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All of us have an "inner life" that forms the core of who we are. It shapes and is shaped by our actions and experiences. During physician training, attention to residents' inner life requires a focus on their beliefs and emotions as well as their ethical and spiritual development, topics often considered to be outside the realm of clinical training and practice. We suggest that written reflections, as part of medical residency curriculum, can allow residents to explore their inner lives. The depth and range of residents' explorations show the value of adding brief, protected time for residents to explore their hopes, joys, struggles, and feelings, and to develop meaning from their experiences with patients. 3 Answering these questions also contributes to personal and professional empowerment and flourishing, 4 which is living and functioning that integrates goodness, generativity, growth, and resilience. 5 We suggest that promoting reflection can cultivate physicians' inner lives and nurture personal growth in ways that measuring clinical prowess neglects. CULTIVATING REFLECTION IN RESIDENCY TRAININGIn medical education, written reflective exercises are used to assess learners' critical thinking skills, clinical reasoning, and metacognition about professionalism. 6 We introduced reflective writing into a family medicine residency to nurture self-development without using it as an assessment method. Three times a week in 15-minute slots in their family medicine clinic schedules, residents wrote written reflections about their experiences with patients. We did not provide specific writing prompts. Residents wrote for their own growth, not for a grade. Following residents' graduation we removed identifying information and analyzed written reflections for thematic content. 7,8 We discovered some of these writings reflected the struggles residents' experience, not only in their clinical practices, but also in their personal development. In these reflections residents indicated attentiveness to expressions of their longings and desires, their self-doubt and feelings of helplessness. These writings (paraphrased to disguise identifying details)

We consider spatio-temporal data and functional data with spatial dependence, characterized by complicated missing data patterns. We propose a new method capable to efficiently handle these data structures, including the case where data are missing over large portions of the spatio-temporal domain. The method is based on regression with partial differential equation regularization. The proposed model can accurately deal with data scattered over domains with irregular shapes and can accurately estimate fields exhibiting complicated local features. We demonstrate the consistency and asymptotic normality of the estimators. Moreover, we illustrate the good performances of the method in simulations studies, considering different missing data scenarios, from sparse data to more challenging scenarios where the data are missing over large portions of the spatial and temporal domains and the missing data are clustered in space and/or in time. The proposed method is compared to competing techniques, considering predictive accuracy and uncertainty quantification measures. Finally, we show an application to the analysis of lake surface water temperature data, that further illustrates the ability of the method to handle data featuring complicated patterns of missingness and highlights its potentiality for environmental studies.

Patients share straightforward statements with physicians such as describing their fears about their diagnosis. Physicians need to also understanding implicit, indirect, subtle communication cues that give broader context to patients' illness experiences. This project examines physicians' written reflections that offer insight into their interpretation of both the stated and the tacit aspects of their observations about communication, their resulting responses, and their intended actions. Tufts University Family Medicine residents (N = 33) of the Tufts Family Medicine Cambridge Health Alliance completed three reflective exercises each week over the course of 1 year (756 reflective entries). An interdisciplinary research team identified communication-related concepts within the reflections. Identified themes include (a) physicians recognizing and discovering mutual interplay of their communication with and patient disclosure, (b) physicians paying attention to subtleties of patient behavior as indicative of a fuller picture of patients' lives and their coping with illness, and (c) physician images of growth and awareness about communication indicative of their potential for growth and improvement. The project extends the literature in communication and medical education by examining explicit and tacit points of reflection about communication. The project (a) allows for unpacking the multifaceted aspects of reflection and (b) bridges reflective theory and medical education with communication foundations.

This qualitative study introduces the broad and inclusive concept of the "inner life of physicians" and analyzes the written reflections (N = 756) of family medicine residents (N = 33) during their residency as indicative of the physicians' inner lives. Residents completed reflective entries without specific prompts. Researchers describe unsolicited emergent categorical themes indicative of a robust inner life of the physician. Nurturing physicians' inner life through reflection allows physicians to recognize, identify, and respond to daily emotional events. Reflections about the state of physicians' inner lives can formulate and express fundamental human questions that concern: (a) troubling human experiences (e.g., suffering, death, luck, destiny, and death); (b) questions that surface in practicing their profession; (c) spiritually explicit questions on their beliefs and practices. Physicians' inner lives can become a "place" where physicians look for answers and explore options for dealing with their human and professional challenges, thus enhancing the humanistic aspects of medical practice.