Minutes of the AMSP meeting

Maui, Hawaii

Wednesday, October 22 through Saturday, October 25, 2003.

Present at the meeting were Senior Scholars: Christina M. Delos Reyes, M.D., Karen Drexler, M.D., Katherine McQueen, M.D., and Gail L. Rose, Ph.D.

Junior Scholars: Sarah W. Book, M.D., Andrea F. DiMartini, M.D., Marian Fireman, M.D., and Joseph T. Sakai, M.D., along with Wendol Williams, M.D. from NIAAA

The meeting was chaired by Marc Schuckit, M.D. with the assistance of Marianne Guschwan, M.D. and Marcy Gregg.

I. The initial get together Wednesday, October 22^nd.

The initial get together occurred in the lobby of the Kapalua Bay Resort with an introduction of all those present and a brief overview of the three-day agenda. Discussions continued over dinner at the Sansei Restaurant.

II. Session 2: 8 a.m. - 2:30 p.m. (including working breakfast and lunch) on Thursday, October 23^rd

The morning began with an update of the general responsibilities expected of first and second-year scholars at this meeting and throughout the year. Marc Schuckit then reviewed the lectures already existing on the website. The group did some brainstorming about possible topics for future lectures and came up with such ideas as alcohol in the emergency department, alcohol use among college students, treating chronic pain, brain imaging to show that alcohol is a brain disease, overview of treatment options (although Chris' lecture covers this to some extent), and resilience and prevention among youth. Gail Rose raised the question of how to appropriately date all lectures (Susan Tapert will be asked to follow through) while also updating lectures currently on the site when appropriate. Another suggestion included the need for a lecture on the optimal use of Endnotes or Procite for the next meeting - a task to be taken on be Karen Drexler from Emory.

The majority of the morning was spent with a highly detailed presentation and discussion of the AMSP lecture on “How to Give a Lecture”. The first-year scholars were reminded of the primary importance of preparation: the optimal approach for a literature review (assuming that 20-30 or more references are likely to be given for each of the lectures developed); the importance of carefully following an outline format (with the suggestion that lectures on the website be studied as examples); the need to use sentence fragments rather than full sentences and (even worse) paragraphs in presenting the outline; the importance of using abuse and dependence as defined in DSM IV; issues related to the appropriate use of the term “binge”; the optimal use of slides that can be understood within 10 or 15 seconds; and so on. Readers of these minutes who want to review more details regarding this lecture are invited to see the lecture itself as posted with lecture notes and slides on the web.

General questions regarding the functioning of AMSP were discussed; in particular, the optimal use of the first-year salary offset (meant to enrich research and free up time from clinics but never to give someone a higher salary or to help the university meet its requirements for support of the scholar). Also, in reaction to some of the issues raised, Sarah Book offered to help write a more detailed letter that can be used to help orient first-year scholars as they prepare for their first meeting. In addition, we will consider the possibility of creating another poster session at the Research Society on Alcoholism, and Sarah offered to take this on as her responsibility.

Karen Drexler next reviewed her accomplishments over the last six months at Emory University. These included: giving a lecture to the Neuroscience and Behavioral Biology undergraduate students on emotion regulation in cocaine dependence; being invited to help organize and speak on SUD treatment at the Advances in Medicine day given to112 third-year medical students; being one of the 10 teachers from all of the Emory University School of Medicine to receive the Emory Medical School Dean's Teaching Award; being promoted from Associate to Assistant Professor; joining the advisory group for the Faculty Staff Assistance Program at Emory Wellhouse; submitting an RO1 grant on the treatment of nicotine dependence with a neuroimaging component to examine neural correlates of craving before and after treatment (it was the skills and clinical perspectives learned in AMSP that made this application possible); and becoming a member of the Board of Directors, Metro Atlanta Recovery Residences. Her ongoing activities include: being Director of the Addiction Psychiatry Residency Training Program; being an Assistant Professor in Emory's school of medicine; being Director of the Substance Abuse Treatment Program in the Atlanta VAMC; participating as a scholar in the Drug Abuse Research Scholars Program in Psychiatry (APA, NIDA-sponsored career development award) studying emotion regulation and emotional decision making in substance dependence; working as Block Director for Substance Use Disorders/Human Behavior course for second-year medical students (12 hours); working as Course Director for Addiction Psychiatry course for Psychiatry Residents and organizing eight hours of lectures to the PGY-1 constituents and four hours of lectures for PGY-2 residents; working with the VA Psychiatry Residents Journal Club two to four hours per year; participating as a co-author in a chapter for the Oxford University Press Textbook on Neuropsychiatry on Craving in Human Subjects; being placed in a position where she herself can hire two junior faculty to help augment the substance use disorders program. In addition, Karen: gives a lecture on Comorbid SUDs for PGY-3 psychiatry residents; has submitted a paper on neural correlates of cocaine craving in women; continues to mentor medical students starting in their first year and now into their third year; mentored two MS-2 students in the summer research program from which one of those resident's project was selected for special recognition; lectures in the Cognitive Behavior Therapy course for PGY-3s at the VAMC outpatient clinic; is a member of the ABPN Addiction Psychiatry Exam Committee, a member of the AAAP PGY-5 Committee, a member of the Atlanta VAMC Research and Development Committee, and a member of the Mental Health Clinical Operations Committee in the VAMC.

