Meeting #5

Kapalua Bay, Maui, Hawaii

October 17 - 20, 2001

Present: Marc A. Schuckit, M.D., Susan Tapert, Ph.D., Marianne Guschwan, M.D., Donna Londino, M.D., Jean-Joel Villier, M.D., Christopher Welsh, M.D., Lauren Williams, M.D., Evaristo Akerele, M.D., Woody Levy, M.D., Steven Madonick, M.D., Laura Pieri, M.D., Margaret Rukstalis, M.D., and Marcy Gregg

I. Wednesday evening, October 17th

The meeting began with the arrival of junior and senior scholars. The entire group assembled at 6:50 pm with introductions, a brief review of the tentative schedule, and dinner. The meeting room for Thursday, October 18th was established, with plans for all to reassemble at 8:00 a.m.

II. Thursday, October 18th

The meeting began at 8:00 a.m. with a review of the Alcohol Medical Scholars Program history and goals. Junior and senior scholars were given the charge of finding appropriate pairs for the development of new lectures by junior scholars, the schedule for the three days was reviewed, and general issues were discussed.

The meeting then progressed to a general discussion of requests from scholars. Based on these comments, an agreement was made that issues regarding academic promotion would be covered as part of the meeting, career development would be discussed, issues related to the need to establish an alumnus group were highlighted, the importance of making all efforts possible to continue funding of AMSP in upcoming years was raised by the scholars, and a need to review optimum teaching approaches to medical students was proposed.

The next item on the agenda was a demonstration by Marc Schuckit of how to give a lecture and develop slides. The scholars were told that each of the senior scholars would be presenting their lectures from their first year to demonstrate issues related to lecture development and delivery.

Senior scholar, Donna Londino next delivered her report of developments at the Medical College of Georgia. Donna reminded the participants that she entered AMSP with a strong interest in education but little background in substance use disorders, and has worked this past year to enhance her focus on alcohol and drug-related issues. During the prior six months Donna assumed the role of Director of the General Psychiatric Course for first-year medical students. In so doing, she has incorporated four lectures that relate to substance use disorders and associated topics such as domestic violence. The ratings from the medical students have been excellent and have resulted in a planned continuation of the course at a time when the medical school had been considering decreasing formal lectures in psychiatry. In addition, Donna received approval for a Phase I ten-week elective for medical students; has participated with the DOC program, fostering community involvement and monitoring presentations; she has established a third and fourth year medical student clinical rotation in adolescent psychiatry that emphasizes DSM-IV criteria in substance-related problems; she has expanded her work with residents and fellows by continuing a movie club and delegating several residents to substance use disorders training; and she has delivered numerous substance use disorders lectures including one on the fetal alcohol syndrome developed for AMSP by Lauren Williams. Donna’s goal for the upcoming year is to meet with the Dean’s office to review the need to expand substance use disorder education; expand the information and interest in a AIDS; and expand efforts on treating troubled youth who have substance use disorders through expansion of a two-week intensive outpatient program, while continuing to work with research projects at her university.

Susan Tapert, Marc’s AMSP assistant from UCSD, then demonstrated a lecture on Harm Reduction. The discussion focused on the pros and cons of various kinds of slides, as well as comments on the high level of overall effectiveness of the lecture itself.

A working lunch was used to discuss issues related to academic advancement, as well as the development of articles for journals and the review process.

Lauren Williams next presented an overview of her recent accomplishments at the University of Miami. The highlight was a recent 9:00 a.m. to 2:00 p.m. Addiction Day Seminar attended by all chairs of departments and capped off with a panel of chairs at the end of the day. This was the first year this approach had been used, and Lauren used this as a direct outgrowth of her AMSP experience. Another positive new development was the change that occurred in the psychiatric rotation for year-three medical students where one-half of the students visit the substance use disorders unit on a rotation of all day for four weeks. At the same time, Lauren continues her outreach to both DOC and a related AMSP program whereby medical students reach out to the community. Lauren has faced some challenges regarding a move by the medical school to delete a year-one lecture on substance use disorders and replace it by small groups, a process that was felt by those present to be a step backwards and about which much discussion ensued. On the psychiatry resident level Lauren now delivers a variety of lectures to both PGY-1 and 2, and residents; and on the fellowship level she has now developed a lecture from her AMSP experience entitled “How to Give a Lecture.” Finally, Lauren is busy working with the Physicians Recovery Network at her university regarding the recognition and treatment of substance-impaired physicians.

Marc then discussed the process of submitting a paper to a journal and explained the review process. Marianne discussed the possibility of adding a lecture on motivational interviewing to the web site.

The day’s proceedings ended with Marc Schuckit demonstrating how a 45-minute lecture can be collapsed to a 15-minute presentation through delivering a lecture on “The Genetics of Alcoholism.”

