Meeting # 43 - via ZOOM

via ZOOM

May 7 - 8, 2020

Alcohol Medical Scholars ZOOM Meeting May 7 and May 8, 2020

Present during these sessions include second year scholars, Brook Arterberry, Elizabeth Aston, Kathleen Broad, and first year Scholars Alejandro Meruelo, Neeral Sheth, and Alan F. Francis. The meeting was led by Marc Schuckit, Director of the AMSP, as well as with the Assistant Director, Jennifer Merrill.

Reflecting the special circumstance of the COVID-19 emergency, this meeting that had been planned for Laguna, California, to take place across May 6 – May 9, was changed to a ZOOM meeting.

Day 1, May 7, 8:00am-3:00pm, PDT

The meeting began with an update of the current situation among scholars. The group took the opportunity to talk about the stresses placed on all of us by the COVID-19 emergency, how we are coping with those stresses, and whether any members had suggestions about how further adaptations can be made.

Marc next discussed the structure of the meeting. Times were set for the second year scholars to present their lectures. This included the 25-minute new lecture by Brooke Arterberry. Brook will modify her original 45-minute lecture to medical and graduate students to a 25-minute presentation aimed at entering freshman at Iowa State University. Also, Elizabeth Aston will present her full original first year lecture modified by an emphasis on examples of the major points Marc will make in his review of “How to Tell Your Story” presentation. Times were also established for first and second year scholars to review their recent accomplishments regarding improving alcohol and drug education at their universities.

The remainder of the morning focused on Marc Schuckit presenting the lecture on “How to Tell Your Story”. In this instance, the material was used as a seminar where participants had an opportunity to make suggestions about how the Marc’s original presentation at the fall, 2019 meeting might have been improved. Discussion also expanded to the role of second year scholars.

The next item on the agenda was a time for scholars on the east coast to take their lunch break and for those in the Midwest and West coast to grab a quick snack. After a brief break, the group discussed career development issues, especially now in the time of coronavirus. Alan Francis from the Harvard Service at MGH, discussed some challenges that junior scholars often face when their current position, (e.g. a junior faculty position) is about to end. The discussion covered how one decides whether to stay at the current university or go elsewhere; how to select among possible positions (keeping a major emphasis on what it is that the individual enjoys doing most and those tasks that the new applicant for a job might find less desirable); determining which potential positions are unacceptable based on the

individuals preference; and how to determine the balance between the amounts of time allocated to clinical work, administration, and (if an individual is so inclined) teaching and research. Alejandro Meruelo discussed some of the challenges he is facing regarding clinical care through telemedicine, as well as the assets and liabilities of that approach. The discussion also ranged into whether this situation with the need for current telemedicine will continue even after the world has readjusted to COVID-19. Brook Arterberry, raised the issue of the challenges we all face in taking our traditionally personally delivered lecture and placing it into a ZOOM or video tape format. Often, that change comes with little warning and time to prepare (e.g., a month or less). Some comments included the absence of interpersonal relationships between professors and students that can be an important part of education and mentoring. Suggestions for such situations included looking to find ways for more one-on-one ZOOM sessions with students, sending a syllabus and slides to students before any video or lecture is shown, and the potential of sharing memory sticks with more extensive information to be given to students.

After lunch, Marc returned to some of the major issues related to “How to Tell Your Story”. He also reviewed specific issues related to the development of posters.

Elizabeth Aston, second year scholar from Brown University, next presented her full lecture (from her first year) on medical use of cannabis. The lecture was well organized, Elizabeth delivered the material with enthusiasm, she demonstrated excellent transitions between sections, and carefully defined almost all of the jargon, especially when a shortened phrase was required for brevity of slides. Also discussed were other aspects of the lecture including the benefits of limiting the lecture section on potential future treatments to fewer examples to avoid the problem that someone in the audience might inaccurately assume that that untested mode of treatment was being endorsed as ready for prime-time.

