Alumni Feature: Dr. Justin Lam
Tell us about yourself.
I’m a third year pediatrics resident here at SickKids. I went to medical school in Toronto and am also from Toronto originally. I did my undergrad in art history, specifically focused on Japanese art history, partly because the professor was fantastic, and partly because it was an area of interest. It’s interesting to see how everything has tied together from undergrad to medical school to my interest in pediatrics and to my research.
How did you go from an art history undergrad and to med school? How has that been like for you?
In high school, I had the opportunity to take classes in art history and I really enjoyed looking at a work of art and figuring out its place in society and the whole production process. I was fascinated by the process of looking closely into pieces of art to see what we could discover about the civilization at that time.
Coming out of high school, I thought that I might be interested in medicine. Because of this, I figured, “Why not take the time I have in undergrad to pursue something completely different from medicine?” This was out of a misconception that medicine would be purely a study of biology, chemistry, physics, and the biomedical sciences. That’s what led to an undergrad degree in art history.
When I first started undergrad, I still did my premed courses. I took biology, chem and physics, and it wasn’t until the end of my second year in undergrad that I took my first art history class. Thinking back, some of my favorite terms were ones with a mix of classes, where I could draw connections between the different classes I was taking. It was intellectually fulfilling.
What drew me to Japanese art history was the art from the Edo period, which was a very hierarchical time that lasted from 1600 to 1868. At that time, there were very strict rules around what someone could do, wear and display their wealth. It wasn’t until a couple years ago when I made the connection between the hierarchy of the Edo period with the hierarchical culture of medicine.
I also took education classes during undergrad, and getting to know the history and sociology of education. Those are some of my favourite classes. It was such a fantastic time.
Interestingly enough, it was a humanities course that helped me to decide that medicine truly was for me. In my second year, I took a class called “How to Become a Doctor?” It was a small seminar class taught by a retired cardiothoracic surgeon. We read stories, poems, and other pieces written by med students, patients, and doctors from all walks of life. Although I had shadowed and volunteered before, it was through reading and reflecting on those pieces that I got a more nuanced expectation of what medicine would be. It was through that class that I decided that maybe medicine was for me.
There was a moment at our graduation, after I had applied and been accepted to medical school, when I started to doubt myself, whether I could do it. There were times where I felt like my background in art history would help me be a better doctor, but I was nervous. After all, it was two years since I had done any biology and chemistry classes. At my graduation, there were only 4-5 of us graduating from the Department of Art History. I remember after the ceremony, this elderly gentleman walked up to me and shared with me that he was also a doctor who had studied art history. The exact words he said were “It will all work out.” It was so reassuring to hear that, and it helped me believe that maybe I could do it, too.
Medical school started, and I would be lying if I said I didn’t feel like I was at a disadvantage compared to my peers, because I really hadn’t taken any anatomy whatsoever. For the first couple of years, I felt like I would be seeing content for the first time while my classmates would be going through their second or third pass. At the very beginning, I had to catch up and work a bit harder, but I didn’t feel like my arts background ever put me at a disadvantage in the long run. All the skills I got from studying art history and the humanities, including looking closely at something or piecing together a narrative or remembering the bigger picture and social context, were skills that I found useful throughout medical school and residency.
I found that many of my medical school highlights were from experiences related to the humanities. I was involved in ArtBeat and drawn to people who recognized the value of the humanities in the art and science of medicine. Through ArtBeat, we were able to digitize a lot of the companion curriculum, and create the corresponding website and Facebook page. I was also involved in the Humans of 1T7 project, inspired by Humans of New York. A group of friends and I started the project because we wanted to know our classmates on a deeper level. My involvement in the humanities was a highlight of my medical school experience, which continued onto residency.
I also took one of those elective educational experiences at the AGO. Every Wednesday night, we would go around the art gallery with Dr. Lisa Richardson and Dr. Allison Crawford. We’d look closely at the paintings and have discussions around how they were relevant to us, and how they resonated with our experience of learning to be doctors. That was a fantastic experience as well.
Dialing it back to your undergrad—was there a specific reason you chose the Edo period of Japanese art? What drew you to it?
Partly, it was because of what courses were available, and partly, it was because I had previously taken a fantastic course with a professor who specialized in the Edo period of Japanese art - one of my favourites was an entire class about art and politics of the Japanese tea ceremony. I had also happened to study the Edo period during high school. Today, I see a lot of parallels between how societal hierarchies play out in Japanese Edo period art and how societal hierarchies play out in medicine. My research experiences in the hidden curriculum, power, equity, diversity and inclusion highlight how hierarchies exist in learning environments. My art history experiences helped me better understand how power influences society and how individuals act.