III. Friday, October 19th

The group assembled at 8:00 a.m. and began with a demonstration by Jean-Joel Villier of his lecture on “Substance Use Disorders in African Americans.” This was a very effective lecture that has progressed impressively based on feedback received last year from the AMSP group.

Marc Schuckit next reviewed the outline form which will be used by all junior scholars as they develop their lectures. Scholars were encouraged to visit the AMSP web site to gather more information and to observe templates of how the outline can be effectively used.

The second AMSP assistant, Marianne Guschwan, next reviewed her accomplishments at New York University. Marianne has moved on from the senior scholar position to a role in helping to teach in AMSP overall, and thus, her report reflects her long-term commitment. Among her accomplishments are the expansion of a medical student rotation on the detoxification unit which she had originally developed; expansion of work as Director of the Substance Abuse Referral Team which reaches out to the entire Bellevue community; the assumption of the role of Associate Director of Substance Use Disorders Treatment at Bellevue; Marianne’s assumption of the role as Chair of the Substance Use Disorders Treatment Committee for the American Psychiatric Association; outreach to the employee health service at Bellevue regarding substance use disorders; the implementation of resident luncheons to review cases related to substance use disorders; the writing of a substance use disorders chapter in the manual for medical students; the upcoming presentation of a workshop on teaching about substance use disorders at the American Psychiatric Association meeting which is to be carried out jointly with Susan Tapert and Chris Welsh from AMSP; the recent acceptance of a poster on the same topic for the annual meeting of the American Association of Addiction Psychiatrists; a continuation of the program teaching fellows how to teach and then implementing their new skills through their interactions with medical students; staff education at her medical center regarding motivational interviewing for substance use disordered patients; the development of grand rounds based on AMSP information at several hospitals in New York City; outreach to a group of primary care physicians; and continuing to work regarding substance use disorders as demonstrated in movies as an elective for residents.

Margaret Rukstalis, a junior scholar from the University of Pennsylvania, presented her preliminary goals for accomplishments during her first year with us. First, she will look into the ACGME requirements regarding substance use disorders for medical students. Second, she hopes to survey the history of substance use disorders education at Penn, and evaluate the current curriculum to see the proportion of students’ time related to alcohol and drug issues across the four years. Third, she will focus on ways to enhance alcohol and drug education during the third and fourth year clinical clerkships. Fourth, she hopes to look into the possibility of adding a visit to AA to the third-year clerkship. Finally, Margaret will consider the possibility of developing an elective on substance use disorders at Penn based on the program developed for AMSP and integrated at several of the participating medical schools. She will look into ways to encourage medical students to do honors papers on substance use disorders.

Susan Tapert then presented information on PowerPoint slide presentations with an emphasis on the use of animation.

Chris Welsh, a senior scholar, next delivered his lecture on “Substance Use Disorders Among Physicians.” This was another example of an excellent lecture, and Chris demonstrated an ability to modify the content with a restricted time requirement.

Lauren Williams, a senior scholar, then delivered a fine lecture on the Fetal Alcohol Syndrome. Both the content and style were well received and several scholars said they hoped to use this lecture at their school.

A working lunch then ensued where potential dates and venues for the next AMSP meeting were discussed. Scholars had the assignment of going back to their schedules to see which of the dates might work. The discussion next turned to issues related to optimum time management and decision-making in career development.

Chris Welsh then reviewed his accomplishments at the University of Maryland. We were all pleased to hear that Chris was the recipient of the Virginia Huffer Award for Outstanding Medical Student Teaching. This is a wonderful accomplishment and he deserves great kudos. This recent time frame has also witnessed a marked expansion of Chris’s efforts in education and he recently joined the Undergraduate Medical Education Committee for the American Academy of Addiction Psychiatry, chairing a subcommittee on medical school education. Chris recently joined the Interprofessional Drug and Alcohol Program at University of Maryland, a group that encourages education about substance use disorders across disciplines. He has also instituted a six-week block rotation on substance use disorders for psychiatric residents; he works with the second-year psychiatric residents regarding substance use disorders-related consultation; and he has been reaching out to child psychiatry, psychology interns, social workers, and ICU nurses regarding education on substance use disorders; he has finalized plans for setting up a film series devoted to substance use disorders (this will be implemented in the upcoming months); he has been designated as a mentor in psychiatry regarding substance use disorders issues; he is working as a member of a group helping to plan the first-year medical school course on addictions; he is working with the Accelerated Program in Psychiatry for 12 first-year medical students where he serves as a leader of a weekly seminar; through his efforts the first-year introduction to clinical practice now has sites that deal with substance use disorders; he is increasing the amount of education regarding substance use disorders for second-year medical students; he marshals a third-year course on an addictions consultation service where approximately a third of the medical students serve; Chris has delivered lectures as part of a series for the state psychiatric society; he helps present information for the Prite Review focusing on issues related to substance use disorders; Chris reaches out to non-psychiatric physicians (e.g., internal medicine) relating to substance use disorders; and he works with the Impaired Physicians Committee.

