in lectures, papers, grant applications and posters. Slide copy related to this topic was handed out to all members present as Marc progressed through discussions of the major philosophy being taught through AMSP. This included: 1) remembering the audience is key and the lecturer is the least important person there; 2) people learn through building ideas upon ideas, and slides should be in service of a well structured outline of material being presented; 3) lectures should be based on the most impressive and most recent data possible; and so on. Marc also reviewed how to efficiently review the literature relating to any specific topic, organizing the information based on topics that might be subheadings in a paper, grant application, poster, or lecture.

The talk then progressed to an overview of how the background information is stored in a series of files (written or on the computer) that can then be organized in a way that becomes the basis for the lecture outline, giving several examples of what a lecture outline might look like. Based on the information offered, Marc then progressed to the key elements of effective slides including: 1) no more than one slide per minute; 2) material that can be easily assimilated with a quick glance while the audience (or readers) focus on other issues being covered by the organizer; 3) slides need to be clear to individuals at the back of the room; 4) the problems associated with using tables and figures taken directly from papers as they are not quickly assimilated; 5) along with other suggestions that can be seen in the lecture “How To Tell A Story” also posted on the AMSP website.

The next topic in story telling discussed the approach of focusing on the clarity of presentations and slides and turned to optimal posters. Here there is optimally only one or two major points that are developed to attract to people to talk with the person presenting the poster. Key elements are the clarity of the title, absence of jargon, and using a highlighted central table or figure.
The morning progressed quickly as individuals had an opportunity to ask questions about the approach and second year scholars who already used this approach for their own project shared their experiences and made suggestions of how Marc’s presentation might be modified.

After a short break, the group then proceeded to have a working lunch focusing on issues in career development. Topics that were discussed included issues related to the optimal way (and conditions in which) to ask for a raise in salary or a promotion. Another topic involved Marc’s emphasis on the fact that the balance between home and work should be best focused on home without losing sight of the importance of relationships. The group also discussed issues related to the importance of finding optimal mentors, especially at universities where research is not strongly emphasized.

Following lunch Elizabeth Aston, second year scholar from Brown University, presented her lecture on medical marijuana. Marc asked Liz to use a seminar format where she fairly rapidly progressed through the elements of the talk. Liz stopped along the way to teach first year scholars about a particular challenge that occurred in creating the slide, information regarding times that she changed what she had originally written based on input or additional material form the literature, etc. During this time both Marc and the second year scholars offered their input on their own development of lectures or on the overall approach on telling a story. The period for discussion was helpful to first year scholars and set the stage for what would occur when the second of the second year scholar delivered her lecture on Friday morning.

Following the presentation, Marc asked Liz to put all of her slides into a slide-sorter mode and to go through them to select slides that might not have been essential, decreasing the number from 40 slides to as low as it might be while still maintaining approximately 40 minutes of lecture time for medical students. Following that exercise, Liz was asked to take no more than an hour later that day or that evening to modify the lecture even further. The new task involved no more than 15 minutes and 15 slides to present her medical marijuana lecture to skeptics who are either police officers or local government administrators who had negative feelings about medical marijuana. That lecture was to be delivered on Friday.

Brooke Arterberry, second year scholar from the University of Iowa, next presented her report of her activities to enhance education about alcohol and drugs at her school. Brooke is currently the clinical supervisor for the BASICS program (brief motivational intervention for college students that is designed to reduce consequences associated with heavy drinking). Dr. Arterberry will provide education regarding alcohol and other drugs to Counseling Psychology graduate students and university staff working in Student Wellness and Student Conduct. Brooke will also deliver the “How to Tell Your Story” lecture to Psychology graduate students. Additionally, she will be developing a seminar for Counseling Psychology graduate students regarding alcohol and other drug use among college students.

The group then progressed to a discussion of potential topics for projects for first year scholars. Alejandro Meruelo thought that it might be worthwhile to take Kathleen Broad’s lecture giving an overview of alcohol use disorders, but now to be delivered to patients and Adina Fischer thought that she might develop a lecture on cannabis psychosis. All scholars were advised that developing lectures from scratch would be very welcome and be important for the AMSP website, but might be more time consuming than many busy scholars can deal with. Therefore, Marc placed an emphasis on building upon an existing lecture with a new ad different outline and new slides or taking a lecture an individual has already developed and modifying it for AMSP style. The group adjourned at 3:10pm with the scholars on their own for dinner on Thursday night.