Alejandro Meruelo, first year scholar, presented his adaptation an introduction to the treatment of alcohol use disorders, based on the original lecture by Kathleen Broad. Alejandro demonstrated excellent knowledge of his topic, and had worked hard to make changes as he progressed through drafts. Possible modifications to make before the lecture was to be loaded on the AMSP included: presenting the material verbally in the same order in which the material is presented on the slide to make the points easier for the audience to follow; limiting the “abuse” unless referring to a DSM diagnosis; and a suggestion to make certain the audience does not have the erroneous impression that the only people who develop alcohol use disorders are those who live on the streets. With these minor issues and a few comments about spacing of material on slides, the lecture was quite effective.

Kathleen Broad, second year scholar, next discussed her accomplishments at the University of Western Ontario. Dr Broad is a consultant psychiatrist for clinics in

Pangnirtung and Qikiqtarjuaq, Baffin Island, Nunavut Canada with the U of Toronto NPOP-Center for Addictions and Mental Health (CAMH) program where 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 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. In addition, Kathleen is the Medical Program Director of the Department of Psychiatry at Huron Perth Healthcare Alliance. Through these activities she recently presented "Pharmacotherapy for Alcohol Use Disorders " at HPHA Grand Rounds. The recent COVID-19 Pandemic has presented new clinical and administrative challenges, and she has been working closely with interdisciplinary colleagues to ensure equitable access to mental health services for individuals with mental health and addictions in the region, while providing virtual care.

Elizabeth Aston, second year scholar, next presented her AMSP accomplishments. Dr. Aston continued her membership in 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. She plans to give her AMSP lecture on Medical Marijuana for the Providence Veterans Association Medical Center in a virtual format as part of their Grand Rounds lecture series in May 2020. A variety of healthcare professionals will attend the talk virtually, including physicians, psychologists, psychiatrists, and medical students. Dr Aston is also the Co-Chair for the Collaborative Perspectives on Addiction Conference, a meeting scheduled for April 2020 that was cancelled due to the COVID-19 pandemic and hopes to hold the meeting in Portland in 2021. Elizabeth contributed to a podcast on medical and recreational use of marijuana and commented specifically on studies pertaining to use among individuals with HIV/AIDS. The podcast was disseminated on social media and will be used as a resource for medical students and medical health professionals.

Next, second year scholar, Brook Arterberry, next presented her recent accomplishments that increased alcohol and drug education at Iowa State University. Brooke continues to be the clinical supervisor for the BASICS program (Brief Motivational Intervention for College Students) that is designed to reduce heavy drinking. Additionally, she is co-facilitating the implementation of a collegiate recovery program for students to attend that are in recovery at Iowa State University. Dr. Arterberry also has provided education regarding alcohol and other drugs to Counseling Psychology graduate students and university staff working in Student Wellness and Student Conduct. Brooke will deliver the “How to Tell Your Story” lecture to Psychology graduate students every other year. Although postponed due to COVID-19, Brooke

plans to deliver a lecture about drug use and prevention with adolescents and young adults during grand rounds at Mary Greeley Medical Center in Ames, Iowa.

The first day of the meeting ended with a general discussion of how well things worked within ZOOM, as well as suggestions of any materials that we might present differently on the second day of the ZOOM meeting.

Day 2, May 8, 8:00am-3:00pm PDT

The day began with Brooke Aterberry’s presentation of a modified lecture redesigned with the goal of decreasing heavy drinking in entering college students. This was an excellent lecture, the number of slides was appropriate, her message was clear, the logic was perfect, and Brooke’s ability to adjust the message to the audience was a good example for everyone regarding their own future lectures.

Next, Rachel Gunn, first year scholar, presented her lecture on the co-use of alcohol and cannabis. This lecture was highly informative, and the slides were clear. In an exercise to discuss any possible changes that might emphasize the material and the group had an opportunity to discuss things that might be done a bit differently in some of the slides. This included rounding off numbers to make it easier for the audience to remember, animating a few additional slides, working to enhance the font level to at least 28, decrease the number of words in a slide to a minimum, and cut down to fewer bits of information when possible. In an exercise related to other scholars as well, the group discussed how some slides and some material might not be essential by deleting some information that was not directly relevant to Rachel’s 4 or 5 major points listed on the take home message in her last slide.

