Interview with Dr. Kim

Dr. Sarah Kim is an Assistant Professor at the Department of Family and Community Medicine at the University of Toronto, serving as the Health Humanities Theme Lead for the Temerty Faculty of Medicine at the University of Toronto. She heads the Program in Health, Arts & Humanities, contributing additionally as Dance Artist-in-Residence. Dr. Kim works as a family physician with focused practices in Narrative Medicine, Surgical Assisting, Internal Family Systems Psychotherapy and Sports & Exercise Medicine, formerly practicing Emergency Medicine for nearly a decade prior to motherhood.  Dr. Kim is the former Chief Medical Officer for Canada Basketball’s Women’s Elite Program with extensive field experience in event coverage, having travelled internationally for ten years representing Canada with the National Women’s Basketball Teams. Within her medical and teaching practice, Sarah integrates the arts and humanities, mindfulness meditation and movement education as generative components of resiliency and compassion-based care.  Her investigations examine the relationship between high performance and historical ideas around the body, exploring embedded hierarchies and the intersection of humanness within industrialized systems.  As a teacher, Sarah employs the arts a means of transformative analysis in the deconstruction and reconstruction of professional identity.  Her method encourages a non-intrusive approach, inviting dialogue and positive affirmation of the full spectrum of the human experience that support the development of a well and resilient healthcare force; the foundation of a robust and compassionate healthcare system.  

Dr. Kim received her Doctor of Medicine degree at McMaster University in 2003 and completed her Residency in Family Medicine at the University of Toronto in 2005.  Following this, she specialized in Sport & Exercise Medicine at the University of Toronto, obtaining her Fellowship Certification in 2006.  She holds her Diploma in Sport & Exercise Medicine with the Canadian Academy of Sport and Exercise Medicine. Dr. Kim completed a Masters of Science in Community Health in 2011 at the now named Dalla Lana School of Public Health. As a professionally contemporary dance artist, Dr. Kim integrates the circus arts, martial arts, urban dance and contemporary dance, all reflections of her diverse physical training background.  

A more detailed bio can be found on her website:  https://sarahkim.org   

Samples of current and past artistic work can be found on Instagram: @sarahkim_md

Q: How do you currently balance that time along with your different passions and projects outside of medicine?

The number one thing I've learned over time is not to be rigid. While it can help to organize and structure things, life will always challenge your rigidity. It's keeping stock of what is a priority but then deciding how to organize your time around what is time-sensitive versus things that can wait, while not sacrificing all of yourself. What is interesting about medicine is no one tells you how much sacrifice it takes. People almost feel stripped of their identities entering into the system—moving from high school to undergraduate is a big step, and then going from undergraduate to medicine is like this huge thing that no one can prepare you for. It's like parenthood; no one can tell you what it's like. They can try, but because you have no reference point for something as all-consuming, it is one of those things that most people learn the hard way of how to keep a balance.

Medicine is a place where the need is endless. The need to learn, and the need to serve. It is a place where we are serving a massive amount of needs. What's also difficult is that as trainees and learners, you enter this time-limited period where you must be equipped not to cause harm. The primary goal of the training period is to produce safe and conscientious practitioners who are adaptable and can tolerate uncertainty in trying to balance life with medicine. It's changing now in medicine, at least, we're starting to arrive at a different discourse around what it means to be a person rather than part of a system simply put in there to serve. That's the historical model we struggle against and is why we see a lot of burnout right now. Because in medicine, we are not valued as people. It's (Emotions and bodily needs are) a place of shame. Historically, acknowledging that you are a person with needs is seen as weak, and we still internalize that value because it's part of many different cultures. It is an interesting emotional place that many cultures try not to go to or deny that it's there. That was something I was very acutely aware of within my first week of med school, where I felt a dissonance of what was embedded in the structural value system of medicine, which in many ways is like a patriarchal, military model. This dialogue is about dismantling the historical values that don't align with who we are. But again, it's within our structures. I often think about why I was thinking about these things as a student. I think it was because my family life was not conventional. Life was difficult and chaotic, and many things about it forced my siblings and I to be outside of the usual structures. I chose to disagree.