Friday, October 4, 2019

The meeting began at 8:00am with a discussion and additional thoughts individuals might have regarding the material presented on Thursday. Following that discussion Kathleen Broad, second year scholar from London, Ontario, Canada, presented her lecture. Similar to Liz, Marc requested that the presentation be informal, and the material be used as guidelines that might be useful for developing a project among first year scholars. Also similar to the experience with Liz, this was a wonderful learning session for everyone, made possible by the excellent command that Kathleen had regarding her material.

The next order of business was for the second year scholars to discuss their accomplishments during the prior six months.

Dr. Kathleen Broad, second year scholar from Western University Medical School in London, Ontario next reviewed her accomplishments and future plans regarding enhancing medical education on alcohol and drugs. Dr Broad is a consultant psychiatrist for clinics in Pangnirtung and Qikiqtarjuaq, Baffin Island, Nunavut Canada with the NPOP-CAMH program where she provides addiction and psychiatric clinical consultation and education for mental health nurses at local health centres and provides clinical supervision of senior psychiatry residents at the University of Toronto. In her role as adjunct professor of psychiatry, Kathleen also clinically supervises medical students at Schulich School of Medicine and Dentistry at Western University.

On October 1 2019, Kathleen received a promotion to Medical Program Director of the Department of Psychiatry at Huron Perth Healthcare Alliance (HPHA). In this role, she will provide leadership to colleagues in psychiatry and allied health, particularly in the area of regional program delivery for mental health and addictions. Through these activities she recently presented her AMSP lecture "Introduction to Alcohol Use Disorder" to nursing colleagues at the HPHA "DocTalks". In addition, Kathleen has established intake rounds with the transitional case manager at the Choices for Change Addiction Counselling Centre and will present the HPHA Grand Rounds on "Pharmacotherapy of Alcohol Use Disorder" to medical and surgical colleagues. In Spring 2020, Dr. Broad will present in the AMSP format on an addiction topic to family physician colleagues at the HPHA Clinical Round Table."

Elizabeth Aston, Second Year Scholar from Brown University presented her efforts to enhance alcohol and drug education at her university. Liz continued mentoring students in the AMSP guidelines in her writing group with postdoctoral students, gave a brief “How to give a lecture” presentation, and plans to give this kind of presentation to the new postdoctoral fellows again in the coming year. Dr Aston was the co-chair of the Center for Alcohol and Addiction Studies Rounds Committee where she helped bring relevant speakers to talk about research topics pertaining to substance use and substance use disorders. Elizabeth will also present outcomes from her current research during CAAS Rounds in the coming year, implementing AMSP guidelines and principles, and has developed 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. Each summer she teaches an Introduction to Neuroscience course to high school students from across the country each summer as part of Summer@Brown with lectures that were restyled using the ASMP principals. Elizabeth will give her AMSP lecture on Medical Marijuana at the Providence Veterans Association Medical Center as part of their Grand Rounds lecture series and to graduate students in the Brown University School of Public Health as part of their required seminar. She was also the Co-Chair 2019 Collaborative Perspectives on Addiction Conference which will be held in San Diego in 2020 where much research will focus on assessment, prevention, and intervention for alcohol and other substance use and will serve as co-chair of the meeting for 2020. Elizabeth has worked with the American Automobile Association in the past year to refine a program for adolescents on marijuana and driving which will be presented to high school students across Rhode Island. Finally, Dr Aston 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.

Next, Liz demonstrated the 15-slide, 15-minute lecture developed from her original presentation but now focusing on police officers and administrators skeptical about the usefulness of medical marijuana. Liz explained how she went from 40 slides to 15 slides, followed by an exercise to see if the 15 minute lecture could be given with ten slides. This was possible by combining several slides into one, deleting several slides, and by eliminating some of the segue slides that were useful within the talk.

Following this, in a very important step, the group reviewed additional potential topics for first year scholars, as well as naming individuals among Liz, Kathleen, Brooke, Jennifer, and Marc who could serve as initial mentors for the new project. These resulted in the following decisions:

1. Adina will modify one of her existing lectures on marijuana, while working with Marc as a mentor.

2. Alan Francis will develop a new lecture on transcranial stimulation (TNS). He, too, will be working with Marc.

3. Javier will develop a new lecture focusing on Koob et al’s theory of the dark side of addiction. In the process, Javier will work with Jennifer Merrill from Brown University.

4. Alejandro Meruelo from UCSD will indeed focus on adapting a prior lecture about medical treatment of alcohol use disorders (he is also free to go back to the idea the day before of developing a lecture for patients based on Kathleen’s lecture). Alejandro will be working with Kathleen.

