PurposeAlthough focused reviews have characterized subsets of the literature on the arts and humanities in medical education, a large-scale overview of the field is needed to inform efforts to strengthen these approaches in medicine.

Our findings suggest that to draw meaningful conclusions about reflective capacity as a stable construct in individuals requires 14 writing samples per student, each assessed by four or five raters. This calls into question the feasibility and utility of using reflective writing rigorously as an assessment tool in undergraduate medical education.

Introduction The arts and humanities have transformative potential for medical education. Realizing this potential requires an understanding of what arts and humanities teaching is and what it aims to do. A 2016 review of exclusively quantitative studies mapped three discursive positions (art as intrinsic to, additive to or curative for medicine) and three epistemic functions (art for mastering skills, perspective taking, and personal growth and activism). A more inclusive sample might offer new insights into the position and function of arts and humanities teaching in medical education. Methods Informed by this 2016 framework, we conducted discursive and conceptual analyses of 769 citations from a database created in a recent scoping review. We also analyzed the 15 stakeholder interviews from this review for recurring themes. These three analyses were iteratively compared and combined to produce a model representing the complex relationship among discursive functions and learning domains. Results The literature largely positioned arts and humanities as additive to medicine and focused on the functions of mastering skills and perspective taking. Stakeholders emphasized the intrinsic value of arts and humanities and advocated their utility for social critique and change. We offer a refined theory of practice—the Prism Model of four functions (mastering skills, perspective taking, personal insight and social advocacy)—to support more strategic use of arts and humanities in medical education across all learning domains. Discussion The Prism Model encourages greater pedagogical flexibility and critical reflection in arts and humanities teaching, offering a foundation for achieving its transformative potential.

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In special sections such as this one (A Piece of My Mind), leading medical journals publish physicians' narrative anecdotes. These narratives offer a unique window onto the practice of medicine, and, in a context of current concerns about physician wellness and rising rates of burnout, 1 they may constitute an untapped resource for understanding how physicians perceive their personal and professional challenges. Using a narrative inquiry approach, 2 we explored the stories that physicians spontaneously chose to tell about the practice of medicine in narrative sections of medical journals, focusing on the lessons conveyed, the narrative strategies used to convey them, and the relationships between the two.We read all 158 narrative reflections published in the corresponding sections of JAMA (A Piece of My Mind), the New England Journal of Medicine (Perspective), and the Annals of Internal Medicine (On Being a Doctor) between May 2011 and July 2013, with no exclusions. We selected these journals because they published the most reflective narratives among a list of medical journals surveyed, 3 all with high impact factors and space devoted to physicians' stories. While editorial direction likely influences the content and nature of these published stories, author instructions and reviewer guidelines in these journals are broad and general; therefore, the 158 narrative reflections we selected likely represent a reasonable spectrum of views and perspectives. Guided