how to pass a case study interview

Secrets to a successful case-study interview

January 9, 2023

Prepping for (and maybe fretting) the case-study interview?

While this kind of interview may appear intimidating, consider this: The interviewer really wants you to do well.

So, shake off the nerves, relax and have fun.

Tips for standing out in the case-study interview: 

• Take your time; don't rush it.  Talk through the problem. If you can't make sense of it, take a moment and allow yourself some time to process what you've been missing. If you get stuck, get creative. Don't let yourself get bogged down; rely on your ingenuity. 
• Ask questions.  You can always ask your interviewer to define an acronym or to repeat or confirm details. If the interviewer asks, “How do we achieve success?”, don’t be afraid to ask, “What does ‘success’ mean to you? Is it turning a profit? Raising the company’s profile?” When you work on a client project, you need to ask questions to figure out what the problems might be, and the same applies here. The interviewer is your biggest asset in the room. They have the information you need to “solve the case” successfully. Use them wisely!
• Be flexible.  The focus of a case-study interview may vary. So, be prepared to participate in whatever discussion the interviewer has in mind. They may spend the first half of the interview asking about your previous experience, or they may dive right into the case study at the start. The bottom line: Be flexible, and be ready to discuss the work you do and how you do it.
• Use visual aids.  Don’t be afraid to use pen and paper, sketch out your thoughts, and talk through the problem at hand if it helps you get your ideas across. What matters most is demonstrating that you can solve problems.
• Focus on impact.  Inventory the information you have, and then dive in where you can have the most impact. Don’t forget to discuss your thought process and explain your assumptions.
• Tell a story.  Your experience has helped you progress in your career and education; use that experience. For example, in a business case study, you could bring your experience as a traveler to a case about a hypothetical airline. Your individuality is important. Your unique insights will serve you well when you’re interviewing.
• Pay attention to cues.  If the interviewer says something, it probably means something. Don’t dismiss seemingly extraneous details. For example, the interviewer might say, “The case is about a retailer who wants to increase the value of a company it purchased, and the owner loved the brand when growing up.” The purpose of that detail is to indicate that turning around and selling the asset is not an option for making it profitable, because the owner is attached to it.

Preparing for the job you want can take time, but it’s a worthwhile investment—especially when you receive an offer.

Your ideas, ingenuity and determination make a difference. 

Find your fit  with Accenture. 

Stay connected

Explore open roles that match your interests and skills.

Keep up to date

Get the latest stories delivered to your inbox. Select "Life at Accenture" on the registration form.

Get job alerts

Receive notifications when we have open roles and get other relevant career news.

Anaam Zamorano

RECRUITING ASSOCIATE MANAGER, HOUSTON, TEXAS

• Hacking the Case Interview

This is a complete guide to case interviews for beginners. Whether you have no idea what a case interview is or have just started preparing for consulting interviews, we’ll walk you through the case interview fundamentals.

Case interviews can seem complicated, confusing, and difficult to learn. However, with the right knowledge and strategies, case interviews can be fairly straight forward and mastered by anyone.

In this complete guide to case interviews for beginners, we’ll cover:

Introduction to Case Interviews

Purpose of case interviews, key components of a case interview, types of case interviews, case interview preparation strategies for beginners, case interview practice cases for beginners, common case interview beginner mistakes to avoid, case interview beginner tips for success, beginner case interview resources for further learning.

If you’re looking for a step-by-step shortcut to learn case interviews quickly, enroll in our case interview course . These insider strategies from a former Bain interviewer helped 30,000+ land consulting offers while saving hundreds of hours of prep time.

What is a case interview?

Case interviews are a special type of interview that every single consulting firm uses. They are almost exclusively used by consulting firms, although some companies with ex- consultants may also use them.

A case interview, also known as a “case” for short, is a 30 to 60-minute exercise in which you and the interviewer work together to develop a recommendation or answer to a business problem.

These business problems can be anything that real companies face:

• How can Amazon increase its profitability?
• What can Apple do to increase customer retention?
• How should Tesla price its new electric vehicle?
• Where should Disney open another Disneyland theme park?

Case interviews simulate what the consulting job will be like by placing you in a hypothetical business situation. Cases simulate real business problems that consulting firms solve for their clients. Many case interviews are based on actual projects that interviewers have worked on.

While consulting projects typically last between 3 to 9 months, case interviews condense solving the business problem into just 30 to 45 minutes.

Case interviews can cover any industry, including retail, consumer packaged goods, financial services, energy, education, healthcare, government, and technology.

They can also cover a wide range of business situations, including entering a new market, launching a new product, acquiring a company, improving profitability, and growing revenues.

Although case interviews cover a wide range of industries and business situations, no technical or specialized knowledge is needed.

Unless you are interviewing for a consulting firm that specializes in a particular industry or function, cases are designed to be solved by someone that has general business knowledge.

Nailing your case interviews is critical to getting  into consulting . There is no way to get a consulting job offer without passing your case interviews.

What are examples of a case interview?

Here is an example of what a perfectly solved case interview looks like:

Here is another example of what a case interview looks like. This case interview is one where the interviewer leads most of the interview.

Here is a third example of a case interview. In this case interview, the candidate leads most of the interview. We’ll cover the difference between interviewer-led and candidate-led case interviews later in the article.

Finally, here is a fourth example of what a case interview looks like. This case is primarily focused on market sizing. We’ll cover what market sizing is and how to solve it later in the article.

Why are case interviews used?

Case interviews are the best way for consulting firms to predict which candidates will make the best consultants. Case interviews do not predict this perfectly, but they come quite close.

Since case interviews simulate the consulting job by placing you in a hypothetical business situation, interviewers use case interviews to see how you would perform as a hypothetical consultant.

Many of the skills and qualities needed to successfully complete a case interview are the same skills and qualities needed to successfully finish a consulting case project.

Case interviews also give you a sense of whether you would like the consulting job. If you find case interviews interesting and exciting, you’ll likely enjoy consulting. If you find case interviews dull and boring, consulting may not be the best profession for you.

What do case interviews assess?

Case interviews assess five different qualities or characteristics: logical and structured thinking, analytical problem solving, business acumen, communication skills, and personality and cultural fit.

1. Logical and structured thinking : Consultants need to be organized and methodical in order to work efficiently.

• Can you structure complex problems in a clear, simple way?
• Can you take tremendous amounts of information and data and identify the most important points?
• Can you use logic and reason to make appropriate conclusions?

2. Analytical problem solving : Consultants work with a tremendous amount of data and information in order to develop recommendations to complex problems.

• Can you read and interpret data well?
• Can you perform math computations smoothly and accurately?
• Can you conduct the right analyses to draw the right conclusions?

3. Business acumen : A strong business instinct helps consultants make the right decisions and develop the right recommendations.

• Do you have a basic understanding of fundamental business concepts?
• Do your conclusions and recommendations make sense from a business perspective?

4. Communication skills : Consultants need strong communication skills to collaborate with teammates and clients effectively.

• Can you communicate in a clear, concise way?
• Are you articulate in what you are saying?

5. Personality and cultural fit : Consultants spend a lot of time working closely in small teams. Having a personality and attitude that fits with the team makes the whole team work better together.

• Are you coachable and easy to work with?
• Are you pleasant to be around?

All of these five qualities can be assessed in just a 30 to 60-minute case interview. This is what makes case interviews so effective in assessing consulting candidates.

What companies give case interviews?

Case interviews are primarily used by management consulting firms (e.g., McKinsey, BCG, and Bain), but they are also used by some technology companies (e.g., Meta, Google) and private equity firms (e.g., KKR, Blackstone) that have a lot of ex-consultants.

Management consulting firms that give case interviews

• EY-Parthenon
• PwC and Strategy&
• Roland Berger
• Oliver Wyman

Technology companies that give case interviews

• Microsoft (including LinkedIn)
• Capital One

Private equity firms that give case interviews

• The Blackstone Group
• Bain Capital

When are case interviews given?

Case interviews are given in nearly every single round of interviews. During first round consulting interviews expect 1-2 case interviews. During final round consulting interviews , expect another 2-4 case interviews.

The only round of interviews that will not have a case interview is the initial phone screen with a recruiter. They will ask primarily resume and behavioral interview questions.

First round interviews are heavily focused on case interviews. There will typically be few behavioral or fit interview questions asked. Each case interview is typically 30 to 40 minutes each. Behavioral or fit interview questions may take up less than 10 minutes.

Final round interviews have a bit more focus on behavioral and fit interview questions, but the vast majority of time is still spent on case interviews. Each case interview is typically 40 to 60 minutes each. Behavioral or fit interview questions may take up to 40 minutes.

As you can see, case interviews are the primary way that management consulting firms assess and select candidates.

There are seven key components or steps of a case interview: understanding the case background, asking clarifying questions, structuring a framework, kicking off the case, solving quantitative problems, answering qualitative questions, and delivering a recommendation.

1. Understanding the case background

The case interview will begin with the interviewer giving you the case background information. Let’s say that the interviewer reads you the following:

Interviewer: Our client, Coca-Cola, is a large manufacturer and retailer of non-alcoholic beverages, such as sodas, juices, sports drinks, and teas. They have annual revenues of roughly $30 billion and an operating margin of roughly 30%. Coca-Cola is looking to grow and is considering entering the beer market in the United States. Should they enter?

As the interviewer reads this, take notes. It is important to understand what the objective of the case is and keep track of information.

One strategy for taking notes effectively is to turn your paper landscape and draw a vertical line to divide your paper into two sections. The first section should be roughly two-thirds of the page while the second section will be one-third of the page.

Take notes in the second section of your page:

After the interviewer finishes giving the case background information, confirm that you understand the situation and objective. Provide a concise synthesis like the following:

You: To make sure I understand correctly, our client, Coca-Cola, is a large manufacturer and retailer of non-alcoholic beverages. They are looking to grow and our objective is to determine whether or not they should enter the U.S. beer market.

Interviewer: That sounds right.

Make sure your synthesis is concise. You do not want to regurgitate verbatim everything that the interviewer has said. Only mention the most important pieces of information.

You should also make sure you verify the objective of the case. Answering or solving the wrong case objective is the quickest way to fail a case interview.

2. Asking clarifying questions

Next in the case interview, you’ll have the opportunity to ask questions before you begin thinking about how to solve the case.

At this point, only ask questions that are critical for you to fully understand the case background and objective. You’ll be able to ask more questions later.

Types of questions you should ask:

• Asking for a definition of a term you’re unfamiliar with
• Asking for information that strengthens your understanding of the company or situation
• Asking questions that clarify the objective of the case
• Asking to repeat information you may have missed

You might ask a few questions like the following:

You: Is Coca-Cola looking to specifically grow revenues or profits?

Interviewer: Coca-Cola wants to grow profits.

You: Is there a particular financial goal or metric Coca-Cola is trying to reach within a certain time frame?

Interviewer: They are looking to grow annual profits by $2 billion within 5 years.

You: Great. Those are all the immediate questions I have for now.

3. Structuring a framework

After you understand the case background and objective of the case interview, lay out a framework of what areas you want to look into in order to answer or solve the case.

A case interview framework is simply a tool that helps you structure and break down complex problems into simpler, smaller components. Think of a framework as brainstorming different ideas and organizing them into different categories.

When creating a framework, it is completely acceptable to ask the interviewer for a few minutes of silence to write out a framework.

You: Would you mind if I take a few minutes to structure my thoughts and develop a framework to tackle this case?

Interviewer: Of course, go ahead.

For this case example, what do you need to know in order to help Coca-Cola decide whether or not they should enter the beer market?

You might brainstorm the following questions:

• Does Coca-Cola know how to produce beer?
• Would people buy beer made by Coca-Cola?
• Where would Coca Cola sell its beer?
• How much would it cost to enter the beer market?
• Will Coca-Cola be profitable from doing this?
• How can Coca-Cola outcompete competitors?
• What is the market size of the beer market?

This is not a very structured way of tackling the case, so organize these ideas into a framework that has 3 – 4 broad areas, also called “buckets”, that you want to investigate.

An easy way to develop these buckets is to ask yourself, what 3 – 4 things must be true for you to 100% recommend that Coca-Cola should enter the beer market.

In an ideal world. These four things would need to be true:

• The beer market is an attractive market with high profit margins
• Competitors are weak and Coca-Cola will be able to capture significant market share
• Coca-Cola has the capabilities to produce an outstanding beer product
• Coca-Cola will be extremely profitable

You can rephrase these points to be the broad categories in your framework. You can write your framework in the first section of your paper:

Next, let’s add a few bullets under each category to give more detail on exactly what information we need to know to decide whether Coca-Cola should enter the beer market.

This entire process of brainstorming ideas and developing a structured framework should only take a few minutes.

How do you come up with a framework so quickly?

Most candidates make the mistake of either using a single memorized framework for every case or memorizing multiple different frameworks for different cases.

The issue with memorized frameworks is that they aren’t tailored to the specific case you are solving for. When given an atypical business problem, your framework elements will not be entirely relevant.

Interviewers can easily tell that you are regurgitating memorized information and not thinking critically.