5. Rachel Gunn will develop a lecture based on concomitant use of alcohol and marijuana. This was the topic of her recent grant application and she already has an outline, during which she will work with Liz Aston.

6. Neeral Sheth will develop a lecture on testing procedures for alcohol and drugs, material that might be based on the prior lecture developed in 2015 by Marty Plawicki. Brooke Arterberry will be Neeral’s mentor on this project.

Next, the group reviewed the plans for a working dinner on Friday evening. This will take place at Osteria Romantica, and those present reviewed how individuals who have cars can team up with individuals who do not have cars so that everyone can be transported to the restaurant which is about ten minutes driving distance from the hotel.

The group adjourned at 2:30pm with plans to reconvene for dinner.
Everyone met again in the lobby of the hotel at 6:30pm for transportation to the restaurant. We were once again fortunate to have a room almost to ourselves and the opportunity to be together in one long table. This facilitated easy and very enjoyable conversation across ends of the table and those in the middle – a fine example of networking and planning for potential future contacts.

Saturday, October 6, 2019

The group resumed meeting at 8:00am. Among the topics discussed on Saturday included reports by each of the first year scholars as well as second year scholars.

Javier Ballester, a first year scholar from the University of Utah, presented his thoughts for enhancing education on substance problems at his university. First, Javier will continue participating in the Addiction Medicine Interest group of the University of Utah, School of Medicine. This group is formed for medical students who have expressed an interest in widening their knowledge of Addiction Medicine. He will also gather information about didactics intended for medical students in the third year psychiatry clerkship and will participate in the development of this curriculum. In his role at the University of Utah,Dr. Ballester collaborates teaching psychiatry residents in their first year with a bi-annual class about pathophysiology of addiction. He is also an active member of the Addiction Medicine and Addiction Psychiatry Fellowships and teaches the following courses: Introduction to CBT in Addiction, Outpatient Protocols for the Management of Alcohol and Opioid Use Disorders, and has four classes about Neuroscience in Addiction. Finally, he will disseminate the Alcohol Medical Scholars Program list of lectures and approach to How to Tell Your Story in lectures/papers/grant applications, etc as part of his roles as a professor and as secretary of the Utah Chapter of the American Society of Addiction Medicine.

Adina Fischer, First Year Scholar from Stanford University presented her efforts to enhance alcohol and drug education at her university. Dr. Fischer will be presenting two invited talks on the effects of adolescent marijuana use at the 66th American Association of Child and Adolescent Psychiatry (AACAP) annual meeting in October 2019. She will also continue to present a talk on what is known regarding neurobiological and psychiatric effects of marijuana use in adolescence and young adulthood to (1) resident physicians and third year medical students rotating on the inpatient units at Stanford Hospital, and (2) clinicians working with college students at the Stanford Counseling and Psychological Services Center (CAPS). Dr. Fischer is also co-chair of the Neuroscience Curriculum Committee for the Stanford Psychiatry Residency, where she is helping to bring relevant research topics and speakers pertaining to educating first and second year psychiatry residents as well as 3rd and 4th year medical students on their clinical rotations in psychiatry. She will also continue to help lead an initiative to add mandatory Suboxone training and certification for all psychiatry residents, as a deliverable means of enhancing drug and alcohol education. Adina will be presenting a lecture on cannabis use and psychosis at a Caminar Seminar for patients and patient families as well as a lecture on the relationship between cannabis and mood disorders at the annual Stanford Mood Disorders Education Day. Finally, Dr Fischer will look for other opportunities to present on marijuana and other substance use disorders both at Stanford University and at national meetings, including at conferences and as part of invited talks.

Alan Francis, first year scholar from Harvard Medical School, presented his plans to improve drug and alcohol education at his institution. Alan teaches two courses at the Harvard Extension School: 1. Addiction Neuroscience – Substance Use and the Brain and 2. Neuroimaging in Addictive disorders. He plans to serve on the Massachusetts General Hospitals’ Executive Committee on Curriculum and Evaluation. Through these roles, he plans to conduct a thorough survey of substance use education throughout the curriculum. He plans to improve the quality and number of substance use lectures in the medical school’s core curriculum, as well as implement hands-on naltrexone/suboxone training for the students. Dr Francis has plans to lecture to the addiction fellows on several topics related to substance use this coming December and will use existing AMSP presentations when appropriate. In his clinical role as Instructor in Psychiatry he plans to continue his participation in the substance use subcommittee and improve clinical guidelines related to substance use. In addition, Alan will continue to give a monthly presentation on substance use disorders to the Mind Brain and Behavior course students at Harvard University.