At approximately 10:30am PDT (1:30pm EDT), a short break was taken for participants to get snacks and for those on the east coast to prepare a quick lunch. The remainder of that hour was then used to discuss several academic issues including: how to balance home and work; how to overcome the inefficiency that is inherent in working from home in part by adjusting goals; issues related to promotion; and discussions of how to create optimal grant applications. This last main topic was gone over in detail using examples of how to pick a topic for the grant application, how to adjust to whomever the reviewers are likely to be, how long before submission it is advisable to begin working on a grant, and how to determine if a research review committee is telling you that there is little hope that this could be funded even with major changes.

Following lunch, Neeral Sheth, first year scholar, next presented his lecture on drug testing. This was delivered within the appropriate period of time, the lecture was extremely well organized (very important for a complex topic such as this), the material

was so complete as to be useful as a general reference source for pros and cons of different approaches to drug testing, and Neeral worked very hard to avoid jargon. Dr. Seth was asked to think through how the lecture might remain effective but be a bit shorter. As a good exercise for all scholars, the answer, of course, depended on focusing on the limited number of major points the lecture needed to cover. For Dr Seth’s lecture, offering more than 1 or 2 examples of a point could cause frustration among students and some confusion about what they are supposed to remember. Specific slides that might be deleted were discussed, and Neeral will consider these as he develops his final version of the slides and outline to be placed on to the AMSP website. It is to be noted that it is much easier to cut back on a longer lecture as Neeral will be doing here compared the amount of work to expand a lecture where important material had been left out.

Alan Francis, first year scholar, then presented his lecture on nicotine dependence and its treatment. Alan had worked closely with Marc on the development of his slides and outline and was able to overcome many challenges, especially regarding the need to consider the next stage of his career, as well as a very serious illness in a close relative. This was an effective lecture, and it was a modification of a prior lecture that Dr. Francis had used regarding nicotine dependence. There were many steps in the development of the slides, of the flow of logic, and staying true to the need to focus on a limited number of major points, Alan was able to incorporate improvements to his prior lectures.

The next series of items related to reports by first year scholars regarding what it is they were able to accomplish in relationship to what was learned from their participation in AMSP.

This step began with Rachel Gunn, first year scholar from Brown University who reported that she gave a series of guest lectures (adapted from AMSP lectures) in the Fall semester to undergraduate nursing students at the University of St Joseph in Hartford, CT. Topics included Diagnosis and Treatment of Alcohol Use Disorder, College Drinking, and Motivational Interviewing. She was asked to return to the University of St. Joseph for a zoom-based lecture on cannabis use for an Addiction course, which she delivered in the Fall. She was also able to mentor a master’s in public health student on a thesis examining etiology of cannabis use. This mentorship involved teaching AMSP skills, including outlining and poster presentation. This past summer, Dr. Gunn also taught a course for the Brown University pre-college program (Introduction to Psychology, including topics on substance use and misuse), where she was able to deliver daily lectures using AMSP principles and guidelines. This course will be repeated for the upcoming summer. Unfortunately, some conference meetings were cancelled because of COVID19, in which Dr. Gunn had accepted symposia, including the Research Society on Alcoholism and Collaborative Perspectives on Addiction. She plans to deliver both research talks at a later date once conference meetings resume.

Finally, Dr. Gunn plans to deliver the AMSP lecture she developed 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 in the coming year.

