Fiction is understood to have unique qualities that emotionally engage the reader, making it suitable as a didactic tool in medical education to help students prepare for the emotional aspects of their future profession. To date, however, little is known about the processes through which talking about fiction, film or poetry can help medical students to co-construct emotional reactions as affective stances and how that might contribute to their professional development.

Using a discursive psychology approach, video recordings from 36 fiction seminars collected from 2016 to 2018 were analysed regarding how affective stances related to reading were constructed by medical students. The findings illustrate how students use subject–object relations to account for affective stances, meaning that they attribute their emotional reaction either to an aspect of the book (object-side explanations), or to personal characteristics (subject-side explanations). The way students enact and account for their affective stances can provide opportunities for tutors to create teachable moments for the students. This study contributes to discursive psychology and reader-response research, as well as medical education research.