Instead of memorizing frameworks, I recommend memorizing a list of 8 - 10 broad business elements, such as the following:

When given a case, mentally run through this list and pick the 3-4 elements that are most relevant to the case. This will be your framework. If the list does not give you enough elements, brainstorm and add your own elements to your framework.

This strategy guarantees that your framework elements are relevant to the case. It also demonstrates that you can create unique, tailored frameworks for every business problem.

Using this strategy for this case, you would run through your list of memorized business elements and select the following:

This strategy is a shortcut for creating unique tailored frameworks for every business problem. You do not need to develop a framework entirely from scratch every time.

Now that you have your framework, turn your paper to face the interviewer and walk them through it.

You: To decide whether or not Coca-Cola should enter the market, I want to look into four main areas.

One, I want to look into the beer market attractiveness. Is this an attractive market to enter? I’d want to look into areas such as the market size, growth rate, and profit margins.

Two, I want to look into the beer competitive landscape. Is this market competitive, and will Coca-Cola be able to capture meaningful market share? I want to look into questions such as the number of competitors, how much market share each competitor has, and whether competitors have any competitive advantages.

Three, I want to look into Coca-Cola’s capabilities. Do they have the capabilities to succeed in the beer market? I want to look into things such as whether they have the expertise to produce beer, whether they have the distribution channels to sell beer, and whether there are any existing synergies they can leverage.

Four, I want to look into expected profitability. Will Coca-Cola be profitable from entering the beer market? I want to look into areas such as expected revenues, expected costs, and how long it would take to break even.

The interviewer might ask a few questions on your framework, but will otherwise indicate whether they agree or disagree with your approach.

For a complete guide on how to create tailored and unique frameworks for each case, check out our article on case interview frameworks .

4. Kicking off the case

If this is an interviewer-led case, the interviewer will propose which area of your framework they would like to dive deeper into. They might say something like the following:

Interviewer: Your framework makes sense to me. Why don’t we start by estimating the size of the U.S. beer market.

If this is a candidate-led case, you will be expected to propose an area to look into. There is no right or wrong area to start first. Propose any area of your framework as long as you have a reason for it.

You could say something like:

You: To start, I’d like to look into the beer market attractiveness. I’d like to first understand the market size to determine if the beer market is an attractive market.

If you end up picking an area that the interviewer does not want you to explore, they will redirect you to an area that they do want you to explore.

The two styles of case interviews are nearly identical. The only difference is whether or not you have to proactively propose what area to explore first and what area you want to explore next.

5. Solving quantitative problems

Expect to perform calculations and analyze charts and graphs during your case interview.

Market sizing questions are one type of quantitative question you may get asked.

Let’s say the interviewer asks you:

Interviewer: What is the market size of beer in the U.S.?

Most candidates jump right into the math, stating the U.S. population and then performing various calculations. Doing math without laying out a structure often leads to making unnecessary calculations or reaching a dead-end.

Laying out an upfront approach helps avoid these mistakes and demonstrates that you are a logical, structured thinker.

For this market sizing problem, you could structure your approach in the following way:

• Start with the U.S. population
• Estimate the percentage that are legally allowed to drink alcohol
• Estimate the percentage that drink beer
• Estimate the frequency in which people drink beer
• Estimate the average price per can or bottle of beer

Multiplying these steps together gives you the answer. By laying out an approach up front, the interviewer can easily understand how you are thinking about the problem. With the right structure, the rest of the problem is simple arithmetic.

Sometimes the interviewer will give you numbers to use for these calculations. Other times, you’ll be expected to make assumptions or estimates.

When performing your calculations, make sure to do them on a separate sheet of paper. Calculations often get messy and you want to keep your original paper clean and organized.

A sample answer to this question could look like this:

You: To estimate the market size of beer in the U.S., I’m going to start with the U.S. population. Then, I’ll estimate the percentage that are eligible to drink alcohol. I’ll then estimate the percentage of the remaining population that drinks beer.

If we take this and multiply it by the frequency in which people drink beer and the average price per can or bottle of beer, we will find an estimate for the market size. 

Does this approach make sense to you?

Interviewer: Makes sense to me.

You: Great. I’ll assume the U.S. population is 320M people. Assuming the average life expectancy is 80 years old and an even distribution of ages, roughly 75% of the population can legally drink alcohol.

This gives us 240M people. Of these, let’s assume 75% of people drink beer. That gives us 180M beer drinkers.

Let’s say on average, a person drinks five beers a week, or roughly 250 beers per year, assuming roughly 50 weeks per year.

This gives us 180M * 250 = 45B cans or bottles of beer.

Assuming the average can or bottle of beer costs $2, this gives a market size of $90B.

You should not only answer the question, but tie the answer to the case objective.

In other words, how does knowing the U.S. market size of beer help you decide whether or not Coca-Cola should enter the market?

You could say something like the following:

You: Given that Coca-Cola has annual revenues of $30B, a $90B beer market represents a massive opportunity. The market size makes the beer market look attractive, but I’d like to understand if beer margins are typically high and determine how much market share Coca-Cola could realistically capture.

A second type of quantitative question you could be asked is to calculate profit or profitability. The interviewer may ask you:

Interviewer: Assume that a 12-ounce can of beer sells for $2 on average. To produce a keg of beer, it costs $100 for raw materials, $95 for labor, and $75 for storage. If a keg of beer holds 1,800 oz. of beer, what is the profit margin for beer?

Make sure you structure your approach and connect your answer to the case objective.

A sample answer could look like:

You: To calculate the profit margin for beer, I will first calculate the total costs to produce a keg of beer. Next, I will divide the volume of a keg by the volume of a can to determine how many cans a keg of beer produces.

Afterwards, I will divide the total cost of producing a keg of beer by the number of cans in a keg of beer to determine the cost per can.

Finally, I can use the price and cost per can of beer to calculate the margin of beer. Does this approach make sense to you?

You: Great. The total cost of a keg of beer is $100 plus $95 plus $75, or $270. The number of cans of beer in a keg is 1,800 oz. divided by 12 oz., or 150 cans.

Therefore, the cost per can of beer is $270 divided by 150 cans, or $1.80. Since the average price of beer is $2 per can, the profit is $0.20 per can. This makes the margin $0.20 divided by $2 or 10%.

Compared to Coca-Cola’s overall operating margin of 30%, the beer market profit margin of 10% is significantly lower. Although the market size for beer is large, the low margin makes the beer market less attractive.

A third type of quantitative question you could get asked is interpreting charts and graphs. The interviewer may show you the following:

A helpful strategy is to start your analysis by explaining what the axes of the chart show. This will help you understand the chart better.

Next, don’t just read what numbers the chart shows, but interpret what those numbers mean for the case objective.

A sample answer might look like the following:

You: For this chart, we have market share on the y-axis and different categories of beer on the x-axis. For each category, we see that market share is concentrated among a few large players. This implies a highly competitive market with high barriers to entry. Because of this, the beer market does not look attractive because it is so competitive.

6. Answering qualitative questions

In addition to asking quantitative questions during the case interview, the interviewer will also ask qualitative questions.

One type of qualitative question you could get asked are brainstorming questions. For example, the interviewer might ask:

Interviewer: What are the barriers to entry in the beer market?

Most candidates answer by listing ideas that immediately come to mind:

• Brewing equipment
• Beer production expertise
• Distribution channels

This is a highly unstructured way of answering the question. Make sure to use a simple structure to organize your thoughts.

A simple structure, such as thinking about barriers to entry as either economic barriers or non-economic barriers, helps facilitate brainstorming and demonstrates logic and structure.

With this structure, you might come up with the following answer:

Have a simple structure when answering qualitative questions. Examples of other simple structures to use include the following:

Additionally, take your answer and connect it to the case objective. In this example, are these barriers to entry high or low? Do you think Coca-Cola can overcome these obstacles to enter the beer market?

You might answer this question in the following way:

You: I’m thinking of barriers to entry as economic barriers and non-economic barriers. Economic barriers include things such as equipment, raw material, and other capital. Non-economic barriers include: beer brewing expertise, brand name, and distribution channels.

Looking at these barriers, I think it will take Coca-Cola a lot of work to overcome these barriers. While Coca-Cola does have a brand name and distribution channels, they lack beer brewing expertise and would have to buy a lot of expensive equipment and machinery. These barriers make entering the beer market difficult.

Another type of question you could get asked are business opinion questions, such as the following:

Interviewer: Do you think there are significant production synergies in producing non-alcoholic beverages and producing beer?

As always, structure your answer and connect your answer to the case objective.

Here is a sample answer:

You: Production involves equipment, raw materials, and labor. There is likely some overlap in equipment, such as using the same bottling machines, but Coca-Cola will likely need new equipment for brewing beer.

Raw materials, on the other hand, are completely different. Coca-Cola will need to source barley, hops, and yeast, which it currently does not use in its existing beverages.

Finally, the same labor can be used, but employees will need new training since producing beer is fairly different from producing a non-alcoholic drink.

Overall, I think there are only a few production synergies that Coca-Cola can leverage, which makes entering the market a bit more difficult.

7. Delivering a recommendation

You’ve done a ton of work so far in the case interview and now it is time to put everything together into a recommendation.

Throughout the interview, you should have been making notes of key takeaways after each question you answer.

Take a look at the key takeaways you’ve accumulated so far and decide whether you want to recommend entering the beer market or not entering the beer market:

• The U.S. beer market size is $90B compared to Coca-Cola’s annual revenue of $30B
• The beer market profit margins are 10% compared to Coca-Cola’s average margin of 30%
• The beer market is highly concentrated across all categories
• Barriers to entry are moderate
• There are some synergies with existing production

There is no right or wrong recommendation, as long as you support your recommendation with reasons and evidence.

Regardless of what stance you take, make sure you have a firm recommendation. You do not want to be flimsy and switch back and forth between recommending entering the market and not entering the market.

Secondly, make sure your recommendation is clear and concise. Use the following structure:

• Clearly state what your recommendation is
• Follow that with the 2 - 3 reasons that support your recommendation
• State what potential next steps would be to further validate your recommendation

The conclusion of the case might look like the following:

Interviewer: Let’s say that you bump into the CEO of Coca-Cola in the elevator. He asks you what your preliminary recommendation is. What do you say?

You: I recommend that Coca-Cola should not enter the U.S. beer market for the following three reasons.

One, although the market size is fairly large at $90B, the margins for beer are just 10%, significantly less than Coca-Cola’s overall operating margin of 30%.

Two, the beer market is very competitive. In all beer segments, market share is concentrated among a few players, which implies high barriers to entry. Coca-Cola lacks beer brewing expertise to produce a great product that existing incumbents have.

Three, there are not that many production synergies that Coca-Cola can leverage with its existing products. Coca-Cola would need to buy new equipment, source new raw materials, and provide new training to employees, which will be time-consuming and costly.

For next steps, I want to look into Coca-Cola’s annual expected profits if they were to enter the U.S. beer market. I hypothesize that they will be unable to achieve an increase in annual profits of $2B within five years, but I’d like to confirm this through further analysis.

What are the different types of case interviews?

Case interviews cover a wide variety of functions and business situations. However, there are six common case interview business situations that account for the majority of all case interviews: profitability, market entry, growth, pricing, merger and acquisition, and new product.

There is a very high chance that you’ll see these types of case interviews in your first-round and final-round consulting interviews.

1. Profitability case interviews

Profitability cases ask you to identify why a company is experiencing a decline in profitability and what they should do to address it. This is the most common business situation for case interviews.

To solve these types of cases, you’ll need to understand quantitatively, what is the driver causing the decline in profits? You will need to determine whether revenues have gone down, costs have gone up, or both have occurred.

Afterwards, you’ll need to understand why this is happening. Once you understand this, you can brainstorm potential ideas and prioritize the solutions that are the most impactful and feasible to implement.

2. Market entry case interviews

Market entry cases ask you to determine whether a company should enter a new market. This is the second most common business situation for case interviews.

To make this decision, you’ll need to assess whether the market is attractive, how strong competitors are, whether your company has the capabilities to enter, and what the expected profitability is.

3. Growth case interviews

Growth cases ask you to determine how a company can best increase its revenues.

To solve this case, you’ll need to identify all of the major ways the company can grow.

Should the company grow organically by targeting new geographies or customer segments?

Should they grow by launching new products and services?

Instead, should the company grow inorganically by acquiring or forming a partnership with another company?

Once you have identified all of the major opportunities for growth, you can prioritize the opportunities that are the most impactful and feasible.

4. Pricing case interviews

Pricing cases ask you to determine how to set the optimal price on a product or service. To do this, you’ll need to consider different factors.

How much does the product cost to produce? You don’t want to price the product too low such that you have a loss on each sale.

How much are customers willing to pay for the product? You don’t want to price the product too high such that no customer is willing to purchase your product.

How much are competitors setting prices for similar products? You don’t want to price the product too high such that customers choose to purchase competitor products.

Considering each of these points will help you determine the right price to set.

5. Merger and acquisition case interviews

Merger and acquisition cases ask you to determine whether a particular company should be acquired.

