Sacred Reflection: Creating Space for Moral and Spiritual Formation in the Clinical Years of Medical Education
Elizabeth Rizk, Nicole Piemonte, and Tracy Leavelle, Creighton University School of Medicine, and Joelle Worm, MPA, Kern National Network for Flourishing in Health
For healing to occur in medicine, we must invest in the humanistic development of its trainees. This highlights that wholeness in healthcare cannot exist without intentional spaces for the spiritual, moral, and professional development of trainees. In today’s culture of medical education, marked by burnout, moral injury, and feelings of disillusionment, students frequently encounter suffering, inequity, and ethical distress without structured opportunities to process these experiences. The result is a profound fragmentation of purpose and a silencing of the very humanity that once called them to medicine (Dyrbye et al., 2014; Kinghorn, 2010).
Our initiative, a guided reflection series, directly responds to this crisis by cultivating spaces for medical students of intentional reflection that allows them to grapple with the injustices and difficulties of clinical training. The initiative integrates Jesuit reflection practices with the Kern National Network (KNN) Framework for Flourishing, which emphasizes character, caring, practical wisdom, and wholeness as essential dimensions of medical formation (Maurana et al., 2024). Within these guided reflection sessions, medical students are invited to pause, and to process encounters with suffering and injustice through writing, narrative, and dialogue—and to rediscover their vocation as healers, not merely clinical experts.
Research demonstrates that empathy scores among medical students decline sharply during the third year, coinciding with their first sustained exposures to death, illness, suffering, injustice, and mistreatment as trainees (Dyrbye et al., 2014). Many experience this as a loss of moral agency, leading to disillusionment and detachment from the values that originally drew them to medicine (Coulehan, 2005). Yet, as Piemonte and Kumagai (2019) argue, it is precisely through the medical humanities—story, art, poetry, reflection, and meditation—that trainees can reclaim meaning and reconnect with the humanistic core of their vocation. These creative practices serve as prophetic gestures: countercultural acts of courage and care within systems that often prioritize productivity over presence (Piemonte & Kumagai, 2019; Carson, Burns, & Cole, 2003).
Informed by Ignatian pedagogy, the reflection series draws inspiration from the Examen, a centuries-old practice of contemplative discernment that helps practitioners recognize grace, gratitude, and growth amid the challenges of daily life (Fuchs, Fuchs, & Mescher, 2023). Each session integrates reflective writing, narrative dialogue, and moral discernment, inviting students to engage both the intellect and emotion. Through this process, they cultivate virtues such as humility, integrity, empathy, and courage—traits identified as central to flourishing and professional moral formation (Bryan & Babelay, 2009; Kaldjian, 2025).
We anticipate that preliminary qualitative findings will suggest that these structured reflection groups function as a remedy to the empathy decline and loss of moral agency. As students engage one another’s stories of moral conflict and suffering, they not only make sense of their experiences but also begin to name and challenge the injustices within the systems in which they train. Reflection thus becomes both creative and subversive: a spiritual practice that reclaims the moral imagination of medicine (Piemonte & Kumagai, 2019; Shapiro et al., 2006). By offering space for lament, gratitude, and hope, this work enacts what Bryan and Babelay (2009) describe as “building character through reflective practice,” advancing wholeness and resilience in the face of moral complexity.
As Kaldjian (2025) notes, practical wisdom emerges when knowledge, judgment, and virtue converge in service of the good. This program embodies that synthesis—uniting theologies of vocation with pedagogies of reflection to form physicians who are both clinically excellent and morally grounded. In this sense, reflection is a sacred act: it restores the capacity to discern meaning, witness suffering, and speak prophetically to a broken system (Fatima, 2022; Pearson, 2017).
Ultimately, this initiative illustrates that healing in medicine requires creativity, compassion, and courage—the very elements this conference calls prophetic. Reflection, when framed as ritual, becomes not merely a wellness intervention but a transformative act of moral formation. It restores to medicine its depth of meaning and to medical education its sacred purpose.
Our initiative, a guided reflection series, directly responds to this crisis by cultivating spaces for medical students of intentional reflection that allows them to grapple with the injustices and difficulties of clinical training. The initiative integrates Jesuit reflection practices with the Kern National Network (KNN) Framework for Flourishing, which emphasizes character, caring, practical wisdom, and wholeness as essential dimensions of medical formation (Maurana et al., 2024). Within these guided reflection sessions, medical students are invited to pause, and to process encounters with suffering and injustice through writing, narrative, and dialogue—and to rediscover their vocation as healers, not merely clinical experts.
Research demonstrates that empathy scores among medical students decline sharply during the third year, coinciding with their first sustained exposures to death, illness, suffering, injustice, and mistreatment as trainees (Dyrbye et al., 2014). Many experience this as a loss of moral agency, leading to disillusionment and detachment from the values that originally drew them to medicine (Coulehan, 2005). Yet, as Piemonte and Kumagai (2019) argue, it is precisely through the medical humanities—story, art, poetry, reflection, and meditation—that trainees can reclaim meaning and reconnect with the humanistic core of their vocation. These creative practices serve as prophetic gestures: countercultural acts of courage and care within systems that often prioritize productivity over presence (Piemonte & Kumagai, 2019; Carson, Burns, & Cole, 2003).
Informed by Ignatian pedagogy, the reflection series draws inspiration from the Examen, a centuries-old practice of contemplative discernment that helps practitioners recognize grace, gratitude, and growth amid the challenges of daily life (Fuchs, Fuchs, & Mescher, 2023). Each session integrates reflective writing, narrative dialogue, and moral discernment, inviting students to engage both the intellect and emotion. Through this process, they cultivate virtues such as humility, integrity, empathy, and courage—traits identified as central to flourishing and professional moral formation (Bryan & Babelay, 2009; Kaldjian, 2025).
We anticipate that preliminary qualitative findings will suggest that these structured reflection groups function as a remedy to the empathy decline and loss of moral agency. As students engage one another’s stories of moral conflict and suffering, they not only make sense of their experiences but also begin to name and challenge the injustices within the systems in which they train. Reflection thus becomes both creative and subversive: a spiritual practice that reclaims the moral imagination of medicine (Piemonte & Kumagai, 2019; Shapiro et al., 2006). By offering space for lament, gratitude, and hope, this work enacts what Bryan and Babelay (2009) describe as “building character through reflective practice,” advancing wholeness and resilience in the face of moral complexity.
As Kaldjian (2025) notes, practical wisdom emerges when knowledge, judgment, and virtue converge in service of the good. This program embodies that synthesis—uniting theologies of vocation with pedagogies of reflection to form physicians who are both clinically excellent and morally grounded. In this sense, reflection is a sacred act: it restores the capacity to discern meaning, witness suffering, and speak prophetically to a broken system (Fatima, 2022; Pearson, 2017).
Ultimately, this initiative illustrates that healing in medicine requires creativity, compassion, and courage—the very elements this conference calls prophetic. Reflection, when framed as ritual, becomes not merely a wellness intervention but a transformative act of moral formation. It restores to medicine its depth of meaning and to medical education its sacred purpose.