Laura Pieri next outlined her tentative goals as a first-year scholar at Temple University. She hopes to expand the information she is able to offer first-year medical students on alcohol and drugs as part of the Standardized Family Exercise; Laura plans to enhance the information on substance use disorders as part of the two lectures she delivers to second-year medical students; she will be assuming the directorship of the substance use disorders lecture given as part of the third-year medical student clerkship; she hopes to create an elective at a therapeutic community for substance use disordered individuals (Gaudenzia); Laura hopes to expand her education for PGY-2 and 3 psychiatric residents relating to substance use disorders; she will continue on the Impaired Physicians Committee; and she hopes to implement some of the AMSP lectures as part of her medical students’ and residents’ education.

Our very busy day ended with Woody Levy, a first-year scholar from the University of South Florida, as he described potential goals. These include his joining the Medical Student Education Committee; efforts to catalog what is being done in substance use disorders at his university; expanding a weekly case presentation for medical students to enhance information on substance use disorders; consider the development of an AMSP-type elective for medical students; Woody plans to develop a course for medical students or psychiatric residents on how to give lectures; he is considering the possibility of a journal club focusing on substance use disorders issues; he will look into the possibility of developing a film series on substance-related issues; he hopes to work with the Education Committee for the Psychiatric Residency to ensure that maximum amounts of information on substance-related issues are offered; he is hoping to work with a rotation in substance use disorders for psychiatric residents; he will expand his efforts on a NIDA-related fellowship program by helping them to expand the number of participating fellows; he hopes to work to establish a two-month, full-time clinical rotation for at least one fellow on an inpatient substance use disorders unit; and he is hoping to expand his outreach to internists and pharmacists with the goal of having them improve their efforts in detoxification of substance use disordered patients.

IV. Saturday, October 20th

The morning began with senior scholar Donna Londino’s demonstration of her lecture on “Substance Use Disorders and the Family.” This was a very effective lecture and generated a discussion of a number of important teaching-related issues.

Susan Tapert next reviewed the web site and the accomplishments at UCSD. To place this in perspective, Susan works closely with Marc Schuckit and has an ongoing AMSP role. She began by telling us that in August of 2001 our web site had 2,492 visits. In September 2001 there were 12,434 hits as well as 736 unique visits (i.e., unique individuals). Susan then broke down the interactions to the lectures visited, with an overall remarkable level of interest demonstrated. The AMSP web site is now linked to the Research Society on Alcoholism, the National Institute of Drug Abuse, the National Alcohol Institute, the American Society of Addiction Medicine, the Alcohol Beverage Medical Research Foundation, and many additional important sites. Susan reminded us that the issues of copyright for our web site (to protect the lectures so that anyone in the world may use them for free) is progressing. In addition, she is working actively with the DOC program at UCSD; has an interaction with San Diego State University regarding a fellowship application in substance use disorders; and continues to head the UCSD alcohol and drug elective for first and second-year medical students.

Jean-Joel Villier, a senior scholar, next presented his report of accomplishments at Howard University. In the past year Jean-Joel has served as director of substance use disorders issues in the Department of Psychiatry at Howard; he has joined the Curriculum Committee for that department; Jean-Joel delivers an introduction to alcohol lecture to the first-year students, as well as lectures to second, third and fourth-year students – often using AMSP material; he has developed a six-week rotation in psychiatry with an emphasis on substance use disorders for third-year medical students; Jean-Joel delivers lectures on diagnostic issues in substance use disorders to family practice physicians, psychologists, and physicians assistants; he is working with the DOC program; Dr. Villier has developed a lecture at Howard regarding how to give lectures and hopes to implement the use of the AMSP videotape on that topic; he has presented grand rounds to psychiatry, family practice, and internal medicine; Jean-Joel has participated in the alcohol screening day at his university; he uses the AMSP web site for his journal club; and he is expanding his outreach to residents and fellows regarding substance use disorders research. In the upcoming year he is hoping to make participation in a session on how to give a lecture mandatory for psychiatric residents; Jean-Joel hopes to develop an outpatient rotation for third-year residents in psychiatry; he hopes to develop a video clip session on substance use disorders for psychiatric residents; he hopes to expand information on substance use disorders at the open house at his university; he hopes to utilize the AMSP lecture on the fetal alcohol syndrome in an outreach to OB-Gyn physicians; he hopes to implement the AMSP lecture on the pharmacology of alcohol in his outreach to the nursing school; and he is planning to continue expansion of his efforts to medical students in general.