Marc Schuckit then reviewed the time frame for the first-year scholars regarding the development of their lectures. These include: the need to have created a first workable draft of the outline to be shared with the senior scholar no later than November 20^th; working with the senior scholars to put together the best possible draft of the lecture outline and have this to Marc no later than December 20^th (this is an extremely important deadline); to then continue to work with Marc going through sequential drafts of the lecture; beginning to develop rough drafts of the slides, and beginning to think of and create the bibliography with a goal of having a final draft of the lecture and workable drafts of the slides to the senior scholar by 01/10/04 and best form to Marc no later than 01/25/04. Final drafts of everything must be completed no later than March 1^st. First-year scholars are encouraged to go back to the website repeatedly to look at how outlines, slides, and references are done.

The discussion next turned to some preliminary thoughts by the first-year scholars on topics that they might use for their lecture, along with some thoughts on how first and second-year scholars might team up. Because (including Wendol Williams) there are five first-year people preparing lectures, but only four second-year scholars, Marianne Guschwan will serve in the additional second-year scholar role.

The lunchtime was used for a discussion of career development issues. These included: promotions; sharing of data with colleagues; time management; working out ways when and how to say “no”, if appropriate, when asked to do things within the department; research versus clinical tracks; the meaning of tenure; and so on.

Gail Rose demonstrated her lecture on mentoring. It was assumed (as the original lecture had been developed) that this was being given to medical students over approximately a forty minute period. Issues related to organization, presentation style, the use of slides, handling of questions, and so on were discussed for this excellent lecture, with an emphasis on issues relevant to junior scholars as they develop their material.

The meeting adjourned around 2:45 p.m. with a review of the next day’s agenda and time frames.

III. The working session of Friday, October 24^th from 7:30 a.m. to 2:30 p.m. (with working breakfast and lunch).

Katie McQueen began the morning with her lecture on alcohol and cocaine. Once again, this excellent lecture was used to discuss issues of slide preparation, organization of lectures, various aspects of delivery; and so on. Some elements of diagnostic instruments and references were discussed.

Christina Delos Reyes from Case Western Reserve next presented an overview of her accomplishments over the prior six months. These include her promotion to assistant professor (for which she cited the help given by AMSP); her taking over the second-year medical student lectures regarding substance use disorders as part of a month long immerson in psychiatry for the second-year students - she is responsible for four hours of material for approximately 150 students; her work as an active editor of a report commissioned by the Ohio Substance Abuse Authority involving a survey of seven Ohio medical schools regarding education on substance use disorders; her lecturing to first year psychiatry residents offering two hours on substance related emergencies; her role as chair of the Physician Wellness program at her medical school; co-authoring a chapter for a text book on dual diagnoses; helping a fourth-year psychiatric resident present at grand rounds - using AMSP lecture guidelines as a model; along with her active clinical responsibilities. Over the next six months she hopes to increase the number of lecture hours to both medical students and psychiatric residents.

