My career as an attending urologist began in July 2020; a few months earlier, all nonessential activity was halted due to the SARS-CoV-2 pandemic. With the virus-induced physical isolation came additional costs, which were both well documented and widely shared by anyone starting their career at this time: a loss of clinical collaboration outside of multidisciplinary tumor board conferences, a lack of spontaneous interaction with colleagues and mentors due to purely online medical conferences, and complete absence of ancillary activities and collaborative events deemed nonessential (eg, visiting professorships, professional development activities). This has since improved, yet like a child forced to cope with at-home schooling, my extraclinical career development during the pandemic had somewhat stagnated.

Selection as a USMART (AUA Urology Scientific Mentoring and Research Training) Academy mentee offers the opportunity to advance my career development in the research domain. As a nonfellowship-trained urologist, I have broad clinical and academic interests, ranging from population-level disease screening, to public health and quality of care, geriatric and older urology, and stone disease and advanced imaging. Additional mentorship from an outside perspective will allow me to hone my research portfolio and to develop connections with other programs and groups that would allow me additional opportunities for advancement.

My goals for research advancement in my career are 2-fold. First, I’d like to gain focus in my academic interests and build a more cohesive body of work, allowing me to contribute more to the field. Geriatric urology, and frailty in particular, unites my interests in palliative care within urology, bladder cancer quality of care, and functional outcomes related to urological malignancy. Frailty is increasingly an area of importance given that the burden of urological disease is borne to a significant degree by the elderly; between 5% and 17% of this population can be qualified as frail, and as such any clinical intervention should aim to identify this before completing potentially risky and costly procedures with little promise of benefit (eg, PSA screening).¹ Our preliminary analysis of claims data has suggested that patients undergoing prostate biopsy are more likely to experience complications related to the intervention (unpublished data); others have examined different areas of urological disease and demonstrated similar findings.² Further work is necessary with regard to assisting the urologist in identifying the frail patient and leading a nuanced risk-benefit discussion within the limitations of a busy clinical practice.³

Another opportunity for advancing the care of geriatric urology patients lies in ensuring the availability of appropriate perioperative infrastructure needed for geriatric patients to succeed in surgery. My current primary practice site, the Rocky Mountain Regional VA Medical Center, is an accredited center of excellence for geriatric surgery (one of few sites nationally), and incorporates palliative care, social work, internal medicine and anesthesia clinicians, and family members within weekly meetings to elucidate clear goals of care discussions and identify operative goals. These meetings, set up like a multidisciplinary tumor board, would feel familiar to most clinicians. The value of these is to identify perioperative and postoperative risks especially germane to the elderly, frail population and to mitigate them when possible with anticipatory action. Early outcomes have demonstrated reduced length of stay as a result of this intervention; urological-specific evaluations within this framework would identify potential avenues for surgical improvement.⁴

My second aim as a USMART mentee is to identify within my career my own ideal balance of research with the other pillars of clinical medicine, resident training, and student education. Given that I am still early within my career, there are many models for career growth which I have yet to be exposed to, whether achieving grant-based protected research time or focusing on clinical, quality-driven goals. No career model is the same, yet an outside perspective can help to clarify goals and identify opportunity for growth in any or all aspects of the classic tripartite academic mission of clinical medicine, teaching, and research.