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Medical schools have increased their use of the humanities (visual arts, performing arts, literature, writing, film) to support teaching of content such as communication, empathy, bias, stigma, and relationships with patients and families. While such content is highly relevant to the work of physicians and to the professional identity formation of medical students, the prevalent methods of assessing students and evaluating medical education activities may not be the best fit for humanities-based education. Tensions may arise between the post-positivist philosophical assumptions that underlie much of medicine, in which educators teach and assess with one-right-reality epistemology, and epistemologies that consider multiple realities and interpretations, all equally valid, as reflected in much of the humanities.