At the University of Connecticut School of Medicine (Farmington, Connecticut, USA), a program known as Beginning to End (B to E) provides a unique opportunity for medical students to identify examples of less than optimal care and to suggest improvement strategies. Each fourth year student is assigned to follow a patient as an observer throughout the complete hospitalization. The student observes interactions with health professionals and staff that occur in the patient’s room and accompanies the patient when transported to other parts of the hospital for procedures or tests.

Every instance of care that is perceived to be less than optimal is recorded by the student as well as those judged as exemplary. Examples of less than optimal care include detected medication errors, unprofessional behavior, long waiting times for transportation, delayed or incorrect meals, slow nurse response time, poor housekeeping, inadequate pain relief, poor communication, and the like. The log kept by the student is then reviewed with a mentor and corrective approaches discussed. Student observations are systematically fed into the hospital’s quality improvement program.

This exciting B to E project has been in place for some years as part of a major revision of the curriculum and plans are underway to analyze and share the wealth of information gleaned from the student logs through reports and publications.