As second-year medical students, the transition from the classroom to the clinic is sudden. In preparation, we visit with patients to learn a fundamental, yet complex part of medicine: the history and physical exam. Each time, we modify our approach, changing it slightly from the previous session. This time, a more thorough history of present illness; next time probe the patient’s drug and alcohol abuse. There are endless changes to make as we learn, and undoubtedly, as medical students, we spend our entire careers tweaking our approach. But when do we learn how to evaluate our approaches to determine, what is working? How do we best implement changes, and, importantly, how do we measure improvement when there are not clear metrics? As students, we could learn this fund of knowledge early in our training so that we are prepared to improve the systems in which we practice medicine. If we begin to apply a methodology to our small tests of change as medical students, our future impact on the safety …