Evaristo Akerele, a first-year scholar from Columbia University, reviewed his tentative goals for the upcoming year. These will include efforts to catalog the amount of time medical students and residents are spending on substance use disorders-related issues; begin a lecture for fellows on giving a lecture; to implement substance use disorders-related issues for the journal club; to increase the education regarding substance use disorders for residents by expanding their participation in the substance use disorders unit; develop a clinical case conference on substance use disorders for fellows; work to increase the amount of education on substance use disorders in the medical school; develop an elective; reach out to psychologists and internists; expand information about AMSP to CPDD; and expand his interest in substance use disorders and schizophrenia.

At this point, Marc and Marcy reminded the scholars of two PBS series, one on the brain slated for February/March 2002 and the Bill Moyers’ “Hijacked Brain” from about a year ago. The idea of adding movies, TV programs such as those and relevant CNN Presents Sunday programs, and books to the web site was enthusiastically received. Copies of Marc’s taped lecture on how to give a lecture will be sent to the new scholars.

Marianne Guschwan then delivered her lecture on “Spirituality in Substance Abuse/Dependence Treatment.” She demonstrated the ability to decrease a lecture from 45 minutes to 30 minutes, and presented the material very successfully. This demonstration was also used to discuss the optimal approach to handling questions.

The next report came from Steve Madonick who presented his preliminary thoughts on plans for his first AMSP year at Yale. The first goal will be to approach educators throughout the medical school to catalog the current status of education on substance use disorders. This includes the need to gather information on medical students, residents, and fellows. Second, Steve hopes to work with the fellowship on substance use disorders which is currently located at the VA hospital, looking for ways to increase his impact. Third, he will make an effort to try to determine the pattern of types of teaching currently being carried out on substance use disorders – focusing primarily on the balance between practical experience and research-based information. Steve will also look into the possibility of developing a medical school elective on substance use disorders, and the possible usefulness of the information on how to give a lecture as it relates to residents and fellows.

Approaching the final stages of the meeting, the first-year scholars were asked to select topics for delivery of lectures at the next meeting (April 2002). Margaret Rukstalis will give a lecture on Combined Alcohol and Nicotine Dependence; Evaristo Akerele will give a lecture on Nonpharmacological Approaches to the Treatment of Comorbid Substance Use Disorders and Schizophrenia; Woody Levy will deliver a lecture on Substance Use Disorders Among Athletes; will speak on Substance Use Disorders Among Older Men and Women; Laura Pieri will focus on Therapeutic Communities and Substance Use Disorders.

To help with this preparation Marc reviewed two relevant topics, the do’s and don’ts of using the term abuse, and more detail about how to review literature in preparing for a lecture.

The first and second-year scholars also selected the pairs in which they will work. These include Laura working with Marianne; Lauren working with Woody; Jean-Joel helping Steve; Susan working with Evaristo; Chris helping Margaret; and Donna helping Marc in an overview of all of the topics overall and in generating a movie list to add to the web site.

Regarding future contact, the next meeting of the AMSP group will occur in Del Mar, California (about 20 miles north of the San Diego airport) at L’Auberge Del Mar, convening at 6:00 p.m. on Wednesday, April 24, 2002, and ending at noon on Saturday, April 27th. The next conference call for AMSP scholars will occur on Wednesday, January 16, 2002 at 12 noon, Pacific Standard.

Time (3:00 p.m. Eastern Standard Time). Marcy will be taking steps to reserve the hotel for the April meeting, and will also contact all scholars regarding the specifics for the conference call.

Deadlines were also discussed; November 15, 2001 for sending Marc a rough draft of the lecture and slides, and February 1, 2002 for near-final outline and slide copy for a 45-minute lecture using 15-25 slides.

The scholars raised the issue of the importance of keeping AMSP graduates up to date and in touch with the organization. Therefore, we hope that all possible current and past members of AMSP might get together at RSA. Furthermore, Marcy will be sending minutes of this meeting to all AMSP graduates, as well as active participants.

The final business issue was the request by some members of AMSP that an editorial about our group in a major journal to be certain that as many organizations as possible know about us. Marc volunteered to do the first draft of an editorial to possibly be published by the Journal of Studies on Alcohol and to be signed by all current and past AMSP members who would like to be included. The topic will probably be about how our web site is a resource of lecture outline and slide copy which might be of use to medical school faculty, but ample opportunity will be taken to describe our goals and accomplishments.

The meeting adjourned at noon for a group picture and informal discussions.

Layout and design by Brian Klima