You mentioned that you’re a pediatrics resident? What drew to that specialty?
I didn't come into medical school thinking I would be interested in pediatrics. My first exposure to pediatrics was in the summer after first year while doing a summer research project on the hidden curriculum. I had luckily stumbled into that topic and worked with that supervisor in the SickKids SPReSS (Social Pediatrics Research Summer Studentship) Program. As part of that program, we listened to weekly talks by different pediatricians and had some opportunities to shadow pediatricians. Through that experience, I felt like, “Hey, this might be a group of people that I fit in with, that I get along with. I can see myself belonging here.” I think that's something that's really important in making a residency choice. It's almost as if you're joining a community. And it's so helpful when that community values the same things that you do.
As a medical student and now as a resident, I felt like it was important to be able to address the social determinants of health (SDOH). Through SPReSS, I saw that pediatrics was one of those spaces. I’m not saying that pediatrics is the only space, but as a medical student, I found that pediatrics was one of those spaces where we could talk about and address the SDOH for our patients, and that was something that was really, really important for me in choosing a specialty.
In clerkship, I participated in the Longitudinal Integrated Clerkship Program (LInC). In this program, we would be paired with preceptors and would work with them throughout the entire year. During my year-long pediatrics experience, I found that I really enjoy working with parents and families. It wasn't that I didn't enjoy working with adults, but I found myself deriving more meaning and joy from working with children and their families. I also enjoyed the puzzle-solving aspect of figuring out pediatric problems, since, you know, a baby can't talk to you. You have to work with the parents to figure out a diagnosis and management plan.
Ultimately, it was a combination of all those different factors that drew me to pediatrics. Finding a community that I thought I could fit into, having a space where I could make an impact on the SDOH, a clinical practice that I enjoyed, and the kind of relational aspect of it that can fit well with who I was and what I was looking for. Could I have been happy in other specialties? I think so. Probably. And I think that's important to recognize as well. I often tell med students this, that 90-95% of us probably could be happy in more than one specialty.
If you didn’t go into medicine, what are some alternative careers you’ve thought about?
When I was studying art history during undergrad, I was drawn to the study of power and inequity in society with art as a lens. Some of my favorite classes were in the sociology and history of education. There was a period of time when I was really interested in meritocracy, the idea that the best rises to top, and problematizing that concept. With those interests, I think I would probably have ended up in some kind of education job, either as a teacher or an academic studying inequities in education and access to education.. That would have been one path I could have taken. I try as much as possible to bring that path and combine it with the path that I'm taking right now.
Photography has also been a big passion of mine throughout my life, and I’ve considered it as another potential career path. There’s an element of storytelling to capturing moments through photography that I really find meaningful. One of the elements of LInC was a patient panel, where we can follow patients, with their permission of course, through different stages of their healthcare journey. One patient I followed was someone who was admitted to the hospital for a terminal illness. I went back to visit him multiple times. I asked permission to take a photo of him. I still have that photo and ended up publishing it in a journal. It’s not the publication that is important; it’s what the photo was able to capture in that moment. In another life, I could have been a photographer. Throughout medical school, I pursued photography with the Humans of 1T7 project and photography for Daffy, which was a lot of fun.
In a long way of answering, maybe something in education, either in a teaching or academic capacity, or something around photography.
What does photography look like?
I've mostly been using DSLRs because of the convenience of the digital medium, and the lack of opportunity to take a dark room class. Although I took a photography course in undergrad, most of my work has been with digital cameras. There was a period of time when I dabbled in film cameras with some old film cameras I found in my parents’ house. With film, I like the desire to slow things down and be mindful, and really cherish each photo.
I’ve found that when you're being more intentional about the photo that you're taking, it takes longer to fill up a roll of film. One time, I took 3 to 4 months to fill up a roll of film during undergrad. After I had taken the last photo. I took it to the local drug store to get it developed. I put the film down and was told to come back in a couple of hours to get my photos. I went to dinner and when I went back, the person told me that they had lost all the photos. They must have accidentally exposed everything, and it was just such a soul crushing moment. But because I was intentional about the photos I was taking at that time, I still remember the photos I had taken and feel like I don’t always get that with the digital photos.
I have another roll of film that I’m in the process of shooting. Hopefully it doesn’t get lost.