To solve this case, you’ll first need to understand what the reason is for the acquisition. In most cases, the company will be looking to grow its revenues and profits.

Then, you’ll need to assess whether the market that the acquisition target plays in is attractive, whether the acquisition target itself is attractive, whether there will be any meaningful synergies, and whether the financials of the acquisition make sense.

These considerations will help you determine whether the acquisition should be made.

6. New product case interviews

New product cases ask you to determine whether a company should create and launch a particular new product.

To solve this case, you’ll need to assess whether the product’s market is attractive, whether the product meets customer needs, whether the product is superior to competitor products, whether the company has the capabilities to create and launch the product, and what the expected profitability is.

These considerations will help you make a smart and informed decision.

W hat are the different formats of case interviews?

There are three major formats of case interviews: traditional case interviews, written case interviews which assess presentation and communication skills more heavily and group case interviews which assess teamwork and collaboration more heavily.

1. Traditional Case Interview

The traditional case interview is the format that accounts for 80 to 90 percent of all case interviews. It is the format we have covered so far in which you and the interviewer work together to develop a recommendation or answer to a business problem.

The traditional case interview starts with the interviewer explaining the case background information to you. The case interview ends after you have delivered your recommendation to the interviewer.

There are two styles of traditional case interviews, candidate-led case interviews and interviewer-led case interviews.

• Candidate-led case interviews : You will be driving the direction of the case. You will propose what area of your framework to start in, what questions you would want to answer, what analyses you would want to do, and what the next step is to solve the case. If you go down the wrong direction, the interviewer will steer you back on course, but you ultimately decide what to do next.
• Interviewer-led case interviews : The interviewer will be steering and controlling the direction of the case. The interviewer will point you to which questions to answer, what analyses to do, and what the next step is to solve the case.

2. Written Case Interview

Written case interviews are much less common than traditional case interviews.

For written case interviews, you will be given a packet of information at the beginning of the interview. This packet usually has between 20 to 40 pages of graphs, charts, tables, and notes. You’ll be given information on the case background and the objective of the case.

In some written case interviews, you may also be given a list of important questions to answer. In other written case interviews, you’ll only be given the primary business problem you are asked to answer.

You’ll then have 1 to 2 hours to analyze the information packet and then make 3 to 5 slides to present your analysis and recommendation to the interviewer.

In some written case interviews, you’ll have to create these slides completely from scratch. In other written case interviews, you’ll have pre-filled slide templates that you will fill out with your analysis and work.

For written case interviews, you’ll be working by yourself. The interviewer will leave the room to let you work and then return when time is up to hear your presentation. During the presentation, the interviewer may ask follow-up questions on your work and findings.

3. Group Case Interview

Group case interviews are also much less common than traditional case interviews.

For group case interviews, you’ll be put into a group of 3 to 6 people with other candidates that are also interviewing for the same consulting job you are interviewing for. The group will be given materials which contain the case background, objective, and all of the information needed to solve the case.

You’ll then have 1 to 2 hours to work together as a group to create a slide presentation that summarizes your work and recommendation.

During this time, the interviewer will be listening in on the discussions and conversations that the group will have, but they will not interfere or answer any questions.

Once the time is up, your group will deliver your presentation to the interviewer, who may also ask follow-up questions on the work and findings.

For group case interviews, there is a heavy emphasis on assessing how well you work in a team. Consultants spend almost all of their time working closely in small teams, so teamwork and collaboration are essential.

Interviewers will assess you on criteria such as the following:

• Can you make meaningful contributions while working in a group?
• Are you easy to work with?
• Can you handle conflict and disagreement with teammates?
• Do you bring out the best ideas and qualities in other people?

How long does it take to prepare for case interviews?

Candidates typically spend 60 to 80 hours preparing for case interviews, equivalent to 6 to 8 weeks of preparation. However, exceptional candidates with strong business and communication skills might need as little as 4 weeks. Those lacking a business background could require as long as 12 weeks.

We have seen exceptional candidates pass their consulting interviews and receive offers from McKinsey, BCG, or Bain in just one or two weeks. We have also heard of candidates spending more than 100 hours preparing for case interviews, but receiving no consulting offers.

There are four factors that impact how much time you’ll need to dedicate to preparing for case interviews. Assessing these factors will help you set expectations for the amount of time you should expect to spend.

1. Natural intuition and ability

Case interviews require a strong business intuition and excellent communication skills. Some people will have a higher baseline on these skills than others.

If you have studied business in school or have worked a job that does similar work to consulting, you’ll likely already have a good business intuition. If you give speeches, presentations, or participate in debates frequently, you’ll likely already have good communication skills.

Although these abilities can be learned by anyone, some people will naturally have strong abilities to start with. For these people, they will likely need to spend less time preparing for case interviews than the average person.

2. Learning speed

Some people are faster learners than others. There are many skills you’ll need to learn and develop to be proficient in case interviews, such as structuring a framework, developing a hypothesis, solving math problems , and delivering a recommendation.

These skills require no specialized knowledge or expertise. Anyone can learn and master these skills with enough practice. However, some people will pick up these skills faster than others.

3. Quality of practice

The quality of your practice determines how quickly you can learn and master case interviews.

If you practice with case interview partners that don’t know how to properly deliver a case interview and provide feedback, you’ll learn much more slowly than someone practicing with a consultant who has given interviews before.

Similarly, if the practice cases you use are not representative of an actual case interview or don’t have outstanding model answers, you’ll learn much more slowly than someone using high-quality practice cases.

4. Consulting firm requirements

The amount of time needed to prepare for case interviews also depends on the consulting firms that you are applying for.

The top three consulting firms, McKinsey, BCG, and Bain, have the highest standards and requirements when assessing a candidate’s case interview capabilities. Less prestigious consulting firms may have a lower bar that you need to pass.

If you are recruiting for McKinsey, BCG, and Bain, you’ll likely need to spend more time preparing for case interviews than someone recruiting for Deloitte or Accenture.

When should I begin preparing for case interviews?

Given that it takes candidates on average 60 to 80 hours to prepare for case interviews, you should begin preparing for case interviews at least 6 to 8 weeks in advance. To give yourself adequate time, you should ideally start preparing 16 to 24 weeks in advance.

Preparing 16 to 24 weeks in advance provides sufficient buffer time. You may find yourself too busy to prepare for case interviews during some weeks. You may also realize that you have significant skill or capability gaps as you start preparing, requiring more time to improve.

Preparing for case interviews more than 24 weeks in advance should not be necessary. 

Often times, candidates that start preparing too early will burn themselves out from having done too many practice cases. This often happens right before interviews begin, which leads to poor outcomes.

To avoid burning yourself out, start preparing for interviews ideally 16 to 24 weeks in advance and a minimum of 6 to 8 weeks in advance.

How do I prepare for case interviews?

There are seven steps to preparing for case interviews.

1. Understand what a case interview is

The first step in preparing for consulting case interviews is to understand exactly what case interviews are.

Case interviews are a special type of interview that every single consulting firm uses. They typically take 30 – 60 minutes and involve you working with the interviewer to solve a business problem and provide a recommendation.

When you are familiar with what case interviews are, it is important to know what a great case interview performance looks like.

Knowing what a great case interview performance looks like will facilitate how quickly you learn case interview strategies in the next step.

Before continuing onto the next step, you should be familiar with:

• The overall objective of a case interview
• The structure and flow of a case interview
• The types of questions you could get asked
• What a great case interview performance looks like

2. Learn the right strategies

Now that you have sufficient background knowledge, the next step in preparing for case interviews is to learn the right strategies to build good case interview habits.

It is much more effective to learn the right case strategies the first time than to learn poor strategies and try to correct them later.

The quickest, most efficient way to learn these strategies is to go through our Comprehensive Case Interview Course .

If you prefer reading case interview prep books instead, the three I recommend are:

• The Ultimate Case Interview Workbook
• Case Interview Secrets

Hacking the Case Interview provides strategies on exactly what to do and what to say in every step of the case interview. It is a concise and straight to the point guide. I recommend this book as the first book to read for beginners.

Case Interview Secrets teaches core concepts such as the issue tree , drill-down analysis, and a hypothesis driven approach. It illustrates these concepts through stories and anecdotes. If you have read Hacking the Case Interview, I recommend also reading this book to get perspectives from a second author. Check out our full review of Case Interview Secrets .

Case in Point provides a ton of specific and complex frameworks. However, you likely won’t be using many of these in an actual case interview because many of them are overly complex and specific. If you have time, it may be useful to skim through this book. Check out our full review of Case in Point .

At the bare minimum, read either the first or second book. If you have the time, read the first two books so that you can get strategies from two different authors.

Make sure to spend sufficient time learning the right strategies before starting to practice cases. It is ineffective to practice cases if you have no idea what strategies to practice and refine.

Before moving onto the next step, you should at least have strategies for the following parts of a case interview:

• Developing unique and tailored frameworks
• Solving quantitative problems
• Answering qualitative questions
• Delivering a recommendation

3. Practice 3-5 cases by yourself

Once you have learned the right strategies, the next step in case interview prep is to practice.

When practicing case interviews, it is usually better to practice with a case interview partner than to practice by yourself . Casing with a partner better simulates the real case interview experience.

However, when you are just starting to practice, I recommend doing the first 3 – 5 cases by yourself.

There are three reasons for this:

• You can get the hang of the case interview structure and format much more quickly working by yourself rather than having to wait to schedule a time with a partner
• There are many aspects of case interviews that you can practice without a partner, such as structuring a framework and solving quantitative problems. You can get much more practice working through these parts by yourself
• You may have difficulty finding a case interview partner if you are a complete beginner. Without having done any cases, you likely won’t know how to properly give a case or provide good feedback

4. Practice 5-10 cases with a partner

The next step in preparing for case interviews is to case with a partner.

Casing with a partner is the best way to simulate a real case interview. There are many aspects of case interviews that you won’t be able to improve on unless you practice live with a partner.

When practicing cases with a partner, ensure you are spending enough time after cases to deliver feedback.

For a case that takes around 30 – 40 minutes, spend at least 15 – 20 minutes for feedback. Much of your learning and improvement will come from these feedback sessions.

Do not move onto the next step until you have done at least 5 – 10 cases and are beginning to feel comfortable with case interviews.

5. Practice with a former or current consultant

At this point, I highly recommend asking former or current consultants to give you a practice case. This will significantly help you prepare for case interviews.

Doing a mock case with a former or current consultant is highly advantageous because they know exactly how to run cases and give feedback. You’ll receive incredibly helpful feedback that your previous case partners likely missed.

If you feel that you are plateauing with your case partner, that is a sign you should do a mock case interview with a former or current consultant.

You can find former or current consultants among:

• People you met during the consulting recruiting process
• Your broader LinkedIn network

I would not ask a consultant that is involved with the consulting recruiting process for a case too prematurely. Although these practice cases are not evaluative, some firms will actually make note of how well you perform during the practice case.

At this point, you will have accumulated a long list of improvement areas from all of the different people you have cased with.

6. Work on your improvement areas

In this step of preparing for case interviews, you will work on strengthening and fine-tuning your improvement areas. Examples of common improvement areas include:

• Creating a more complete and mutually exclusive framework
• Performing math calculations quicker or more smoothly
• Providing more structure to your qualitative answers
• Leading the case more proactively
• Delivering a more succinct recommendation

Try to focus on improving one thing at a time. This is much more effective than trying to improve everything at once.

For some areas, such as math, it will be better to work independently. For other areas, such as learning to proactively lead the case, it will be better to work with a case partner.

If you are looking for more cases, look at the resources listed in step four. If you are looking for specific drills or practice problems for a particular part of a case interview, check out The Ultimate Case Interview Workbook .

Do not move onto the next step until you have finished working on all of your improvement areas.

7. Stay sharp

If you have progressed this far, congratulations! You have almost finished preparing for case interviews.

Once you feel that you have no more improvement areas to work on, the key is to not burn yourself out by doing too many unnecessary cases.

While each case that you do makes you slightly better, there is a point when doing too many cases can create case fatigue right before your interview. Case fatigue can negatively impact your interview performance.

On the other hand, you also don’t want to go weeks without having done a case. You may end up forgetting strategies or become rusty and slow.

Once you have achieved case mastery, I recommend doing no more than 2 cases per week in the weeks leading up to your interview. This ensures that you remain sharp for case interviews, but don’t have case fatigue.

What resources should I use to prepare for case interviews?

Here are our three resources that we recommend for case interview prep.

These resources teach the best case interview strategies that you only need to learn once. These strategies are robust, effective, and will help you stand out from the hundreds or thousands of other candidates competing for a consulting job offer.

• Comprehensive Case Interview Course (our #1 recommendation): The only resource you need. Whether you have no business background, rusty math skills, or are short on time, this step-by-step course will transform you into a top 1% caser that lands multiple consulting offers.
• Hacking the Case Interview Book   (available on Amazon): Perfect for beginners that are short on time. Transform yourself from a stressed-out case interview newbie to a confident intermediate in under a week. Some readers finish this book in a day and can already tackle tough cases.
• The Ultimate Case Interview Workbook (available on Amazon): Perfect for intermediates struggling with frameworks, case math, or generating business insights. No need to find a case partner – these drills, practice problems, and full-length cases can all be done by yourself.

