This year’s chief resident of internal medicine at the Durham VA Medical Center has a particular interest in serving veterans because he is one himself. Christopher Hostler, MD, MPH, is a graduate of the United States Military Academy at West Point, and since he started training in medicine it has been his dream to work at the VA.
Dr. Hostler said veterans are a well-deserving patient population.
“Regardless of what they have done in their lives, at some point they raised their right hand and swore to support and defend the Constitution,” he said. “The VA system practices good, evidence-based medicine and provides good outcomes for patients who otherwise wouldn’t have access to care.”
Before going to medical school, Hostler’s goal was to be a tanker or helicopter pilot, but when he was medically discharged from the Army, Hostler decided to go to medical school and ended up at Duke University School of Medicine.
He said coming to Duke and having the opportunity to serve at the VA filled a void in his life.
“When I was looking for residency and fellowship programs, I looked exclusively at places that had a VA because I wanted to be able to give back in some way,” Hostler said.
As chief resident of internal medicine at the Durham VA, Hostler oversees the Durham VA’s medicine services, including VA General Medicine, the Medical Intensive Care Unit, the Cardiac Intensive Care Unit and the Emergency Room.
The other part of Hostler’s role is improving the VA health system by serving on different VA committees. Areas he is focused on are improving the transfer process for patients from outside hospitals to the VA and improving coordination of care between inpatient and outpatient services.
Hostler also came into his chief resident year with the goal of improving communication between the microbiology lab and the residents. As a Duke Infectious Diseases fellow last year, Hostler identified a lag in the time between when test results were available and residents received and could act on those results.
“In the microbiology lab we have a machine called the BioFire, which can give us blood culture results within the span of hours instead of days. We don’t have a means to report that yet in the (VA) computer system, but as we are starting to develop that I’ll be helping to educate the house staff on how to interpret the data so they can appropriately manage their patients 1-2 days before they would normally have that information,” Hostler said.
When I was looking for residency and fellowship programs, I looked exclusively at places that had a VA because I wanted to be able to give back in some way, Hostler said.
Another goal Hostler has set for his chief resident year is improving communication between internal medicine residents and the surgical specialties they interact with. At the VA, they have a monthly combined Medicine and Surgery conference where internal medicine residents and surgical residents talk through a case.
“Having those combined conferences lets us see things from a surgical side and lets them see where we are coming from a medical side and improves communication,” he said.
Hostler said he’d also like to encourage communication between specialties outside of the hospital in social settings.
“One of the things I’ve continued to do since I came here for medical school nine years ago was play intramurals. We have an intramural soccer team that has a lot of medicine people but also anesthesia residents, orthopedic residents and even some faculty. Engaging with people in a social context seems to help crosstalk in the hospital setting,” Hostler said.
As a training site, Hostler said the VA is unique because residents have hands-on training opportunities that they may not have at Duke University Hospital.
“At the VA, we don’t have all of the ancillary services that we have at Duke, so the residents do more of the detailed work to provide for the patient. For instance, at Duke we have a procedure team so if someone needs a paracentesis or lumbar puncture, you call the procedure team and they can do it for you. Over at the VA there is no procedure team, so if your patient needs a paracentesis, the intern or resident is going to perform that procedure. They get to have more hands on experience taking care of their patients, which is a huge benefit,” he said.
The residents at the VA also have a lot of autonomy, particularly in the ICU, Hostler said. At Duke, a fellow is always with the residents in the ICU, but at the VA, while there is usually an intensivist in the hospital, there isn’t always someone with the residents at all times, so it is a great opportunity for senior residents to have some autonomy.
“It builds a lot of confidence that the last two and a half years of their training has prepared them to take care of really sick patients,” he said.
Hostler said so far in his time as chief resident he has learned to take a step back.
“I think that equity is a really important concept in leadership that isn’t always applied, but taking a step back from a situation and thinking about how you would apply a situation or response to all other individuals is really helpful,” he said.
Hostler also recognizes that you can’t always apply the same situation to every resident.
“It’s a unique experience to try to individualize training for 150 people, but I think that’s what you end up doing because as you learn how people react to feedback, and how people deal with pressure, you tailor their educational experience. We all want to get them to the same end point of being an independent physician, and I think it takes different strokes for different people,” Hostler said.
Going into his chief resident year, Hostler said he benefited from advice from past chief residents including Vaishali Patel, MD (2013-14), Eileen Maziarz, MD (2011-12), and Coral Giovacchini, MD (2014-15).
“Coral said last year that the chiefs always have to act like a duck on the water, so on the surface everything is smooth and you’re just gliding along, but underneath you are paddling along and there’s a lot of turbulence,” Hostler said. “I think that is a pretty good description of how I have tried to approach this year. You can have a lot of things going on but try to keep an even keel – that’s what a lot of people look for.”
Hostler will complete a fellowship in Infectious Diseases at Duke after his chief resident year. He said his ultimate goal for his career is to build an infection control outreach network for the VA that would be modeled after the Duke Infection Control Outreach Network, founded by Dan Sexton, MD, professor of medicine (Infectious Diseases).
Outside of medicine, Hostler said he plays soccer every week with his intramural team, Toxic Megacolon, and he attends a weekly pint night with his fellow chief residents and others from the Internal Medicine Residency Program. Hostler and his wife, Carol, have a 20-month-old son, Cameron, and a baby girl due in January.