In his report from RUSH University Medical Center of Chicago, Neeral Sheth, first year scholar, presented his efforts to improve drug and alcohol education at his university. Through his role on the medical college's Executive Committee on Curriculum and Evaluation, as well as his position as the Psychiatry Director for pre-clerkship medical education, Dr. Sheth has been able to complete a thorough evaluation of substance use education throughout the medical curriculum. After this survey, the first year didactic curriculum on substance use has been expanded to include several topics not previously included, such as stigma and language of addiction, neurobiology of addiction, and special populations in addiction (with a focus on women, older populations, youth, and physicians). Dr. Sheth and colleagues have also incorporated naloxone training into the second-year medical students' Basic Life Support training. In addition, as a result of the coronavirus pandemic, there came a need for virtual curriculum development and Dr. Sheth, along with the Addiction Medicine Fellow at Rush University, put together a 2-week virtual Addiction Medicine elective for fourth year medical students. This online elective includes over 40 hours of addiction medicine content and utilizes several of the AMSP lectures. Also, the MAT Waiver training which certifies physicians to prescribe life-saving treatment for opioid use disorder has been incorporated into this elective and will be offered to Rush medical students for the first time. Finally, Dr. Sheth continues to be a mentor for students interested in both psychiatry and medical education, the advisor for the Psychiatry Student Interest Group and has been able to utilize AMSP philosophies to advise students interested in medical education on how to teach. He continues to lecture psychiatry residents and addiction medicine fellows during their addiction medicine lecture series, and recently presented his AMSP lecture on Lab Testing in Substance Use to trainees. Through his role as Associate Medical Director of Road Home Program, Dr. Sheth and colleagues are working to expand virtual substance use treatment for U.S. veterans in the era of the coronavirus pandemic. He also continues to teach virtually on substance use disorder at Chicago College of Osteopathic Medicine.

Alejandro Meruelo, first year scholar from UCSD, next reviewed his accomplishments related to what he has learned in the Alcohol Medical Scholars Program (AMSP). Alejandro has been providing lectures to psychiatry residents at UCSD covering the treatment of alcohol and other substance use disorders (e.g. motivational interviewing based on the outline and adapted slides from the AMSP website), in addition to psychoeducation in his clinical role as a psychiatrist to patients

suffering from alcohol and other substance use disorders during the past year. He has provided mentoring to medical students (e.g., MSTP students) for whom he has shared outlining and presentation skills from the AMSP. His recent research focused on investigating the interrelationship of adolescent alcohol use and depression was accepted for presentation at the Research Society for Alcoholism, but the conference was cancelled as a result of the COVID-19 pandemic. He joined the Research Society for Alcoholism as a member this year so that he can further his involvement in the teaching and mentoring of medical students, as well as to further develop his career as a researcher focused on studying the effects of alcohol. He hopes to continue teaching to Psychiatry residents, to become involved in teaching medical students through the VA, as well as to become involved in outreach for the community by providing teaching about alcohol and drug use in local San Diego high schools.

Alan Francis, from the Harvard Service from Massachusetts General Hospital, first year scholar, then presented his efforts to improve drug and alcohol education at his institution. Alan teaches two courses at the Harvard Extension/ summer School: 1. Addiction Neuroscience – Substance Use and the Brain and 2. Neuroimaging in Neuropsychiatric disorders. He also has an online course on Addiction Neuroscience at the ALM (Master of Liberal Arts) program at Harvard University that consists of lectures several topics related to substance use this coming summer and will use existing AMSP presentations when appropriate. Dr Francis will be a guest speaker at the 2020 Teenage Brain conference in Szeged, Hungary. 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 an online monthly presentation on substance use disorders to the Mind Brain and Behavior course students at Harvard University. He plans to serve on the Massachusetts General Hospitals’ Executive Committee on Curriculum and Evaluation where he plans to conduct a thorough survey of substance use education throughout the curriculum with the goal of improving the quality and number of substance use lectures in the medical school’s core curriculum, including hands-on naltrexone/suboxone training for the students.

The meeting then turned toward a series of remining important issues. This included, first, the fact that funding for the next group of scholars (beginning in the fall of 2020) has not been clearly established, but some finances will be found in order to work with at least four new scholars. Second, the potential of a zoom meeting for the fall for the first year scholars going on to the second year as well as for the new first year scholars was discussed, with scholars clearly preferring in-person meetings and Marc will do the best he can to work toward that. Third, the group next offered congratulations and thanks to the second year scholars who are going to be moving on; they were a pleasure to work with. Finally, we all expressed gratitude toward MaryAnn Klima for helping to arrange this meeting, especially under the stressful circumstance related to the COVID-19.

The meeting adjourned on Friday, May 8, at 3:00pm.

Layout and design by Brian Klima