If you’re looking for free resources, you can check out:

1. Learn case interviews in 30 minutes video (embedded below)

2. Other videos on the HackingTheCaseInterview YouTube channel

3. MBA casebooks with 700+ free practice cases

4. Free practice cases from consulting firm websites (see next section of article for links)

The best practice cases for beginners are those that will most closely resemble the actual case interview you’ll get on interview day.

Below, we’ve consolidated official practice cases from all of the top consulting firms:

• McKinsey Diconsa case interview :  Non-profit case focused on deciding whether to leverage a chain of convenience stores to deliver basic financial services to inhabitants of rural Mexico. Great practice case for the non-profit sector.
• McKinsey Electro-light case interview :  New product launch case focused on deciding whether a beverage company should launch a new sports drink. Outstanding case to practice interpreting various charts and graphs.
• McKinsey GlobaPharm case interview :  Acquisition case focused on deciding whether a large pharmaceutical company should acquire a smaller startup. This case has very difficult math calculations that you can practice.
• McKinsey National Education case interview : Non-profit case focused on helping an Eastern European country’s Department of Education improve their school system. Another great practice case for the non-profit sector.
• BCG airline case interview :  Profitability case focused on helping a low-cost carrier airline improve profitability. This was an interactive case that was previously on BCG's website, but they took it down. We've linked our YouTube video that walks through it though, for you to follow along.
• BCG drug case interview :  Pricing case focused on helping a pharmaceutical company determine the optimal price for a new drug. This was an interactive case that was previously on BCG's website, but they took it down. We've linked our YouTube video that walks through it though, for you to follow along.
• Bain PrintCo case interview : Market entry case focused on helping a restaurant menu printing company decide whether to enter the electronic restaurant menu market. This case is in a video format and is helpful in understanding what an associate consultant-level interview looks like (post-undergraduate role).
• Bain NextGen Tech case interview : Partnership case focused on helping a wearable computer device company determine which cellular network company to partner with in order to make $1B over the next two years. This case is in a video format and is helpful in understanding what a consultant-level interview looks like (post-MBA role).
• Bain CoffeeCo case interview :  Market entry case focused on helping a friend decide whether she should open a coffee shop in Cambridge, England. This case is on the simpler, more basic side.
• Bain FashionCo case interview :  Profitability case focused on identifying how a fashion retailer can increase revenues. This case is on the simpler, more basic side.
• Oliver Wyman Wumbleworld case interview practice :  Profitability case focused on helping a theme park operator in China improve profitability. This case is fairly basic, but provides great practice for interpreting charts and graphs and practicing case math.
• Oliver Wyman Aqualine case interview practice :  Revenue case focused on helping a small powerboat manufacturer identify sales growth opportunities. This case is fairly basic, but provides great practice for interpreting charts and graphs and practicing case math.
• LEK Theater Co. case interview example : Revenue growth case focused on helping a theater location increase revenues. This is a very short case in a video format.
• LEK Market sizing example : This video provides an example of how to estimate the market size for medical consumables by general practitioners in the United Kingdom. The video is short and provides a great example on how to structure an approach to market sizing.
• Roland Berger transit-oriented development case example : Profitability case focused on helping a local public transit operator improve its profits. This case is split into two videos, part one and part two .
• Roland Berger 3D printed hip implant case example : Market entry case focused on helping the client assess whether additive manufacturing and the selling of hip implants is an attractive business. This case is split into two videos, part one and part two .
• Deloitte Engagement Strategy: Federal Agency V : Strategy case focused on addressing the Agency’s employee engagement issues as the organization shifts to a customer service model
• Deloitte Recreation Unlimited : Strategy case focused on driving 40% annual growth in direct-to-consumer digital channels over the next five years
• Deloitte Strategic Vision: Federal Benefits Provider : Strategy case to develop a strategy to help the Agency institutionalize the goals of their 10-year vision within its work culture
• Deloitte MedX: The Smart Pill Bottle : Business technology case focused on rolling out a new patient portal
• Deloitte Architecture Strategy: Federal Finance Agency : Business technology case focused on developing an implementation plan for a new, shared enterprise architecture solution
• Deloitte Finance strategy: Federal Health Agency : Strategy case focused on identifying programs that will receive additional funding and ensuring accountable use of funds
• Deloitte Talent Management: Federal Civil Cargo Protection Bureau : Strategy case to review and revamp the current human capital operational practices of the agency
• Deloitte Footloose case interview practice : Strategy case focused on helping a footwear company decide whether to focus on growing in the work boot sector of the market or the casual boot sector of the market. This case provides great practice for interpreting multiple different pieces of data simultaneously.
• OC&C Hotel and Casino Co. case interview practice :  Business strategy case from OC&C Strategy Consultants focused on helping a hotel and casino operator decide what they should do with their health club business, whether they should divest it, grow it, or acquire another player in the market. This case helps illustrate the difference between good answers and excellent answers.
• OC&C Whisky Co. case interview practice :  Profitability case focused on helping a whiskey manufacturer and distributor determine how to increase profitability. This case helps illustrate the difference between good answers and excellent answers.

For even more practice, check out our article on 23 MBA consulting casebooks with 700+ free practice cases .

Case Interview Beginner Mistake #1: Lack of Structure

Failing to establish a clear framework for approaching the problem can lead to a scattered and unorganized response. It's important to outline a structured approach to solving the case.

Case Interview Beginner Mistake #2: Making Assumptions Without Clarification

Assuming information without seeking clarification can lead to incorrect conclusions. It's crucial to ask thoughtful questions to gather all necessary details.

Case Interview Beginner Mistake #3: Ignoring the Importance of Communication

Effective communication is key. Failing to articulate your thought process clearly or not actively engaging with the interviewer can hinder your performance.

Case Interview Beginner Mistake #4: Overlooking the Objective

Some candidates get so engrossed in solving the problem that they lose sight of the ultimate goal - providing actionable recommendations. Make sure your analysis leads to a clear conclusion.

Case Interview Beginner Mistake #5: Rushing Through the Case

Time management is crucial. Rushing through the case without taking the time to think critically about the problem can result in incomplete or inaccurate solutions.

Case Interview Beginner Mistake #6: Neglecting Quantitative Analysis

Many cases involve numerical data. Failing to perform thorough quantitative analysis or making calculation errors can be a significant setback.

Case Interview Beginner Mistake #7: Ignoring Alternative Perspectives

Tunnel vision can be detrimental. Failing to consider alternative viewpoints or approaches to the problem may lead to overlooking valuable insights.

Case Interview Beginner Mistake #8: Focusing Too Much on Memorized Frameworks

While frameworks are useful, relying too heavily on memorized approaches can lead to a superficial understanding of the case. It's important to adapt your framework to the specific context.

Case Interview Beginner Mistake #9: Neglecting to Check Assumptions

Sometimes, candidates make assumptions that are later proven to be incorrect. It's important to periodically revisit and validate your assumptions as you gather more information.

Case Interview Beginner Mistake #10: Lack of Practice and Preparation

Insufficient practice and preparation can lead to nervousness and poor performance during the actual interview. It's important to simulate case interview scenarios to build confidence and proficiency.

Case Interview Beginner Tip #1: Understand the Business Objective

The quickest way to fail a case interview is to answer or address the wrong business problem. Therefore, when the interviewer starts the case by reading the case background information, it is imperative that you identify what is the business problem and what is the primary question you are trying to answer. You should always verify the objective of the case with the interviewer.

Case Interview Beginner Tip #2: Ask Clarifying Questions 

Don’t be afraid to ask clarifying questions. You will not be penalized for this. If there is a term that you are unfamiliar with, ask for the definition. If you don’t understand the objective of the case, ask questions to clarify this. If there is important information that you were not able to write down, ask the interviewer to repeat specific pieces of information.

All of these questions will help strengthen your understanding of the case situation and make it easier for you to solve the case.

Case Interview Beginner Tip #3: Don’t Use Memorized Frameworks

The issue with using memorized frameworks is that they aren’t tailored to the specific case that you are solving for. Many times, some of the elements of your memorized framework will not be relevant or important to the case. Additionally, interviewers can easily tell when you are regurgitating memorized information and not thinking critically.

Instead of memorizing frameworks, memorize a list of 8 – 10 broad business areas, such as the following:

• Competition
• Profitability
• Alternatives

When given a case, mentally run through this list and pick the 3 to 4 areas that are the most relevant to the case. If the list does not give you enough framework areas, brainstorm and add your own areas to your framework.

Case Interview Beginner Tip #4: Structure Your Math Approach 

Before doing any math calculations, lay out an upfront approach or structure to walk the interviewer through what you are about to do. Developing a structure will help you avoid making unnecessary calculations or reaching a dead-end. If the interviewer approves of your approach, then the rest of the math problem is simple arithmetic.

Case Interview Beginner Tip #5: Use Abbreviations for Large Numbers

If you are working with large numbers in the thousands, millions, billions, or trillions, use abbreviations rather than writing out all of the zeroes.

For example, 10,000 can be expressed as 10K, 200,000,000 can be expressed as 200M, and 300,000,000,000 can be expressed as 300B. This reduces the chances that you’ll accidentally add or drop a zero in your numbers.

Case Interview Beginner Tip #6: Talk Through Calculations Out Loud

Talking through your calculations out loud provides two benefits. One, it decreases the likelihood that you’ll make a mistake. Two, it makes it easier for the interviewer to follow what you are doing. If you happen to get stuck or make a mistake, the interviewer can jump in to offer suggestions or guidance. The interviewer cannot do this if you are not communicating exactly what you are doing.

Case Interview Beginner Tip #7: Sense Check Your Numbers

Accidentally missing zeroes or adding extra zeroes during your case interview calculations is the most common math mistake. To avoid this, you can do a quick sense check after each calculation to confirm that your answer is the right order of magnitude.

For example, if you are multiplying 115 million by 22, you should expect your answer to be in the billions because 100 million * 20 = 2 billion.

Case Interview Beginner Tip #8: Talk Through The Axes of Charts and Graphs

When given charts or graphs to interpret, the very first thing you should do is to look at the axes. This is the most effective way to understand what the chart or graph is showing. When you are given multiple charts or graphs, this will also help you understand how each chart or graph relates to each other.

Case Interview Beginner Tip #9: Answer “So What?” After Every Question

When the interviewer asks you a quantitative or qualitative question during a case interview, don’t just answer it and stop there. After answering the question, ask yourself: “so what?” How does your answer help you solve the overall business problem? What implications does your answer have for your potential recommendation? You should be tying each answer that you give back to the case objective.  

Case Interview Beginner Tip #10: Have a Firm Recommendation

You do not want to have a flimsy recommendation in which you switch back and forth between two different recommendations. Instead, have a recommendation that takes a firm stance. Remember that there is no right or wrong recommendation. As long as your recommendation is supported with data and evidence, your recommendation will be accepted.

To see our complete list of 40 case interview tips, check out our comprehensive case interview tips article.

If you’re looking to turn yourself from a case interview newbie to a pro that crushes case interviews in their sleep, here are the resources we recommend to learn the most robust, effective case interview strategies in the least time-consuming way:

• Case Interview Coaching : Personalized, one-on-one coaching with former consulting interviewers
• Behavioral & Fit Interview Course : Be prepared for 98% of behavioral and fit questions in just a few hours. We'll teach you exactly how to draft answers that will impress your interviewer
• Resume Review & Editing : Transform your resume into one that will get you multiple interviews

Land Multiple Consulting Offers

Complete, step-by-step case interview course. 30,000+ happy customers.

• Case Interview: A comprehensive guide
• Pyramid Principle
• Hypothesis driven structure
• Fit Interview
• Consulting math
• The key to landing your consulting job
• What is a case interview?
• Types of case interview
• How to solve cases with the Problem-Driven Structure?
• What to remember in case interviews
• Case examples or building blocks?
• How do I prepare for case interviews
• Interview day tips
• How we can help

1. The key to landing your consulting job.

Case interviews - where you are asked to solve a business case study under scrutiny - are the core of the selection process right across McKinsey, Bain and BCG (the “MBB” firms). This interview format is also used pretty much universally across other high-end consultancies; including LEK, Kearney, Oliver Wyman and the consulting wings of the “Big Four”.

If you want to land a job at any of these firms, you will have to ace multiple case interviews.

It is increasingly likely that you will also have to solve online cases given by chatbots. You might need to pass these either before making it to interview or be asked to sit them alongside first round interviews.

Importantly, case studies aren’t something you can just wing . Firms explicitly expect you to have thoroughly prepared and many of your competitors on interview day will have been prepping for months.

Don’t worry though - MCC is here to help!

This article will take you through a full overview of everything you’ll need to know to do well, linking to more detailed articles and resources at each stage to let you really drill down into the details.

As well as traditional case interviews, we’ll also attend to the new formats in which cases are being delivered and otherwise make sure you’re up to speed with recent trends in this overall part of consulting recruitment.