Gail Rose of the University of Vermont next presented her accomplishments over the last six months. These have included her active consideration for an important promotion in her research track; doing Brief Intervention (an AMSP lecture) and Behavioral Change workshop lectures to third-year medical students in July, to family practice and primary care internal medicine residents (one each this summer), to primary care clinics in the community (has given two since the last AMSP meeting), and to the upcoming Statewide CME Conference next month; working as a case facilitator in teaching medical students about the genetics of alcoholism and nicotine dependence; preparing and implementing two new senior medical student electives regarding research on substance use disorders and the other on medical education and professional development; developing a paper (jointly with a graduate scholar, Margaret Rukstalis) describing mentoring and AMSP ("Multi-Level Mentoring for Junior Faculty in Academic Medicine: AMSP"); she is also working with Margaret to develop another paper for Academic Medicine dealing with additional teaching and mentoring aspects of AMSP; she is mentoriing the Medical Student Leadership Group for first-year medical students, which has a general professional development curriculum of which includes a problem-based learning approach, group functioning skills (collaboration, decision-making, effective teams, constructive controvery), communication skills, ethics, cultural diversity, life balance, and personal wellness and health; her participation in a six session introductory course to psychiatric residents to help them prepare for optimal participation in a journal club; as well as her usual research responsibilities. Gail shared with us the fact that Margaret Rukstalis has been nominated for a teaching award at Pennsylvania University.

A working lunch was used for a discussion of career development issues. This included how to handle issues of politics in the department; the assets and liabilities of becoming part time; how to handle time sheets when one works at several different universities; and so on.

Chris Delos Reyes next presented her lecture giving an overview of the evidence that treatment for substance use disorders works. As always, this was an excellent presentation, and Marc asked her to be prepared at the next meeting to focus on what a shorter lecture with fewer slides would look like. He also asked Chris to give some thought to what five or so slides she would pick if she was going to give a ten-minute lecture, and to share some of these thoughts with the group on Saturday.

Joseph Sakai, a first year scholar from the University of Colorado, next reviewed what he hoped to accomplish during his first six months with AMSP. These included: assessing the courses currently being offered at the university on substance use disorders; increasing his level of involvement in the current teaching activities going on by working with his mentor, Tom Crowley; consider developing a ten-session elective for medical students; working toward the possibility of becoming part of the Physician’s Wellness Committee; looking into the possibility of starting a DOC group at the University of Colorado; and meeting with his chair and other prominent teachers in his university to find ways to optimally expand his role.

The next report was the plans for accomplishment at the Oregon Health & Science University by Marian Fireman. Marian is in an excellent position to have a major impact on alcohol and drug education at OHSU because she is currently the psychiatry clerkship director for medical students, a member of the Medical Student Education Committee, and a member of the Clinical Services Subcommittee for the school of medicine Curriculum Committee. Specifically related to AMSP, she plans to survey the levels of teaching in substance use disorders offered to first and second-year medical students in the neurosciences curriculum and as part of the principles of clinical medicine; she will work to enhance the clerkship-related information for medical students in years three and four as they apply to alcohol and drugs; and will increase the number of lectures on substance use disorders offered to third-year medical students. Regarding psychiatric residents, she also serves in an important role which gives her the opportunity to work toward expanding substance use disorder-related education by: increasing the length of the curriculum involvement for substance-related problems for second and third-year residents; working to improve the quality of lectures offered as part of the introduction to addiction psychiatry; considering (as a consequence of her AMSP involvement) joining the residency training committee; expanding her role as a screener of residency candidates which will enhance the option of choosing individuals with interests in substance use disorders; working to evaluate and improve the rotation in substance-related problems given to third-year residents; and reviewing current components of substance-related teaching to the residents. To accomplish these tasks she is setting up a series of meetings with the director of medical education, director of residency training, chair of her department, and the dean for graduate medical education.

Friday’s discussion ended with a re-review of information related to career development. First and second-year scholars broke off on their own for further discussions and planning beginning at 2:30 p.m.

IV. Saturday, October 25^th: 7:30 a.m. to 10:30 a.m.

The morning began with the presentation of Karen Drexler’s lecture on craving. This was a superb demonstration of a way to get complex information across to medical students while being engaging and approachable. The discussion focused on how to make the lecture even more accessible to individuals who know much less about neuroanatomy, including several ideas regarding slides that might be a bit too complex. Karen will develop an alternative form of this lecture with the hopes of presenting this to our group during our spring 2004 meeting.