Alejandro Meruelo, First Year Scholar from University of California San Diego presented his efforts to enhance alcohol and drug education at his university. Dr. Meruelo plans to become involved in teaching of Psychiatry residents and medical students on alcohol-related topics at the University of California San Diego, present on his research on the interrelationship of alcohol and depression at the annual American College of Neuropsychopharmacology and Research Society on Alcoholism conferences, and to provide community outreach on alcohol use and risk-taking behaviors.

Neeral Sheth, first year scholar from Rush University Medical Center, presented his plans to improve drug and alcohol education at his institution. Neeral serves on the medical college’s Executive Committee on Curriculum and Evaluation and is the Psychiatry Director for pre-clerkship medical education. Through these roles, he plans to conduct a thorough survey of substance use education throughout the curriculum. He plans to improve the quality and number of substance use lectures in the medical school’s core curriculum, as well as implement hands-on naloxone training for the students. Dr Seth has planns to lecture to the psychiatry residents and addiction fellows on several topics related to substance use this coming December and will use existing AMSP presentations when appropriate. In his clinical role as Associate Medical Director of Road Home Program, he plans to continue his participation in the substance use subcommittee and improve clinical guidelines related to substance use. In addition, Neeral will continue to give a monthly presentation on substance use disorders to third year medical students at the Chicago College of Osteopathic Medicine.

Rachel Gunn, first year scholar from Brown University, next reviewed her plans for enhancing alcohol and drug education. Rachel was recently invited to give a day of guest lectures to undergraduate students at the University of St Joseph in Hartford, CT, for which she will adapt and deliver lectures from the AMSP website on topics related to addiction. She will also develop and deliver an AMSP style lecture on the co-use of alcohol and cannabis to postdoctoral fellows in the NIH-funded T32 fellowship in the Center for Alcohol and Addiction Studies (CAAS) as part of their Etiology of Substance Use Disorders course. She also plans to collaborate with senior scholar Elizabeth Aston in delivering the AMSP slides on how to give a lecture to the monthly postdoctoral writing group at CAAS. Dr. Gunn will also modify her course and existing lectures for the Brown University pre-college program (Introduction to Psychology) according to AMSP principles and guidelines. She will also present her research on co-use of alcohol and cannabis at two annual conferences: The Research Society on Alcoholism and Collaborative Perspectives on Addiction. Both presentations will offer the opportunity to integrate AMSP principles.

Dates for the next meeting as well as potential sites for the next AMSP get together were next discussed. The optimal months that are approximately six months from the current get-together are April and May 2020. Among them the optimal dates appeared to be either beginning Wednesday, May 6 and ending on Saturday, May 9 or beginning on May 13 and ending on May 16. The probable date unless someone develops a conflict will be beginning May 6 date. Potential locations will be at least tentatively limited to Laguna, California and possibly San Francisco.

A second very important component of the meeting, the group developed guidelines for when projects at various stages are due.

1. Monday, October 14 is the due date for sending Marc the report of activities and the first rough draft of the project.

2. It is expected that all scholars will spend about 1.5 hours per week and submit their next draft to their senior scholar with a cc to Marc every two weeks.

3. On this process outline with all of the components and the reference list should be completed by Friday, March 6, 2020.

4. The slides (which should not be organized until the outline is complete) would be due in a finished form by Friday, April 3.

5. This final step would allow for a period of revision and updating by this senior scholar for delivery at the next AMSP meeting which will begin on May 6, 2020.

Equally important were guidelines regarding how the projects should progress. Up until March 6 the major work will be done by scholars and their second year mentors and for those working with Jennifer Merrill and March Schuckit. If the process is finished before March 6, that is wonderful – the sooner it is done the better. The period from March 6 to April 3 will be used for Marc to put final touches on all six outlines and for first year scholars to return to their second year mentors for development of slides. The slides, therefore, along with the final, final outline, will be turned over to Marc by April 3.

The last half hour of the Saturday morning meeting was used to review several topics. These included a discussion by Marc about the steps he takes in developing papers, including usually working on sections in the order of: tables and figures, writing up results, the introduction, the discussion, and methods. An additional topic included a discussion of how DSM-IV and DSM-5 were developed. This included a broad discussion of how decisions were made and compromises were required for the final format at no diagnostic criterion approach, especially one for clinicians, is perfect.

The group adjourned at 11:30am as people made their way to enjoy the sunshine in San Diego with individuals leaving to return home either late Saturday night or on Sunday.

Layout and design by Brian Klima