Before we can figure out how to prepare for a case interview, though, we will first have to properly understand in detail what exactly you are up against. What format does a standard consulting case interview take? What is expected of you? How will you be assessed?

Let's dive right in and find out!

Professional help

Before going further, if this sounds like a lot to get your head around on your own, don't worry - help is available!

Our Case Academy course gives you everything you need to know to crack cases like a pro:

Case Academy Course

To put what you learn into practice (and secure some savings in the process) you can add mock interview coaching sessions with expereinced MBB consultants:

Coaching options

And, if you just want an experienced consultant to take charge of the whole selection process for you, you can check out our comprehensive mentoring programmes:

Explore mentoring

Now, back to the article!

2. What is a case interview?

Before we can hope to tackle a case interview, we have to understand what one is.

In short, a case interview simulates real consulting work by having you solve a business case study in conversation with your interviewer.

This case study will be a business problem where you have to advise a client - that is, an imaginary business or similar organisation in need of guidance.

You must help this client solve a problem and/or make a decision. This requires you to analyse the information you are given about that client organisation and figure out a final recommendation for what they should do next.

Business problems in general obviously vary in difficulty. Some are quite straightforward and can be addressed with fairly standard solutions. However, consulting firms exist precisely to solve the tough issues that businesses have failed to deal with internally - and so consultants will typically work on complex, idiosyncratic problems requiring novel solutions.

Some examples of case study questions might be:

• How much would you pay for a banking licence in Ghana?
• Estimate the potential value of the electric vehicle market in Germany
• How much gas storage capacity should a UK domestic energy supplier build?

Consulting firms need the brightest minds they can find to put to work on these important, difficult projects. You can expect the case studies you have to solve in interview, then, to echo the unique, complicated problems consultancies deal with every day. As we’ll explain here, this means that you need to be ready to think outside the box to figure out genuinely novel solutions.

2.1. Where are case interviews in the consulting selection process?

Not everyone who applies to a consulting firm will have a case interview - far from it!

In fact, case interviews are pretty expensive and inconvenient for firms to host, requiring them to take consultants off active projects and even fly them back to the office from location for in-person interviews (although this happens less frequently now). Ideally, firms want to cut costs and save time by narrowing down the candidate pool as much as possible before any live interviews.

As such, there are some hoops to jump through before you make it to interview rounds.

Firms will typically eliminate as much as 80% of the applicant pool before interviews start . For most firms, 50%+ of applicants might be cut based on resumes, before a similar cut is made on those remaining based on aptitude tests. McKinsey currently gives their Solve assessment to most applicants, but will use their resulting test scores alongside resumes to cut 70%+ of the candidate pool before interviews.

You'll need to be on top of your game to get as far as an interview with a top firm. Getting through the resume screen and any aptitude tests is an achievement in itself! Also we need to note that the general timeline of an application can differ depending on a series of factors, including which position you apply, your background, and the office you are applying to. For example, an undergraduate applying for a Business Analyst position (the entry level job at McKinsey) will most likely be part of a recruitment cycle and as such have pretty fixed dates when they need to sit the pre-screening test, and have the first and second round interviews (see more on those below). Conversely, an experienced hire will most likely have a much greater choice of test and interview dates as well as more time at their disposal to prepare.

For readers not yet embroiled in the selection process themselves, let’s put case interviews in context and take a quick look at each stage in turn. Importantly, note that you might also be asked to solve case studies outside interviews as well…

2.1.1. Application screen

It’s sometimes easy to forget that such a large cut is made at the application stage. At larger firms, this will mean your resume and cover letter is looked at by some combination of AI tools, recruitment staff and junior consulting staff (often someone from your own university).

Only the best applications will be passed to later stages, so make sure to check out our free resume and cover letter guides, and potentially get help with editing , to give yourself the best chance possible.

2.1.2. Aptitude tests and online cases

This part of the selection process has been changing quickly in recent years and is increasingly beginning to blur into the traditionally separate case interview rounds.

In the past, GMAT or PST style tests were the norm. Firms then used increasingly sophisticated and often gamified aptitude tests, like the Pymetrics test currently used by several firms, including BCG and Bain, and the original version of McKinsey’s Solve assessment (then branded as the Problem Solving Game).

Now, though, there is a move towards delivering relatively sophisticated case studies online. For example, McKinsey has replaced half the old Solve assessment with an online case. BCG’s Casey chatbot case now directly replaces a live first round case interview, and in the new era of AI chatbots, we expect these online cases to quickly become more realistic and increasingly start to relieve firms of some of the costs of live interviews.

Our consultants collectively reckon that, over time, 50% of case interviews are likely to be replaced with these kinds of cases . We give some specific advice for online cases in section six. However, the important thing to note is that these are still just simulations of traditional case interviews - you still need to learn how to solve cases in precisely the same way, and your prep will largely remain the same.

2.1.3. Rounds of Interviews

Now, let’s not go overboard with talk of AI. Even in the long term, the client facing nature of consulting means that firms will have live case interviews for as long as they are hiring anyone. And in the immediate term, case interviews are still absolutely the core of consulting selection.

Before landing an offer at McKinsey, Bain, BCG or any similar firm, you won’t just have one case interview, but will have to complete four to six case interviews, usually divided into two rounds, with each interview lasting approximately 50-60 minutes .

Being invited to first round usually means two or three case interviews. As noted above, you might also be asked to complete an online case or similar alongside your first round interviews.

If you ace first round, you will be invited to second round to face the same again, but more gruelling. Only then - after up to six case interviews in total, can you hope to receive an offer.

2.2. Differences between first and second round interviews

Despite interviews in the first and second round following the same format, second/final round interviews will be significantly more intense . The seniority of the interviewer, time pressure (with up to three interviews back-to-back), and the sheer value of the job at stake will likely make a second round consulting case interview one of the most challenging moments of your professional life.

There are three key differences between the two rounds:

• Time Pressure : Final round case interviews test your ability to perform under pressure, with as many as three interviews in a row and often only very small breaks between them.
• Focus : Since second round interviewers tend to be more senior (usually partners with 12+ years experience) and will be more interested in your personality and ability to handle challenges independently. Some partners will drill down into your experiences and achievements to the extreme. They want to understand how you react to challenges and your ability to identify and learn from past mistakes.
• Psychological Pressure: While case interviews in the first round are usually more focused on you simply cracking the case, second round interviewers often employ a "bad cop" strategy to test the way you react to challenges and uncertainty.

2.3. What skills do case interviews assess?

Reliably impressing your interviewers means knowing what they are looking for. This means understanding the skills you are being assessed against in some detail.

Overall, it’s important always to remember that, with case studies, there are no strict right or wrong answers. What really matters is how you think problems through, how confident you are with your conclusions and how quick you are with the back of the envelope arithmetic.

The objective of this kind of interview isn’t to get to one particular solution, but to assess your skillset. This is even true of modern online cases, where sophisticated AI algorithms score how you work as well as the solutions you generate.

If you visit McKinsey , Bain and BCG web pages on case interviews, you will find that the three firms look for very similar traits, and the same will be true of other top consultancies.

Broadly speaking, your interviewer will be evaluating you across five key areas:

2.1.1.One: Probing mind

Showing intellectual curiosity by asking relevant and insightful questions that demonstrate critical thinking and a proactive nature. For instance, if we are told that revenues for a leading supermarket chain have been declining over the last ten years, a successful candidate would ask:

“ We know revenues have declined. This could be due to price or volume. Do we know how they changed over the same period? ”

This is as opposed to a laundry list of questions like:

• Did customers change their preferences?
• Which segment has shown the decline in volume?
• Is there a price war in the industry?

2.1.2. Structure

Structure in this context means structuring a problem. This, in turn, means creating a framework - that is, a series of clear, sequential steps in order to get to a solution.

As with the case interview in general, the focus with case study structures isn’t on reaching a solution, but on how you get there.

This is the trickiest part of the case interview and the single most common reason candidates fail.

We discuss how to properly structure a case in more detail in section three. In terms of what your interviewer is looking for at high level, though, key pieces of your structure should be:

• Proper understanding of the objective of the case - Ask yourself: "What is the single crucial piece of advice that the client absolutely needs?"
• Identification of the drivers - Ask yourself: "What are the key forces that play a role in defining the outcome?"

Our Problem Driven Structure method, discussed in section three, bakes this approach in at a fundamental level. This is as opposed to the framework-based approach you will find in older case-solving

Focus on going through memorised sequences of steps too-often means failing to develop a full understanding of the case and the real key drivers.

At this link, we run through a case to illustrate the difference between a standard framework-based approach and our Problem Driven Structure method.

2.1.3. Problem Solving

You’ll be tested on your ability to identify problems and drivers, isolate causes and effects, demonstrate creativity and prioritise issues. In particular, the interviewer will look for the following skills:

• Prioritisation - Can you distinguish relevant and irrelevant facts?
• Connecting the dots - Can you connect new facts and evidence to the big picture?
• Establishing conclusions - Can you establish correct conclusions without rushing to inferences not supported by evidence?

2.1.4. Numerical Agility

In case interviews, you are expected to be quick and confident with both precise and approximated numbers. This translates to:

• Performing simple calculations quickly - Essential to solve cases quickly and impress clients with quick estimates and preliminary conclusions.
• Analysing data - Extract data from graphs and charts, elaborate and draw insightful conclusions.
• Solving business problems - Translate a real world case to a mathematical problem and solve it.

Our article on consulting math is a great resource here, though the extensive math content in our MCC Academy is the best and most comprehensive material available.

2.1.5. Communication

Real consulting work isn’t just about the raw analysis to come up with a recommendation - this then needs to be sold to the client as the right course of action.

Similarly, in a case interview, you must be able to turn your answer into a compelling recommendation. This is just as essential to impressing your interviewer as your structure and analysis.

Consultants already comment on how difficult it is to find candidates with the right communication skills. Add to this the current direction of travel, where AI will be able to automate more and more of the routine analytic side of consulting, and communication becomes a bigger and bigger part of what consultants are being paid for.

So, how do you make sure that your recommendations are relevant, smart, and engaging? The answer is to master what is known as CEO-level communication .

This art of speaking like a CEO can be quite challenging, as it often involves presenting information in effectively the opposite way to how you might normally.

To get it right, there are three key areas to focus on in your communications:

• Top down : A CEO wants to hear the key message first. They will only ask for more details if they think that will actually be useful. Always consider what is absolutely critical for the CEO to know, and start with that. You can read more in our article on the Pyramid Principle .
• Concise : This is not the time for "boiling the ocean" or listing an endless number possible solutions. CEOs, and thus consultants, want a structured, quick and concise recommendation for their business problem, that they can implement immediately.
• Fact-based : Consultants share CEOs' hatred of opinions based on gut feel rather than facts. They want recommendations based on facts to make sure they are actually in control. Always go on to back up your conclusions with the relevant facts.

Being concise and to the point is key in many areas, networking being one for them. For more detail on all this, check out our full article on delivering recommendations .

Prep the right way

3. types of case interview.

While most case interviews share a similar structure, firms will have some differences in the particular ways they like to do things in terms of both the case study and the fit component.

As we’ll see, these differences aren’t hugely impactful in terms of how you prepare. That said, it's always good to know as much as possible about what you will be going up against.

3.1. Different case objectives

A guiding thread throughout this article and our approach in general will be to treat each case as a self-contained problem and not try to pigeonhole it into a certain category. Having said that, there are of course similarities between cases and we can identify certain parameters and objectives.

Broadly speaking, cases can be divided into issue-based cases and strategic decision cases. In the former you will be asked to solve a certain issue, such as declining profits, or low productivity whereas in the latter you will be ask whether your client should or should not do something, such as enter a specific market or acquire another company. The chart below is a good breakdown of these different objectives:

3.2. How do interviewers craft cases

While interviewers will very likely be given a case bank to choose from by their company, a good number of them will also choose to adapt the cases they would currently be working on to an interview setting. The difference is that the latter cases will be harder to pigeonhole and apply standard frameworks to, so a tailored approach will be paramount.

If you’ve applied for a specific practice or type of consulting - such as operational consulting, for example - it’s very likely that you will receive a case geared towards that particular area alongside a ‘generalist’ consulting case (however, if that’s the case, you will generally be notified). The other main distinction when it comes to case interviews is between interviewer-led and candidate-led.

3.3. Candidate-led cases

Most consulting case interview questions test your ability to crack a broad problem, with a case prompt often going something like:

" How much would you pay to secure the rights to run a restaurant in the British Museum? "

You, as a candidate, are then expected to identify your path to solve the case (that is, provide a structure), leveraging your interviewer to collect the data and test your assumptions.

This is known as a “candidate-led” case interview and is used by Bain, BCG and other firms. From a structuring perspective, it’s easier to lose direction in a candidate-led case as there are no sign-posts along the way. As such, you need to come up with an approach that is both broad enough to cover all of the potential drivers in a case but also tailored enough to the problem you are asked to solve. It’s also up to you to figure out when you need to delve deeper into a certain branch of the case, brainstorm or ask for data. The following case from Bain is an excellent example on how to navigate a candidate-led case.