I also recognized that I did have a duty. As someone who accepted the responsibility of becoming a medical professional, there is a duty you have to balance as a learner who will be holding human lives in your hands. I would consider myself a diligent student because I uphold that value; I am responsible for becoming as best a practitioner as possible. But where are my pockets of time? What can I protect? I chose to find moments of social time. At times, I would say, ‘Okay, right now, while I'm studying, am I absorbing information? And if the answer was no, okay, I'll go for an hour and find my dance friends, then we'll dance somewhere.’ Or I would plan that I'm going to study up to this point, but then I'm going out. That's what I do now, too. Realistically, if I stare at my emails beyond 5 PM, am I being effective and productive, or is it taking me an hour to write an email that would normally take me 15 minutes? That's the self-awareness of acknowledging my limits and then how to fit in the work time that has to be put in. It's a lot of trial and error, and failure. The other thing I was willing to accept was failure. Like not being afraid of failure. I'm just going for things, and if it fails, then just be like, okay, well, I pick myself up and dust myself off. I think what's problematic in some of the learning circles is that there's such a fear of failure. You know, there's a lot of perfectionism to try and prevent failure from happening, but failure is often where we have the most amount of growth. What's hard in medicine is that everyone who gets into medicine is at the top of the class, and suddenly, you're in an environment where you face failure. It's hard because it hits you in a very tender spot, and I don't think we talk about that enough in medicine around navigating and normalizing failure as part of the pain of becoming a good medical professional. The better you get at being honest, 'Okay, well, that didn't work. What do I need to change rather than hiding and going into a place of shame?' is where a lot of productive growth happens. It's not an individual issue. It has a lot to do with the systems within which we receive feedback where failure is not supported in a way that fosters positive resilience and growth. But it's improving. Now we're having more conversations around how to support learners and acknowledge this is a normal thing that we all went through and then how to turn that into resilience-building moments. 

Q: Could you guys tell us a bit about yourself and your medical background?

I did not do a science degree. I did my undergraduate studies at McGill University and was accepted to the Faculty of Science. When I was looking through the syllabus, I realized that all I would be doing in my first year was repeating what I felt I had just done in the sciences and maths in high school. I decided to switch out to the Faculty of Arts because I just had no greater exposure. I didn't know what anthropology was. I didn't know what linguistics was. I started as a double major in linguistics and anthropology but felt that was too narrow. I met with the Dean of the Faculty of Arts and asked if I could do my own program. There was a minor in what they called cognitive science, which crossed different disciplines from philosophy to psychology and a whole other collection of courses I could do across departments. I proposed it as an Honours major and ended up doing an Honours major in cognitive science, which allowed me to do courses in philosophy, sociology, anthropology, and computer science. I still kept a handful of the sciences out of interest. At that time, I wasn't necessarily trying to get into medical school.

But I have Korean parents. I was the kid they hoped would be the doctor. It was in the back of my mind, but not my focus in undergrad. But when I came to think about what I would do, I thought I was a pretty good candidate when I looked at my extracurricular interests and the academic side. All the volunteering I did was around care and health promotion. I volunteered with a sexual health group, a peer health group, a peer crisis-line, a student literacy group, a body image group, etc. I also didn't want to go to a medical school where all I would do was sit in a lecture and memorize, so I only applied to Mac and got in. Some of my classmates found what they felt was the lack of structure and direction stressful. I found it fine. I was already a self-directed learner and understood how to identify and fill my gaps, so I did well in the Mac program. I took a research year at Mac to study more on the history of medicine and some of the nontraditional forms of medicine, particularly around Korean and Chinese traditional medicine and then around the politics of what ended up being healthcare in Canada.

I loved all of my rotations. But when I was honest about which environments I felt were best suited, I eliminated surgery because I felt like it was quite a toxic and emotionally abusive training environment. I couldn't see myself tolerating that for a long time, although I loved its technicality. I was also considering anesthesia and psychiatry as well. My interests were broad, making me realize I was probably more of a generalist. After doing interviews for psychiatry, anesthesia and family medicine, I realized I didn't want to be so specific and specialized this early. That's why I chose family medicine and did the family med program at St. Michael's, which is the inner city program. It was great, challenging, and eye-opening in terms of a lot of the social medicine we do in family medicine.