You’ve tried so many things, and been so involved in humanities, education, and medicine. What are some core values or interests that define you as a person?
In a lot of what I do, I strive for kindness. That is very important. With kindness comes other qualities like empathy and compassion. When I think about kindness, not just in our clinical work but also in our educational work, I think about the importance of recognizing where people are coming from and not making any assumptions and remembering that everyone has their own struggle. Actions that may be perceived as challenging or confrontational are probably at the end of the day, really worries or anxiety. They're oftentimes not malicious. This extends to those around us. It's normal to make mistakes, and we're all trying our best. None of us really have the answers on what's completely right, and we're all trying to navigate uncertainty.
It is also really important, from an educational standpoint, to recognize that we're all going through this medical education system, and it is stressful enough as it is. I think being kind and cognizant of where people come from helps us support one another through the experience. Whether it's pre-clerkship and the sheer amount of information to learn, or clerkship and the stress of doing well on your clinical rotation and applying to CaRMS, it is so important to remember what each step of that process is like. It involves compassion and empathy to be able to put yourself in those shoes. As a resident on the “other side,” it helps to remember what it was like at each of those stages.
Another one would be justice. Knowing what we know about the inequities that exist in this world, both within and outside of medicine, drives me, and has shaped my involvement and interests in medical admissions, inclusion in learning environments, and equitable access to health care.
Did you find that being involved in the humanities and the experience you’ve had with art history shaped these core values?
It is hard for me to know because I've only experienced what I’ve experienced, but I do think that my study of the humanities and social sciences have informed my understanding of how society works and how power replicates power. It’s also challenged the theory of meritocracy, the idea that if you just lift yourself up by the bootstraps, you can make it, when really there are so many systemic barriers in the way that. I think my study through art history and sociology gives me an orienting lens by which I approach a lot of the work I do. Something I mentioned earlier was that it helps me keep an eye on the bigger picture. What else is going on here? Where are people coming from, and what have we not asked about? What are we not seeing? What might we not ever need to know about, but what might we also need to understand? For me, the social sciences and humanities gave me the skills to always look for the bigger picture, but also, conversely, look closely at what I'm being told. Whether it’s deconstructing concepts, noticing differences in the language that's being used, observing pauses or moments of hesitation or inflections in a conversation, noticing these “small” things helps us piece together narratives in medicine. I certainly attribute some of that skill to my study of the humanities and social sciences. A lot of it also came through medical school. But I think there are so many skills that are applicable from the humanities and social sciences that are also applicable to the practice of medicine, for the practice of caring for and comforting other people.
Do you feel that your education in art history is a core part of your identity today?
One of my mentors told me that going through medical school and residency is like squeezing yourself through a series of smaller and smaller keyholes. In a way, it’s the socialization process of becoming a doctor. Through socialization, we learn the qualities we have to embody, and the way in which we think, speak, and present ourselves. It's a learning of a way of being. In the process of learning how to be a doctor, it almost necessitates that other parts of yourself fall away, hopefully temporarily.
I think that the process of going into medicine and becoming a doctor inevitably changes you as a person. It's very much a process, and there are elements of the hidden curriculum that shape what is normal, and how we should see the world. My hope is that these interests are things that I can pick back up on the other side. I'm not sure what that will look like, but I think a lot of the skills that have come out of my study of art history and the social sciences have stayed with me, both in caring for patients and in researching around experiences of discrimination.
A lot of the narrative work that comes to the study of social sciences also helps to unpack challenging situations that inevitably arise in medical school and residency and beyond. For me, writing is a way that I unpack and process tough situations.
I don't know that my identity as a student of art history is one that I hold as prominently today as I did during undergrad, but I think the influence on who I am and what I do and how I do things is still there. I don't think it'll be separated. It has attuned me to the human condition and has given me an appreciation for the small moments from which I draw meaning. It doesn't take a lot. It could be one small positive interaction, like a nice moment between parent and child. Moments like that can be energizing. It's hard for me to describe exactly how, but I feel like the social sciences and humanities have given me appreciation for that.
Is there a specific artist that you really liked or resonated with?
There has never been one specific artist - I always have a hard time with favourites!
Is there a piece of art or literature that you would recommend to other people?
There’s a poem from my “How to Be a Doctor” class that stuck with me. It's called “Gaudeamus Igitur.” It is written by a cardiologist, John Stone, who worked at Emory University. It was a poem that he wrote as a commencement speech for a graduating medical school class. To me, that poem captures so much of what medical training and practice is like: the highs and lows, and the full breadth of the experience. I found myself going back to that poem over and over again during my time in medical school.