3.4. Interviewer-led cases

This type of case - employed most famously by McKinsey - is slightly different, with the interviewer controlling the pace and direction of the conversation much more than with other case interviews.

At McKinsey, your interviewer will ask you a set of pre-determined questions, regardless of your initial structure. For each question, you will have to understand the problem, come up with a mini structure, ask for additional data (if necessary) and come to the conclusion that answers the question. This more structured format of case also shows up in online cases by other firms - notably including BCG’s Casey chatbot (with the amusing result that practising McKinsey-style cases can be a great addition when prepping for BCG).

Essentially, these interviewer-led case studies are large cases made up of lots of mini-cases. You still use basically the same method as you would for standard (or candidate-led) cases - the main difference is simply that, instead of using that method to solve one big case, you are solving several mini-cases sequentially. These cases are easier to follow as the interviewer will guide you in the right direction. However, this doesn’t mean you should pay less attention to structure and deliver a generic framework! Also, usually (but not always!) the first question will ask you to map your approach and is the equivalent of the structuring question in candidate-led cases. Sometimes, if you’re missing key elements, the interviewer might prompt you in the right direction - so make sure to take those prompts seriously as they are there to help you get back on track (ask for 30 seconds to think on the prompt and structure your approach). Other times - and this is a less fortunate scenario - the interviewer might say nothing and simply move on to the next question. This is why you should put just as much thought (if not more) into the framework you build for interviewer-led cases , as you may be penalized if you produce something too generic or that doesn’t encompass all the issues of the case.

3.5. Case and fit

The standard case interview can be thought of as splitting into two standalone sub-interviews. Thus “case interviews” can be divided into the case study itself and a “fit interview” section, where culture fit questions are asked.

This can lead to a bit of confusion, as the actual case interview component might take up as little as half of your scheduled “case interview”. You need to make sure you are ready for both aspects.

To illustrate, here is the typical case interview timeline:

• First 15-30 minutes: Fit Interview - with questions assessing your motivation to be a consultant in that specific firm and your traits around leadership and teamwork. Learn more about the fit interview in our in-depth article here .
• Next 30-40 minutes: Case Interview - solving a case study
• Last 5 minutes: Fit Interview again - this time focussing on your questions for your interviewer.

Both the Case and Fit interviews play crucial roles in the finial hiring decision. There is no “average” taken between case and fit interviews: if your performance is not up to scratch in either of the two, you will not be able to move on to the next interview round or get an offer.

NB: No case without fit

Note that, even if you have only been told you are having a case interview or otherwise are just doing a case study, always be prepared to answer fit questions. At most firms, it is standard practice to include some fit questions in all case interviews, even if there are also separate explicit fit interviews, and interviewers will almost invariably include some of these questions around your case. This is perfectly natural - imagine how odd and artificial it would be to show up to an interview, simply do a case and leave again, without talking about anything else with the interviewer before or after.

3.5.1 Differences between firms

For the most part, a case interview is a case interview. However, firms will have some differences in the particular ways they like to do things in terms of both the case study and the fit component.

3.5.2. The McKinsey PEI

McKinsey brands its fit aspect of interviews as the Personal Experience Interview or PEI. Despite the different name, this is really much the same interview you will be going up against in Bain, BCG and any similar firms.

McKinsey does have a reputation for pushing candidates a little harder with fit or PEI questions , focusing on one story per interview and drilling down further into the specific details each time. We discuss this tendency more in our fit interview article . However, no top end firm is going to go easy on you and you should absolutely be ready for the same level of grilling at Bain, BCG and others. Thus any difference isn’t hugely salient in terms of prep.

3.6. What is different in 2023?

For the foreseeable future, you are going to have to go through multiple live case interviews to secure any decent consulting job. These might increasingly happen via Zoom rather than in person, but they should remain largely the same otherwise.

However, things are changing and the rise of AI in recent months seems pretty much guaranteed to accelerate existing trends.

Even before the explosive development of AI chatbots like ChatGPT we have seen in recent months, automation was already starting to change the recruitment process.

As we mentioned, case interviews are expensive and inconvenient for firms to run . Ideally, then, firms will try to reduce the number of interviews required for recruitment as far as possible. For many years, tests of various kinds served to cut down the applicant pool and thus the number of interviews. However, these tests had a limited capacity to assess candidates against the full consulting skillset in the way that case interviews do so well.

More recently, though, the development of online testing has allowed for more and more advanced assessments. Top consulting firms have been leveraging screening tests that better and better capture the same skillset as case interviews. Eventually this is converging on automated case studies. We see this very clearly with the addition of the Redrock case to McKinsey’s Solve assessment.

As these digital cases become closer to the real thing, the line between test and interview blurs. Online cases don’t just reduce the number of candidates to interview, but start directly replacing interviews.

Case in point here is BCG’s Casey chatbot . Previously, BCG had deployed less advanced online cases and similar tests to weed out some candidates before live case interviews began. Now, though, Casey actually replaces one first round case interview.

Casey, at time of writing, is still a relatively “basic” chatbot, basically running through a pre-set script. The Whatsapp-like interface does a lot of work to make it feel like one is chatting to a “real person” - the chatbot itself, though, cannot provide feedback or nudges to candidates as would a human interviewer.

We fully expect that, as soon as BCG and other firms can train a truer AI, these online cases will become more widespread and start replacing more live interviews.

We discuss the likely impacts of advanced AI on consulting recruitment and the industry more broadly in our blog.

Here, though, the real message is that you should expect to run into digital cases as well as traditional case interviews.

Luckily, despite any changes in specific format, you will still need to master the same fundamental skills and prepare in much the same way.

We’ll cover a few ways to help prepare for chatbot cases in section four. Ultimately, though, firms are looking for the same problem solving ability and mindset as a real interviewer. Especially as chatbots get better at mimicking a real interviewer, candidates who are well prepared for case cracking in general should have no problem with AI administered cases.

3.6.1. Automated fit interviews

Analogous to online cases, in recent years there has been a trend towards automated, “one way” fit interviews, with these typically being administered for consultancies by specialist contractors like HireVue or SparkHire.

These are kind of like Zoom interviews, but if the interviewer didn’t show up. Instead you will be given fit questions to answer and must record your answer in your computer webcam. Your response will then go on to be assessed by an algorithm, scoring both what you say and how you say it.

Again, with advances in AI, it is easy to imagine these automated interviews going from fully scripted interactions, where all candidates are asked the same list of questions, to a more interactive experience. Thus, we might soon arrive at a point where you are being grilled on the details of your stories - McKinsey PEI style - but by a bot rather than a human.

We include some tips on this kind of “one way” fit interview in section six here.

4. How to solve cases with the Problem-Driven Structure?

If you look around online for material on how to solve case studies, a lot of what you find will set out framework-based approaches. However, as we have mentioned, these frameworks tend to break down with more complex, unique cases - with these being exactly the kind of tough case studies you can expect to be given in your interviews.

To address this problem, the MyConsultingCoach team has synthesized a new approach to case cracking that replicates how top management consultants approach actual engagements.

MyConsultingCoach’s Problem Driven Structure approach is a universal problem solving method that can be applied to any business problem , irrespective of its nature.

As opposed to just selecting a generic framework for each case, the Problem Driven Structure approach works by generating a bespoke structure for each individual question and is a simplified version of the roadmap McKinsey consultants use when working on engagements.

The canonical seven steps from McKinsey on real projects are simplified to four for case interview questions, as the analysis required for a six-month engagement is somewhat less than that needed for a 45-minute case study. However, the underlying flow is the same (see the method in action in the video below)

Let's zoom in to see how our method actually works in more detail:

4.1. Identify the problem

Identifying the problem means properly understanding the prompt/question you are given, so you get to the actual point of the case.

This might sound simple, but cases are often very tricky, and many candidates irretrievably mess things up within the first few minutes of starting. Often, they won’t notice this has happened until they are getting to the end of their analysis. Then, they suddenly realise that they have misunderstood the case prompt - and have effectively been answering the wrong question all along!

With no time to go back and start again, there is nothing to do. Even if there were time, making such a silly mistake early on will make a terrible impression on their interviewer, who might well have written them off already. The interview is scuppered and all the candidate’s preparation has been for nothing.

This error is so galling as it is so readily avoidable.

Our method prevents this problem by placing huge emphasis on a full understanding of the case prompt. This lays the foundations for success as, once we have identified the fundamental, underlying problem our client is facing, we focus our whole analysis around finding solutions to this specific issue.

Now, some case interview prompts are easy to digest. For example, “Our client, a supermarket, has seen a decline in profits. How can we bring them up?”. However, many of the prompts given in interviews for top firms are much more difficult and might refer to unfamiliar business areas or industries. For example, “How much would you pay for a banking license in Ghana?” or “What would be your key areas of concern be when setting up an NGO?”

Don’t worry if you have no idea how you might go about tackling some of these prompts!

In our article on identifying the problem and in our full lesson on the subject in our MCC Academy course, we teach a systematic, four step approach to identifying the problem , as well as running through common errors to ensure you start off on the right foot every time!

This is summarised here:

Following this method lets you excel where your competitors mess up and get off to a great start in impressing your interviewer!

4.2. Build your problem driven structure

After you have properly understood the problem, the next step is to successfully crack a case is to draw up a bespoke structure that captures all the unique features of the case.

This is what will guide your analysis through the rest of the case study and is precisely the same method used by real consultants working on real engagements.

Of course, it might be easier here to simply roll out one an old-fashioned framework, and a lot of candidates will do so. This is likely to be faster at this stage and requires a lot less thought than our problem-driven structure approach.

However, whilst our problem driven structure approach requires more work from you, our method has the advantage of actually working in the kind of complex case studies where generic frameworks fail - that is exactly the kind of cases you can expect at an MBB interview .

Since we effectively start from first principles every time, we can tackle any case with the same overarching method. Simple or complex, every case is the same to you and you don’t have to gamble a job on whether a framework will actually work

4.2.1 Issue trees

Issue trees break down the overall problem into a set of smaller problems that you can then solve individually. Representing this on a diagram also makes it easy for both you and your interviewer to keep track of your analysis.

To see how this is done, let’s look at the issue tree below breaking down the revenues of an airline:

These revenues can be segmented as the number of customers multiplied by the average ticket price. The number of customers can be further broken down into a number of flights multiplied by the number of seats, times average occupancy rate. The node corresponding to the average ticket price can then be segmented further.

4.2.2 Hypothesis trees

Hypothesis trees are similar, the only difference being that rather than just trying to break up the issue into smaller issues you are assuming that the problem can be solved and you are formulating solutions.

In the example above, you would assume revenues can be increased by either increasing the average ticket price or the number of customers . You can then hypothesize that you can increase the average occupancy rate in three ways: align the schedule of short and long haul flights, run a promotion to boost occupancy in off-peak times, or offer early bird discounts.

4.2.3 Other structures:structured lists

Structured lists are simply subcategories of a problem into which you can fit similar elements. This McKinsey case answer starts off by identifying several buckets such as retailer response, competitor response, current capabilities and brand image and then proceeds to consider what could fit into these categories.

Buckets can be a good way to start the structure of a complex case but when using them it can be very difficult to be MECE and consistent, so you should always aim to then re-organize them into either an issue or a hypothesis tree.

It is worth noting that the same problem can be structured in multiple valid ways by choosing different means to segment the key issues. Ultimately all these lists are methods to set out a logical hierachy among elements.

4.2.4 Structures in practice

That said, not all valid structures are equally useful in solving the underlying problem. A good structure fulfils several requirements - including MECE-ness , level consistency, materiality, simplicity, and actionability. It’s important to put in the time to master segmentation, so you can choose a scheme isn’t only valid, but actually useful in addressing the problem.

After taking the effort to identify the problem properly, an advantage of our method is that it will help ensure you stay focused on that same fundamental problem throughout. This might not sound like much, but many candidates end up getting lost in their own analysis, veering off on huge tangents and returning with an answer to a question they weren’t asked.

Another frequent issue - particularly with certain frameworks - is that candidates finish their analysis and, even if they have successfully stuck to the initial question, they have not actually reached a definite solution. Instead, they might simply have generated a laundry list of pros and cons, with no clear single recommendation for action.

Clients employ consultants for actionable answers, and this is what is expected in the case interview. The problem driven structure excels in ensuring that everything you do is clearly related back to the key question in a way that will generate a definitive answer. Thus, the problem driven structure builds in the hypothesis driven approach so characteristic of real consulting practice.

You can learn how to set out your own problem driven structures in our article here and in our full lesson in the MCC Academy course.

4.2. Lead the analysis

A problem driven structure might ensure we reach a proper solution eventually, but how do we actually get there?

We call this step " leading the analysis ", and it is the process whereby you systematically navigate through your structure, identifying the key factors driving the issue you are addressing.

Generally, this will mean continuing to grow your tree diagram, further segmenting what you identify as the most salient end nodes and thus drilling down into the most crucial factors causing the client’s central problem.