After that, I did a fellowship in sports medicine after being introduced by one of my family medicine preceptors. I've always been very active in sports and did a bit of ballet when I was a kid. I played every sport in school that I could participate in, and then in university, I got into hip-hop and break dance. I competed and went to battles. I have a very clear memory of one battle in Toronto—I think it was in my first year of med school in 1999. I was the only woman to enter the battle, which was weird but fun. Someone recorded that battle and has it on a VHS tape that I saw years later. Movement has always been a big part of my life. When I graduated, I became an independent practitioner and practiced emerg, family, and sports medicine for several years. I narrowed it to emerg and sports medicine later on just because having a narrower practice with the two was easier. When I was pregnant with my first child, I chose to leave emerg—I couldn't imagine doing shift work safely while being a parent. Then, I became a surgical assistant with the orthopedic team at St. Joseph's in Toronto, which I still do. Being part of the orthopedic team was a good fit with sports medicine. In sports medicine, you see a lot of patients with chronic pain or chronic injury that doesn't improve. I identified a gap in my counselling skills and so did a lot of training in trauma and psychotherapy. Over the pandemic, with virtual care, I ended up closing my sports medicine practice because I found it too anxiety-provoking to practice sports medicine virtually and also, at the time, there was just too much going on, such as having the kids home for virtual school. I continue to be a surgical assistant with the surgical department at St. Joseph's, mostly orthopedics. I run virtual group psychotherapy and that continues to expand. Now, I have an academic role for UofT as the Health Humanities Theme Lead, which has shifted my clinical practice. So that's the version of where I'm at right now.

Q: As the Health and Humanities Theme Lead, what is a professional goal that you want to achieve?

It's an enjoyable role. In some ways, it's almost like a dream job where I get to think about cool ways to integrate the arts meaningfully into medical education. There has been a lot of work around narrative medicine, which is often literature-based and through story. But often, it's used as a personal growth tool rather than seeing it integrated into the curriculum as an educational tool. In my role, I will demonstrate how the arts are a valuable tool for generating more than critical thinkers. Arts are a means of questioning. It is also a window into someone else's world; in that sense, it allows us to humanize health care meaningfully.

The concern is that integrating arts and humanities will detract from the time needed to instill the technical knowledge we need to ensure people leave as knowledgeable and safe practitioners. My argument is that it does the opposite. It's a way to enhance that learning because it taps into parts of the brain that aren't necessarily activated when you listen to dry lectures on any topic. For example, in a slide which has all the criteria for any disease process, if you show a painting or a picture or a photograph that a patient has generated of their experience of that disease, you've automatically started to activate another part of the brain that allows a connection to happen. That lets you see the perspective of someone experiencing that disease process, which is fundamental to what we do. Our historical assumption about medicine is incorrect; it's more than just scientific. It's inherently emotional. The moment you engage with another human being, it becomes relational whether you like or suppress it or not. The historical way of dealing with that in medicine is to suppress our emotions. We are never taught to navigate or manage our emotions in that professional context explicitly as part of the teaching, and we end up not processing the weight of some of our clinical interactions. When you look at the personality profiles of people who get into medicine, they are usually highly avoidant individuals on those scales. We do a lot of distress-reducing behaviours like using exercise to relieve stress, but actually, what we're doing is we're being avoidant of the emotion and not ever really going there. Starting to integrate more discussion around the person within the disease process and beginning to discuss the things that come up as we have these encounters is an opportunity for skill building. For instance, we are criticized for lacking communication skills around bedside manner and patients feel like they're just a number. The systemic structures within our institutions are organized so that the bodies get processed as quickly as possible. We are trained to process bodies and parts and disease entities. The system wasn't designed to deal with people. Often, we talk about why compassion decreases as people go further along in their careers. A lot of it is because the system is designed from a place where emotions were seen as interfering or problematic. When in fact, they are quite necessary to acknowledge and learn how to navigate with skill, which we still lack in medicine. Moving forward, with the changing face of medicine, such as technology and AI, those interpersonal relational skills become even more critical for us to, number one, not get burnt out. Because it also means being relational with one another and defining what that means and what that looks like in terms of a future culture of medicine. This is a lot about the medical culture; when you come in, you can feel but may not have the words to articulate the experience. And then, how to support that in an organized way where we are still meeting the educational needs that we identify as critical components of a well-rounded educational framework. My role again is to help support what we want to arrive at but to do it in a way that would make a lecture more interesting and comprehensive of the whole human experience. There are many ways to make it exciting but also in a way that you retain the information more. When you think about how memories are formed, the most salient ones usually have a lot of emotional impact. Because at the heart of it, we are biologically wired as mammals, where emotion is essential. Often, that connection to one another differentiates mammals from others, so trying to fight or deny our biology historically has actually not worked in our favour.

