Direct, covert observation of health care is a novel and underutilized tool to assess health care trainees and clinicians. In this episode we talk with experts about two such approaches: the unannounced standardized patient and patient-collected audio. In the former, actors are sent incognito into practice settings, and in the latter real patients volunteer to record their visits on behalf of a quality improvement team.  Both approaches address the question, “How are our learners and experienced clinicians performing in the real world?” They also identify those who may do well on simulations but underperform in the clinical setting. As one of our guests observed, “If McDonalds is using secret shoppers to improve services, shouldn’t we be doing the same in health care (but with a lot more rigor) where the stakes are so much higher?”