A couple years ago I read the book A Little Life by Hanya Yanagihara. Without giving too much away, it was an exploration of trauma and the impacts of trauma through a story that was both heart-wrenching and devastating and I can’t recommend it enough. The book has stayed with me to this day as one of the most memorable books I have ever read. One of the great things about literature is that it’s a way of putting ourselves in other people’s shoes, of understanding other people's life experiences. I felt like it gave me a window into the life of someone who's been through a lot of trauma. I thought that was a work of art, so to speak, that has lingered and stuck with me.
In my apartment, I have a painting that I bought from the Covenant House, which is an organization that works to provide street youth with a place to stay, medical care, and skill-building programs. While I was doing a fourth-year elective there, they were selling the art created by youth staying there. The piece I have is an abstract painting with splatters and streaks of silver and gold paint a black and blue backdrop. I was drawn to the combination of colours and textures and the feelings that it evoked. It was a piece that just spoke to me. It’s really hard to capture the feeling in words. Right now it is just hanging in my apartment, and I look at it every once in a while.
Looking forward into the future, how do you see your interest in the humanities, social sciences, art history and photography playing out in your career?
As much as we go through the process of identity formation as we look for a specialty in medical school, that process of identity formation continues in residency. Figuring who we want to be and what kind of impact we want to have on the world is a continuous process. I'm hoping to combine a clinical practice in hospitalist general pediatrics with academic interests. Specifically, I'm interested in doing a PhD in health professions education research, so that I can study the intersection of the hidden curriculum, learning environments, equity, diversity, and inclusion. I’d like to work on projects that have tangible, concrete results that can impact how we structure our learning environments and our patient care in an inclusive and non-discriminatory way. For me, that’s how I have gone about trying to combine all those interests and passions.
For photography, I always thought it would be cool to do a photo project in residency, but there are challenges, so maybe I’ll start this somewhere down the line. I'm hoping to be able to bring all those interests together through my clinical practice, with the focus on relationships and caring for others, and through my research interests, with the focus on injustices and inequities. That is the hope for now.
Do you feel like the culture of medicine is changing with regard to being more open and accepting of interests outside of medicine?
Slowly. I think there’s a formal interest that, in part, comes out of an older movement. In the ‘70s and ‘80s, there was a surge of interest in liberal arts education prior to medical school. Recently, there have been examples of that rearing its head again. For example, in the States, the Mount Sinai School of Medicine used to have a humanities program where second-year undergraduate students who majored in the humanities could have an early guaranteed spot in medical school - I think they’ve expanded it now to the FlexMed program. It's definitely much more of a formal priority to have diversity and inclusion in medicine. When we have a body of doctors that reflects our society, it leads to better outcomes. But to answer your question, I definitely feel like there's a growing appreciation for the humanities and arts in medicine, and a lot of that comes from the students, kind of like what you two are doing with Palette, and the work that ArtBeat and other humanities interest groups are doing.
If you had a message to tell medical students, what advice would you give them?
I think it is important to hold onto your interests. For me, these interests were sources of resilience and rejuvenation throughout med school and gave me energy and life when I was going through challenging experiences. Being involved in things outside of medicine can only make you a better clinician, because your interests give you other ways to connect with patients. I would encourage people to do as many things as possible that excite them, and not do things simply because “they have to be done.”
Find ways to pursue your own interests throughout that process and at the end of the day, it’ll lead you to where you should be. For my HSR project, for example, I ended up exploring the experiences of med students who came from social sciences and humanities backgrounds. It was a qualitative research project where we interviewed medical students who had done some undergraduate or masters work in the arts, and it was fascinating to talk to them. By and large, people with social science and humanities backgrounds would talk about how they felt like they couldn’t bring parts of themselves to medical school, and there were parts of themselves that were devalued both interpersonally and systemically by the way medical school is structured. What I mean by that are the answers to questions like, What's on the test? What's part of the formal curriculum? What's given time? What do people show up for? What does that say about what's important or what's perceived to be important? A lot of people we interviewed talked about how they would self-censor, and would look for spaces outside of medicine to pursue those interests. That was an example of how I took a mandatory school project and turned it into something I was interested in—a question that I wanted to explore. It ended up being a really interesting and fascinating project, and we're hoping to feed that back to the undergraduate medical education committee. And we think a lot of other students who come from underrepresented or marginalized backgrounds probably experience very similar things.