Q: How do you think your identity as a lifelong artist has influenced your work as a physician?

My life in the arts has kept me grounded in being a person versus a robot in a system. My artistic career began with dabbling as an undergraduate, and as I went through my residency training, I continued participating in different kinds of movement training. I did a lot of martial arts initially, and then breakdance. There was a lot of overlap in terms of the physical patterns. Dancing was just for fun. I would go out to clubs at night with my friends, dance it all off, and then face another day—that was a big part of my emotional outlet. But then it began to take a much more focused artistic leaning when, sometime during residency, I started to do a lot more professional contemporary dance workshops and spent extended time with these communities where we would sit within our bodies. I would leave the studio and then come to work and feel a distinct change in my body. For a while, I couldn't understand what it was. I thought, oh well, they're just two worlds I must keep separate. But then I realized that in medicine, we are taught to shut our bodies off. We are taught to ignore the signals of the body, whereas, in the studio, I'm supposed to be aware of every little hair. Then, I started to think more intellectually and academically about the discourse around the body in these two different settings. In the art world, it's all about being in the body and the senses and trying to understand what these senses are about and what's being taken in by the sensory experience. But then, as a medical trainee and a person working in health care, you are told to shut down to plough through it, which can be helpful, but also hindering. It is useful at times because it's not great to fall apart emotionally during some critical moments. But then the problem is that we get stuck there. And we bottle it all up. And then we explode at the most inopportune times, like when you are home with your family and someone has left a sock in the middle of the room, and you lose it—moments when emotions get tipped over the edge. In these moments where you’re so stressed and need care, but you're unable to ask for it. And then in this moment suddenly this sock is such an infringement on your space, a sign that someone doesn’t care enough to even be considerate to you. That's when you explode. The contrast of the artistic world started to ground me in understanding that I am not being honest about my needs in my work environment and what I need afterwards. I began to realize I was using the dance as an outlet, but I wasn't sitting with the emotions of why I needed that outlet to begin with. But that's the thing about when you start to have a true practice in the arts: the more it becomes a dedicated practice, the more you can't avoid but go to the place of emotion. Because it just becomes more of a mirror of you. So, that's the self-development portion that an artistic practice provides. And there are different outlets—through that, I do writing, I do some drawing, and I sing and do other expressively reflective things. Most people have something or multiple outlets, but it's not the same as being a professional artist. For me, that came later, the understanding between the two. For a professional artist, their livelihood often depends on their work. Also, just like anything else, it takes at least a decade to develop a craft where you arrive at a much deeper understanding of what that practice is beyond just expressing yourself. It then becomes a medium for other things. In Canada, we don't have a lot of funding for the arts, so many artists have a day job of some kind. I work semi-professionally as a dance artist, but that evolved over at least a decade of beginning to sit with, 'Oh, why is this practice important to me?' It's beyond just personal expression. I'm interested in exploring themes about society through this medium. It took on a greater life of its own and through different collaborations. I spent much time understanding movement—I constantly watch people move. What also strikes me in medicine is how uncomfortable people are within their own bodies. When I watch people's bodies in medicine, it's almost like a disembodied observation of lots of time up in the head, but not a lot of time connected with the gut or the rest of the body. This disembodiment does work against us after a while.

Q: Are you able to have the opportunity to talk to your patients about the importance of movement or perhaps if they come to you for advice. What do some of those conversations look like?