Once you have gotten right down into the detail of what is actually causing the company’s issues, solutions can then be generated quite straightforwardly.

To see this process in action, we can return to our airline revenue example:

Let’s say we discover the average ticket price to be a key issue in the airline’s problems. Looking closer at the drivers of average ticket price, we find that the problem lies with economy class ticket prices. We can then further segment that price into the base fare and additional items such as food.

Having broken down the issue to such a fine-grained level and considering the 80/20 rule(see below), solutions occur quite naturally. In this case, we can suggest incentivising the crew to increase onboard sales, improving assortment in the plane, or offering discounts for online purchases.

Our article on leading the analysis is a great primer on the subject, with our video lesson in the MCC Academy providing the most comprehensive guide available.

4.4. Provide recommendations

So you have a solution - but you aren’t finished yet!

Now, you need to deliver your solution as a final recommendation.

This should be done as if you are briefing a busy CEO and thus should be a one minute, top-down, concise, structured, clear, and fact-based account of your findings.

The brevity of the final recommendation belies its importance. In real life consulting, the recommendation is what the client has potentially paid millions for - from their point of view, it is the only thing that matters.

In an interview, your performance in this final summing up of your case is going to significantly colour your interviewer’s parting impression of you - and thus your chances of getting hired!

So, how do we do it right?

Barbara Minto's Pyramid Principle elegantly sums up almost everything required for a perfect recommendation. The answer comes first , as this is what is most important. This is then supported by a few key arguments , which are in turn buttressed by supporting facts .

Across the whole recommendation, the goal isn’t to just summarise what you have done. Instead, you are aiming to synthesize your findings to extract the key "so what?" insight that is useful to the client going forward.

All this might seem like common sense, but it is actually the opposite of how we relay results in academia and other fields. There, we typically move from data, through arguments and eventually to conclusions. As such, making good recommendations is a skill that takes practice to master.

We can see the Pyramid Principle illustrated in the diagram below:

To supplement the basic Pyramid Principle scheme, we suggest candidates add a few brief remarks on potential risks and suggested next steps . This helps demonstrate the ability for critical self-reflection and lets your interviewer see you going the extra mile.

The combination of logical rigour and communication skills that is so definitive of consulting is particularly on display in the final recommendation.

Despite it only lasting 60 seconds, you will need to leverage a full set of key consulting skills to deliver a really excellent recommendation and leave your interviewer with a good final impression of your case solving abilities.

Our specific article on final recommendations and the specific video lesson on the same topic within our MCC Academy are great, comprehensive resources. Beyond those, our lesson on consulting thinking and our articles on MECE and the Pyramid Principle are also very useful.

4.5. What if I get stuck?

Naturally with case interviews being difficult problems there may be times where you’re unsure what to do or which direction to take. The most common scenario is that you will get stuck midway through the case and there are essentially two things that you should do:

• 1. Go back to your structure
• 2. Ask the interviewer for clarification

Your structure should always be your best friend - after all, this is why you put so much thought and effort into it: if it’s MECE it will point you in the right direction. This may seem abstract but let’s take the very simple example of a profitability issue: if you’ve started your analysis by segmenting profit into revenue minus costs and you’ve seen that the cost side of the analysis is leading you nowhere, you can be certain that the declining profit is due to a decline in revenue.

Similarly, when you’re stuck on the quantitative section, make sure that your framework for calculations is set up correctly (you can confirm this with the interviewer) and see what it is you’re trying to solve for: for example if you’re trying to find what price the client should sell their new t-shirt in order to break even on their investment, you should realize that what you’re trying to find is the break even point, so you can start by calculating either the costs or the revenues. You have all the data for the costs side and you know they’re trying to sell 10.000 pairs so you can simply set up the equation with x being the price.

As we’ve emphasised on several occasions, your consulting interview will be a dialogue. As such, if you don’t know what to do next or don’t understand something, make sure to ask the interviewer (and as a general rule always follow their prompts as they are trying to help, not trick you). This is especially true for the quantitative questions, where you should really understand what data you’re looking at before you jump into any calculations. Ideally you should ask your questions before you take time to formulate your approach but don’t be afraid to ask for further clarification if you really can’t make sense of what’s going on. It’s always good to walk your interviewer through your approach before you start doing the calculations and it’s no mistake to make sure that you both have the same understanding of the data. For example when confronted with the chart below, you might ask what GW (in this case gigawatt) means from the get-go and ask to confirm the different metrics (i.e. whether 1 GW = 1000 megawatts). You will never be penalised for asking a question like that.

5. What to remember in case interviews

If you’re new to case cracking you might feel a bit hopeless when you see a difficult case question, not having any idea where to start.

In fact though, cracking cases is much like playing chess. The rules you need to know to get started are actually pretty simple. What will make you really proficient is time and practice.

In this section, we’ll run through a high level overview of everything you need to know, linking to more detailed resources at every step.

5.1. An overall clear structure

You will probably hear this more than you care for but it is the most important thing to keep in mind as you start solving cases, as not only it is a key evaluation criterion but the greatest tool you will have at your disposal. The ability to build a clear structure in all aspects of the case will be the difference between breezing through a complicated case and struggling at its every step. Let’s look a bit closer at the key areas where you should be structured!

5.1.1 Structured notes

Every case interview starts with a prompt, usually verbal, and as such you will have to take some notes. And here is where your foray into structure begins, as the notes you take should be clear, concise and structured in a way that will allow you to repeat the case back to the interviewer without writing down any unnecessary information.

This may sound very basic but you should absolutely not be dismissive about it: taking clear and organized notes will allow you to navigate a case just like you would a powerpoint! While you should obviously adopt a system that you are comfortable with, what we found helps is to have separate sections for:

• The case brief
• Follow-up questions and answers
• Numerical data
• Case structure (the most crucial part when solving the case)
• Any scrap work during the case (usually calculations)

When solving the case - or, as we call it here, in the Lead the analysis step, it is highly recommended to keep on feeding and integrating your structure, so that you never get lost. Maintaining a clear high level view is one of the most critical skills in consulting: by constantly keeping track of where you are following your structure, you’ll never lose your focus on the end goal.

In the case of an interviewer-led case, you can also have separate sheets for each question (e.g. Question 1. What factors can we look at that drive profitability?). If you develop a system like this you’ll know exactly where to look for each point of data rather than rummage around in untidy notes. There are a couple more sections that you may have, depending on preference - we’ll get to these in the next sections.

5.1.2 Structured communication

There will be three main types of communication in cases:

• 1. Asking and answering questions
• 2. Walking the interviewer through your structure (either the case or calculation framework - we’ll get to that in a bit!)
• 3. Delivering your recommendation

Asking and answering questions will be the most common of these and the key thing to do before you speak is ask for some time to collect your thoughts and get organised. What you want to avoid is a ‘laundry list’ of questions or anything that sounds too much like a stream of consciousness.

Different systems work for different candidates but a sure-fire way of being organised is numbering your questions and answers. So rather than saying something like ‘I would like to ask about the business model, operational capacity and customer personas’ it’s much better to break it down and say something along the lines of ‘I’ve got three key questions. Firstly I would like to inquire into the business model of our client. Secondly I would like to ask about their operational capacity. Thirdly I would like to know more about the different customer personas they are serving’.

A similar principle should be applied when walking the interview through your structure, and this is especially true of online interviews (more and more frequent now) when the interviewer can’t see your notes. Even if you have your branches or buckets clearly defined, you should still use a numbering system to make it obvious to the interviewer. So, for example, when asked to identify whether a company should make an acquisition, you might say ‘I would like to examine the following key areas. Firstly the financial aspects of this issue, secondly the synergies and thirdly the client’s expertise’

The recommendation should be delivered top-down (see section 4.4 for specifics) and should employ the same numbering principle. To do so in a speedy manner, you should circle or mark the key facts that you encounter throughout the case so you can easily pull them out at the end.

5.1.3 Structured framework

It’s very important that you have a systematic approach - or framework - for every case. Let’s get one thing straight: there is a difference between having a problem-solving framework for your case and trying to force a case into a predetermined framework. Doing the former is an absolute must , whilst doing the latter will most likely have you unceremoniously dismissed.

We have seen there are several ways of building a framework, from identifying several categories of issues (or ‘buckets’) to building an issue or hypothesis tree (which is the most efficient type of framework). For the purpose of organization, we recommend having a separate sheet for the framework of the case, or, if it’s too much to manage, you can have it on the same sheet as the initial case prompt. That way you’ll have all the details as well as your proposed solution in one place.

5.1.4 Structured calculations

Whether it’s interviewer or candidate-led, at some point in the case you will get a bunch of numerical data and you will have to perform some calculations (for the specifics of the math you’ll need on consulting interviews, have a look at our Consulting Math Guide ). Here’s where we urge you to take your time and not dive straight into calculating! And here’s why: while your numerical agility is sure to impress interviewers, what they’re actually looking for is your logic and the calculations you need to perform in order to solve the problem . So it’s ok if you make a small mistake, as long as you’re solving for the right thing.

As such, make it easy for them - and yourself. Before you start, write down in steps the calculations you need to perform. Here’s an example: let’s say you need to find out by how much profits will change if variable costs are reduced by 10%. Your approach should look something like:

• 1. Calculate current profits: Profits = Revenues - (Variable costs + Fixed costs)
• 2. Calculate the reduction in variable costs: Variable costs x 0.9
• 3. Calculate new profits: New profits = Revenues - (New variable costs + Fixed costs)

Of course, there may be more efficient ways to do that calculation, but what’s important - much like in the framework section - is to show your interviewer that you have a plan, in the form of a structured approach. You can write your plan on the sheet containing the data, then perform the calculations on a scrap sheet and fill in the results afterward.

5.2. Common business knowledge and formulas

Although some consulting firms claim they don’t evaluate candidates based on their business knowledge, familiarity with basic business concepts and formulae is very useful in terms of understanding the case studies you are given in the first instance and drawing inspiration for structuring and brainstorming.

If you are coming from a business undergrad, an MBA or are an experienced hire, you might well have this covered already. For those coming from a different background, it may be useful to cover some.

Luckily, you don’t need a degree-level understanding of business to crack interview cases , and a lot of the information you will pick up by osmosis as you read through articles like this and go through cases.

However, some things you will just need to sit down and learn. We cover everything you need to know in some detail in our Case Academy Course course. However, some examples here of things you need to learn are:

• Basic accounting (particularly how to understand all the elements of a balance sheet)
• Basic economics
• Basic marketing
• Basic strategy

Below we include a few elementary concepts and formulae so you can hit the ground running in solving cases. We should note that you should not memorise these and indeed a good portion of them can be worked out logically, but you should have at least some idea of what to expect as this will make you faster and will free up much of your mental computing power. In what follows we’ll tackle concepts that you will encounter in the private business sector as well as some situations that come up in cases that feature clients from the NGO or governmental sector.

5.2.1 Business sector concepts

These concepts are the bread and butter of almost any business case so you need to make sure you have them down. Naturally, there will be specificities and differences between cases but for the most part here is a breakdown of each of them.

5.2.1.1. Revenue

The revenue is the money that the company brings in and is usually equal to the number of products they sell multiplied to the price per item and can be expressed with the following equation:

Revenue = Volume x Price

Companies may have various sources of revenue or indeed multiple types of products, all priced differently which is something you will need to account for. Let’s consider some situations. A clothing company such as Nike will derive most of their revenue from the number of products they sell times the average price per item. Conversely, for a retail bank revenue is measured as the volume of loans multiplied by the interest rate at which the loans are given out. As we’ll see below, we might consider primary revenues and ancillary revenues: in the case of a football club, we might calculate primary revenues by multiplying the number of tickets sold by the average ticket price, and ancillary revenues those coming from sales of merchandise (similarly, let’s say average t-shirt price times the number of t-shirts sold), tv rights and sponsorships.

These are but a few examples and another reminder that you should always aim to ask questions and understand the precise revenue structure of the companies you encounter in cases.

5.2.1.2. Costs

The costs are the expenses that a company incurs during its operations. Generally, they can be broken down into fixed and variable costs :

Costs = Fixed Costs + Variable Costs

As their name implies, fixed costs do not change based on the number of units produced or sold. For example, if you produce shoes and are renting the space for your factory, you will have to pay the rent regardless of whether you produce one pair or 100. On the other hand, variable costs depend on the level of activity, so in our shoe factory example they would be equivalent to the materials used to produce each pair of shoes and would increase the more we produce.

These concepts are of course guidelines used in order to simplify the analysis in cases, and you should be aware that in reality often the situation can be more complicated. Costs can also be quasi-fixed, in that they increase marginally with volume. Take the example of a restaurant which has a regular staff, incurring a fixed cost but during very busy hours or periods they also employ some part-time workers. This cost is not exactly variable (as it doesn’t increase with the quantity of food produced) but also not entirely fixed, as the number of extra hands will depend on how busy the restaurant is. Fixed costs can also be non-linear in nature. Let’s consider the rent in the same restaurant: we would normally pay a fixed amount every month, but if the restaurant becomes very popular we might need to rent out some extra space so the cost will increase.