Katie McQueen next presented her accomplishments at Baylor University. Katie recently received a K12 Mentored Clinical Investigator Award which pays 80% of her salary for two years of a project focusing on detoxification in the treatment of cocaine and alcohol dependence and the use of naltrexone; she has been granted a position as an assistant professor of psychiatry and behavioral sciences at the University of Texas Health Sciences Center in Houston; her work was instrumental in obtaining a Waggoner Addiction Scholars Program Funding for a junior collaborator and in recruiting an additional scholar interested in substance-related problems in the department of family and community medicine; Katie teaches and writes the exam in the core medicine course regarding screening and intervention, identification and treatment of intoxication and withdrawal; she has delivered her lecture on alcohol and cocaine as well as the lecture giving an overview of substance-related disorders treatment to psychiatric and family practice residents; Katie developed a lecture on prescription drug misuse which is delivered to primary care physicians, her work was instrumental in obtaining a SAMHSA grant for $17 million spread over five years which was given to the state of Texas to enhance screening and brief intervention in hospital emergency rooms - a process generated through a joint effort with those in her hospital district; and she has regularly used several AMSP lectures (including “Does Substance Use Disorders Treatment Work?”) as part of her teaching efforts at her university.

Sarah Book at the Medical University of South Carolina in Charleston next presented her goals. These include: working to become a lecturer in the ongoing series of lectures to the third-year clinical clerkship (i.e. offering to relieve the load of the person doing it now; working with psychiatric residents to develop lectures on mentoring, how to give a lecture, and other AMSP topics; to consider implementing a 10-session elective; and working with students and the school to develop a DOC program. In addition, Sarah will take advantage of the fact that she is on the medical school education committee and part of a university with some excellent resources regarding research in substance use disorders.

Andrea DiMartini of the University of Pittsburgh next reviewed some of her plans for the upcoming six months. She will: survey current progress on education in substance use disorders at her university; work to have a substance-related problem become the focus of one of the four cases discussed by first-year medical students during their first two weeks as part of a problem-based learning objective; offer a lecture on how to give a lecture to residents - especially to help them for their presentations at grand rounds; work with the alcohol research training program (headed by Dr. Nancy Day) to find additional ways to contribute; and hopes to work toward getting both an R01 and possibly a K24 grant.

Chris Delos Reyes then presented her seven-slide, 10-minute version of her original 30+ slide, 40-minute lecture on “Does Alcoholism Treatment Work?” She did an excellent job in demonstrating that once a lecturer decides on the four or so basic points that are the most important for that presentation, it is possible to then use those goals (as already implemented as part of her longer lecture) to produce a very effective short lecture. This type of exercise is important regarding how to handle a problem that occurs when what was originally posted as a much longer lecture becomes shorter.

Katie McQueen presented a half-hour overview of an introduction to PowerPoint. Katie did an excellent job reviewing the essentials of the preparation of slides and other visual aides. She used the lecture originally developed for AMSP by Susan Tapert, a form which is posted on our website, and brought all members up to date on the important use of this tool.

Marcy Gregg reviewed recent developments on the AMSP website. These include an estimated 3,300 hits on the website from October 1^st to 20th, with the top referrers being Google (U.S., Canada, and Australia), Yahoo Search, MSN Search, and direct hits (about 10%) on our website address. We have received interest from the U.S., Europe, Asia, Oceania (e.g. the South Pacific), South America, and Africa. Depending on the time of year, the greatest interest appears to be in information relating to athletes, medical consequences, pharmacology, personality disorders, substance-related problems in physicians, cocaine, and family issues, along with a high level of interest in our minutes and in our list of videos that can be useful to alcohol and drug programs.

We next reviewed issues of recruitment, established our dates for the spring meeting (beginning on Wednesday, March 31^st); the venue (San Diego); and discussed several career development issues.

The final assignment of first-year topics and mentors were reviewed. Marian Fireman will develop a lecture on hepatitis C in substance use disorders, using as an advisor Marianne Guschwan as well as either Katie McQueen and/or Susan Tapert to help with technical issues; Wendol Williams will develop a lecture on substance use disorders as demonstrated through brain imaging and will be working with both Karen Drexler and Katie McQueen; Sarah Book will produce a lecture on alcoholism and social anxiety disorder working with Karen Drexler as her primary mentor; Joseph Sakai will produce a lecture on opioid agonist treatments (e.g. methadone), using Chris Delos Reyes as a mentor; and Andrea DiMartini will produce a lecture on screening for alcohol use disorders (which will include some videotapes) working with Gail Rose as her primary mentor along with help on the optimal use of the computer through Katie and/or Susan.

The meeting ended with the making of plans for following through with deadlines and working closely with mentors.