I gravitated towards sports medicine because it was a place where you have conversations about people's relationships with their bodies. It's always been an interesting challenge for me to understand what people's resistances are around exercising, for example. Obviously, there's time constraints and varying things around recommendations on how to exercise or how much exercise. I have started not to say go exercise for half an hour. That's not realistic for a lot of people. I say even 10 minutes, broken up at different points in your day, gives you many gains. What I don't like about the exercise world is when people are thrown into a much higher intensity exercise than what their bodies are ready for. There's a lot of preparation required to be able to exercise more vigorously safely, and I feel like there needs to be a lot more time in that pre-exercise preparation. But there are also a ton of things about our society that make people feel ashamed of their bodies. That's a dominant dialogue where you're constantly fighting with your body in medicine. We're all high achievers and perfectionists; many of us are very perfectionistic around our bodies. That was something that I struggled with after entering medicine. When you're in greater distress, you often will pick on yourself more. I developed lots of disordered eating patterns as a trainee. Reflecting back, I remember thinking this isn't normal; this is veering towards some DSM criteria. And I'd even think to myself, why are you doing this? But also feeling so much distress and stress from the lack of sleep, the social deprivation, and all the striving to perform perfectly. While I could articulate that I was distressed, I didn't feel like I had the time or energy to deal with it. I did start counseling as an undergraduate, but something didn't feel right. My problem with some of the counseling world at that time was how quickly they wanted to medicate you whereas I would say, ‘I need someone to talk to and I don't feel like I need to be medicated’. A similar thing did happen in med school at the time when I said I was really burnt out, and then I was told by the physician, “You call it burnout, I call it depression”, and then I thought how quickly they wanted to put me on some antidepressant medication where I felt like 'No, I think I just need to learn how to cope with things better.' I was compliant with the counseling recommendations of going on some of the antidepressant medications but it felt it was simply suppressing my emotions, when in reality, I needed to learn to have skills to deal with my emotions. It's been a long journey, probably informing which counselling frameworks I chose to train in. I want to talk about this openly because if you're not feeling stressed and unhappy at some point in your medical training, you either must have the best supports ever and be able to talk about your feelings honestly all the time, or you're in denial. It's most likely one of those two. But it's a normal thing, that medicine is hard. It's hard, and it's because we are dealing with tragedy every day, and that is not a normal thing. That's why it's often difficult to talk about what you do to your friends who are not in medicine and why communities of support in medicine become much more important. Because what we do is specialized and tough. It's overwhelming because the stakes are high if you're incompetent. The weight of that, the burden of that, is real. Things have improved so much in terms of us trying to support learners through this. Part of it is to have the humility and courage to ask and admit that I'm having a bad day. Because, again, there's so much shame around not being able to take it, that you're not tough enough when, in reality, a lot of the toughness is having the emotional honesty to acknowledge fallibility. That's much harder because it goes to a place of vulnerability, which is hard. Culturally and societally, while we say we talk about it, the resources around this are still developing. It's very individual though, learning what will work for you when. Sometimes, avoidance is necessary because you just have to get through to a particular period. But what I want to encourage learners to do is that you can do that because it is a good survival mechanism, but then there has to be a point where you have some place which is safe for you to collapse into a puddle, being held by a network of support. That will help you get through training much more sustainably than arriving at a crash and burn, which many of us do. Many of us hit really low points. I definitely had some very low points. Thankfully, I had a good, strong support network. My parents are culturally ill-equipped to speak about emotions, but at least my siblings are great. Your community is key. To me, the arts and humanities are accessible tools for personal growth available to anybody. And it doesn't have to be performative. That's the thing. The arts are not just about producing something that someone will buy. A lot of that artistic practice is around just sitting in it and practicing your voice. That's essentially what it's about when you're doing it from a personal standpoint. Artistic practice is about practicing a voice, experimenting with voices, and finally arriving at what voice is authentic to you. There are lots of different voices in you. We have a lot of different roles, but most people want to understand what is actually me? And what is the world asking me to be? That's an important distinction for learners; medicine asks you to be something. That's why there's this massive identity crisis—to separate the performance of medicine from who you are. It's a role you can step into, but you need distance. It's important to have some distance but also understand that immersively ploughing through it and being committed will make you an incredible practitioner. It's an incredible profession to be in. It's just that there are times when it's really hard. Medicine does require sacrifice. You can still have a practice of developing yourself in a personal way. But you have a responsibility in medicine to what you've committed to, and it's because you are holding human life in your hands when you leave. It's a time-limited period for training, so take advantage of all your learning opportunities. No matter if it seems relevant to what you will do later. This early in training everything you’re being taught is relevant so open your minds to all of it. It's hard to explain to trainees that every rotation is so important. There's so much you'll gain if you dive into how fascinating it all is and the skills you'll learn, just in general be broad-minded. There are ways to have fun with it, too. There are days you'll go home and cry like that was awful. That's okay. That's normal. But there will be many amazing days too.

Q: I saw that you were featured on Canada's Got Talent last year. How was that? What is a project that you are particularly proud of?

That was a fun thing I got to do with other women physicians. That particular choir produced a virtual performance during the pandemic, which brought much attention, and we were invited to compete on Canada's Got Talent. That experience for me was a neat thing to try. However, in terms of a project that stood out for me personally and artistically, the one that has sat with me more than being on Canada's Got Talent is a short film I co-created with a bunch of staff at Unity Health Toronto. That film project was so meaningful because it captured a lot of the pain we experienced during the pandemic, but then so much about community connection that helped people get through that time, like their clinical community at work. It was amazing that it all came together and so deeply special. We were so fortunate to collaborate with a very talented film director who has worked as first assistant to Sarah Polley, named Sonia Gemmiti. Her direction and editing is what made the story of the film so beautiful and visually cohesive. The creative team also had another contemporary dancer who is also a cancer survivor, Christy Stoeten, who was able to collaborate and work with staff in such an emotionally intimate way even though none of them were trained dancers. The soundtrack was created by one of our nurses, Danielle Goudge, who is also a musician and she integrated real sounds recorded by staff from their clinical settings. The film project was really something profound for us to experience and navigate together. It's a 6-minute dance short film called The Choreography of Care (https://www.youtube.com/watch?v=kYT-K9FsRMo). We were curious how it would land with many people because it's an abstraction. When you do things in the art world, it can be like Canada's Got Talent where it's a singing performance that’s straightforward and literal. But then, when you take something that's an abstraction of people's experiences, it's always curious to see how it's received. That film project will stay with me for a long time; something that has layers of meaning within it. I continue to be involved with other projects with dancers. That's the part-time work I'm still doing in the dance world, and in one of them, we're investigating our concept of care, like what care means through a dance lens and what that research could bring into the healthcare environment. Canada's Got Talent was fun because being on TV is always something that gets people excited and it brought a lot of joy to colleagues, friends and family. It was a heartwarming experience for everyone. But in some ways it was horrifying because I hate seeing myself on camera. Would I choose to do it again? Probably not. I prefer the not-so-direct. I would rather be more in a contemporary form of presentation; I'm more subtle in terms of what I prefer. I like experimenting with the indirect. Like, seeing how the seemingly competing worlds of the arts and medicine can be merged through my academic role and create some innovations in medical education that will allow students to experience what the arts can bring in a way you don't expect, in a way that will enable you to hear other voices and their stories. Everything in art has a contained story, and what messages you take from that story and what lessons are things that I'm looking forward to exposing learners to. 

Q: Any closing remarks to share?

It is a privileged position to be selected to be in medicine, even though there are times when you question why you chose to do it because it's a complex and highly demanding profession. The more you give yourself little moments to be with yourself or be with people who make you feel supported, the easier it becomes to get through. I recommend people find activities that fill their cups back up. It can be a depleting place if you lean towards giving too much all the time. But that's something you'll learn to navigate: how much of yourself to give and when, because it's not rigidly confined. And when things do come up that hit you more emotionally hard, it is okay to find places where you can sit with that and feel supported in how to process what has happened. But also, it's an adventure. Think about your medical career as an adventure with ups and downs, and just stay open to the possibilities of what a lot of these learnings will bring. Think about what boundaries will help you to feel like you will still have a sense of who you are while stepping into this larger, sometimes all-consuming professional identity. It's a big deal; everyone will arrive intact somewhere and someplace, and know that it changes over time. As a trainee, enjoy the learning as much as possible and understand that all of it is relevant. But to have that place, know where your tipping points are and where you need to cap it so you don't burn out. It's tiring, sleep when you can. Know that the culture of medicine is changing, and we are trying to think of different frameworks and ways to organize our systems. You're part of this transition, part of the generation that will help shape it. Even though it doesn't feel like you have a lot of influence now, your voices matter. I always love spending time with learners and hearing your perspectives because you also help to keep us grounded. It's a two-way exchange. I'm giving you my experiences, but your experiences are equally valuable and help to inform how we continue to try and shape a better system for all of us.