5.2.1.3. Profit and profit margin

The profit is the amount of money a company is left with after it has paid all of its expenses and can be expressed as follows:

Profit = Revenue - Costs

It’s very likely that you will encounter a profitability issue in one of your cases, namely you will be asked to increase a company’s profit. There are two main ways of doing this: increasing revenues and reducing costs , so these will be the two main areas you will have to investigate. This may seem simple but what you will really need to understand in a case are the key drivers of a business (and this should be done through clarifying questions to the interviewer - just as a real consultant would question their client).

For example, if your client is an airline you can assume that the main source of revenue is sales of tickets, but you should inquire how many types of ticket the specific airline sells. You may naturally consider economy and business class tickets, but you may find out that there is a more premium option - such as first class - and several in-between options. Similarly to our football club example, there may be ancillary revenues from selling of food and beverage as well as advertising certain products or services on flights.

You may also come across the profit margin in cases. This is simply the percentage of profit compared to the revenue and can be expressed as follows:

Profit margin = Profit/Revenue x 100

5.2.1.4. Break-even point

An ancillary concept to profit, the break-even point is the moment where revenues equal costs making the profit zero and can be expressed as the following equation:

Revenues = Costs (Fixed costs + Variable costs)

This formula will be useful when you are asked questions such as ‘What is the minimum price I should sell product X?’ or ‘What quantity do I need to sell in order to recoup my investment?’. Let’s say an owner of a sandwich store asks us to figure out how many salami and cheese salami sandwiches she needs to sell in order to break even. She’s spending $4 on salami and $2 for cheese and lettuce per sandwich, and believes she can sell the sandwiches at around $7. The cost of utilities and personnel is around $5000 per month. We could lay this all out in the break-even equation:

7 x Q ( quantity ) = (4+2) x Q + 5000 ( variable + fixed costs )

In a different scenario, we may be asked to calculate the break-even price . Let’s consider our sandwich example and say our owner knows she has enough ingredients for about 5000 sandwiches per month but is not sure how much to sell them for. In that case, if we know our break-even equation, we can simply make the following changes:

P ( price ) x 5000 = (4+2) x 5000 + 5000

By solving the equation we get to the price of $7 per sandwich.

5.2.1.5. Market share and market size

We can also consider the market closely with profit, as in fact the company’s performance in the market is what drives profits. The market size is the total number of potential customers for a certain business or product, whereas the market share is the percentage of that market that your business controls (or could control, depending on the case).

There is a good chance you will have to estimate the market size in one of your case interviews and we get into more details on how to do that below. You may be asked to estimate this in either number of potential customers or total value . The latter simply refers to the number of customers multiplied by the average value of the product or service.

To calculate the market share you will have to divide the company’s share by the total market size and multiply by 100:

Note, though, that learning the very basics of business is the beginning rather than the end of your journey. Once you are able to “speak business” at a rudimentary level, you should try to “become fluent” and immerse yourself in reading/viewing/listening to as wide a variety of business material as possible, getting a feel for all kinds of companies and industries - and especially the kinds of problems that can come up in each context and how they are solved. The material put out by the consulting firms themselves is a great place to start, but you should also follow the business news and find out about different companies and sectors as much as possible between now and interviews. Remember, if you’re going to be a consultant, this should be fun rather than a chore!

5.3 Public sector and NGO concepts

As we mentioned, there will be some cases (see section 6.6 for a more detailed example) where the key performance indicators (or KPIs in short) will not be connected to profit. The most common ones will involve the government of a country or an NGO, but they can be way more diverse and require more thought and application of first principles. We have laid out a couple of the key concepts or KPIs that come up below

5.3.1 Quantifiability

In many such scenarios you will be asked to make an important strategic decision of some kind or to optimise a process. Of course these are not restricted to non-private sector cases but this is where they really come into their own as there can be great variation in the type of decision and the types of field.

While there may be no familiar business concepts to anchor yourself onto, a concept that is essential is quantifiability . This means, however qualitative the decision might seem, consultants rely on data so you should always aim to have aspects of a decision that can be quantified, even if the data doesn’t present itself in a straightforward manner.

Let’s take a practical example. Your younger sibling asks you to help them decide which university they should choose if they want to study engineering. One way to structure your approach would be to segment the problem into factors affecting your sibling’s experience at university and experience post-university. Within the ‘at uni’ category you might think about the following:

• Financials : How much are tuition costs and accommodation costs?
• Quality of teaching and research : How are possible universities ranked in the QS guide based on teaching and research?
• Quality of resources : How well stocked is their library, are the labs well equipped etc.?
• Subject ranking : How is engineering at different unis ranked?
• Life on campus and the city : What are the living costs in the city where the university is based? What are the extracurricular opportunities and would your sibling like to live in that specific city based on them?

Within the ‘out of uni’ category you might think about:

• Exit options : What are the fields in which your sibling could be employed and how long does it take the average student of that university to find a job?
• Alumni network : What percentage of alumni are employed by major companies?
• Signal : What percentage of applicants from the university get an interview in major engineering companies and related technical fields?

You will perhaps notice that all the buckets discussed pose quantifiable questions meant to provide us with data necessary to make a decision. It’s no point to ask ‘Which university has the nicest teaching staff?’ as that can be a very subjective metric.

5.3.1 Impact

Another key concept to consider when dealing with sectors other than the private one is how impactful a decision or a line of inquiry is on the overarching issue , or whether all our branches in our issue tree have a similar impact. This can often come in the form of impact on lives, such as in McKinsey’s conservation case discussed below, namely how many species can we save with our choice of habitat.

5.4 Common consulting concepts

Consultants use basic business concepts on an every day basis, as they help them articulate their frameworks to problems. However, they also use some consulting specific tools to quality check their analysis and perform in the most efficient way possible. These principles can be applied to all aspects of a consultant’s work, but for brevity we can say they mostly impact a consultant’s systematic approach and communication - two very important things that are also tested in case interviews. Therefore, it’s imperative that you not only get to know them, but learn how and when to use them as they are at the very core of good casing. They are MECE-ness, the Pareto Principle and the Pyramid principle and are explained briefly below - you should, however, go on to study them in-depth in their respective articles.

Perhaps the central pillar of all consulting work and an invaluable tool to solve cases, MECE stands for Mutually Exclusive and Collectively Exhaustive . It can refer to any and every aspect in a case but is most often used when talking about structure. We have a detailed article explaining the concept here , but the short version is that MECE-ness ensures that there is no overlap between elements of a structure (i.e. the Mutually Exclusive component) and that it covers all the drivers or areas of a problem (Collectively Exhaustive). It is a concept that can be applied to any segmentation when dividing a set into subsets that include it wholly but do not overlap.

Let’s take a simple example and then a case framework example. In simple terms, when we are asked to break down the set ‘cars’ into subsets, dividing cars into ‘red cars’ and ‘sports cars’ is neither mutually exclusive (as there are indeed red sports cars) nor exhaustive of the whole set (i.e. there are also yellow non-sports cars that are not covered by this segmentation). A MECE way to segment would be ‘cars produced before 2000’ and ‘cars produced after 2000’ as this segmentation allows for no overlap and covers all the cars in existence.

Dividing cars can be simple, but how can we ensure MECEness in a case-interview a.k.a. a business situation. While the same principles apply, a good tip to ensure that your structure is MECE is to think about all the stakeholders - i.e. those whom a specific venture involves.

Let’s consider that our client is a soda manufacturer who wants to move from a business-to-business strategy, i.e. selling to large chains of stores and supermarkets, to a business-to-consumer strategy where it sells directly to consumers. In doing so they would like to retrain part of their account managers as direct salespeople and need to know what factors to consider.

A stakeholder-driven approach would be to consider the workforce and customers and move further down the issue tree, thinking about individual issues that might affect them. In the case of the workforce, we might consider how the shift would affect their workload and whether it takes their skillset into account. As for the customers, we might wonder whether existing customers would be satisfied with this move: will the remaining B2B account managers be able to provide for the needs of all their clients and will the fact that the company is selling directly to consumers now not cannibalise their businesses? We see how by taking a stakeholder-centred approach we can ensure that every single perspective and potential issue arising from it is fully covered.

5.4.2 The Pareto Principle

Also known as the 80/20 rule, this principle is important when gauging the impact of a decision or a factor in your analysis. It simply states that in business (but not only) 80% of outcomes come from 20% of causes. What this means is you can make a few significant changes that will impact most of your business organisation, sales model, cost structure etc.

Let’s have a look at 3 quick examples to illustrate this:

• 80% of all accidents are caused by 20% of drivers
• 20% of a company’s products account for 80% of the sales
• 80% of all results in a company are driven by 20% of its employees

The 80/20 rule will be a very good guide line in real engagements as well as case interviews, as it will essentially point to the easiest and most straightforward way of doing things. Let’s say one of the questions in a case is asking you to come up with an approach to understand the appeal of a new beard trimmer. Obviously you can’t interview the whole male population so you might think about setting up a webpage and asking people to comment their thoughts. But what you would get would be a laundry list of difficult to sift through data.

Using an 80/20 approach you would segment the population based on critical factors (age groups, grooming habits etc.) and then approach a significant sample size of each (e.g. 20), analysing the data and reaching a conclusion.

5.4.3 The Pyramid Principle

This principle refers to organising your communication in a top-down , efficient manner. While this is generally applicable, the pyramid principle will most often be employed when delivering the final recommendation to your client. This means - as is implicit in the name - that you would organise your recommendation (and communication in general) as a pyramid, stating the conclusion or most important element at the top then go down the pyramid listing 3 supporting arguments and then further (ideally also 3) supporting arguments for those supporting arguments.

Let’s look at this in practice: your client is a German air-conditioning unit manufacturer who was looking to expand into the French market. However, after your analysis you’ve determined that the market share they were looking to capture would not be feasible. A final recommendation using the Pyramid Principle would sound something like this: ‘I recommend that we do not enter the German market for the following three reasons. Firstly, the market is too small for our ambitions of $50 million. Secondly the market is heavily concentrated, being controlled by three major players and our 5 year goal would amount to controlling 25% of the market, a share larger than that of any of the players. Thirdly, the alternative of going into the corporate market would not be feasible, as it has high barriers to entry.Then, if needed, we could delve deeper into each of our categories

6. Case examples or building blocks?

As we mentioned before, in your preparation you will undoubtedly find preparation resources that claim that there are several standard types of cases and that there is a general framework that can be applied to each type of case. While there are indeed cases that are straightforward at least in appearance and seemingly invite the application of such frameworks, the reality is never that simple and cases often involve multiple or more complicated components that cannot be fitted into a simple framework.

At MCC we don’t want you to get into the habit of trying to identify which case type you’re dealing with and pull out a framework, but we do recognize that there are recurring elements in frameworks that are useful - such as the profitability of a venture (with its revenues and costs), the valuation of a business, estimating and segmenting a market and pricing a product.

We call these building blocks because they can be used to build case frameworks but are not a framework in and of themselves, and they can be shuffled around and rearranged in any way necessary to be tailored to our case. Hence, our approach is not to make you think in terms of case types but work from first principles and use these building blocks to build your own framework. Let’s take two case prompts to illustrate our point.

The first is from the Bain website, where the candidate is asked whether they think it’s a good idea for their friend to open a coffee shop in Cambridge UK (see the case here ). The answer framework provided here is a very straightforward profitability analysis framework, examining the potential revenues and potential costs of the venture:

While this is a good point to start (especially taken together with the clarifying questions), we will notice that this approach will need more tailoring to the case - for example the quantity of coffee will be determined by the market for coffee drinkers in Cambridge, which we have to determine based on preference. We are in England so a lot of people will be drinking tea but we are in a university town so perhaps more people than average are drinking coffee as it provides a better boost when studying. All these are some much needed case-tailored hypotheses that we can make based on the initial approach.

Just by looking at this case we might be tempted to say that we can just take a profitability case and apply it without any issues. However, this generic framework is just a starting point and in reality we would need to tailor it much further in the way we had started to do in order to get to a satisfactory answer. For example, the framework itself doesn’t cover aspects such as the customer’s expertise: does the friend have any knowledge of the coffee business, such as where to source coffee and how to prepare it? Also, we could argue there may be some legal factors to consider here, such as any approvals that they might need from the city council to run a coffee shop on site, or some specific trade licences that are not really covered in the basic profitability framework.

Let’s take a different case , however, from the McKinsey website. In this scenario, the candidate is being asked to identify some factors in order to choose where to focus the client’s conservation efforts. Immediately we can realise that this case doesn’t lend itself to any pre-packaged framework and we will need to come up with something from scratch - and take a look at McKinsey’s answer of the areas to focus on:

We notice immediately that this framework is 100% tailored to the case - of course there are elements which we encounter in other cases, such as costs and risks but again these are applied in an organic way. It’s pretty clear that while no standard framework would work in this case, the aforementioned concepts - costs and risks - and the way to approach them (a.k.a building blocks ) are fundamentally similar throughout cases (with the obvious specificities of each case).

In what follows, we’ll give a brief description of each building block starting from the Bain example discussed previously, in order to give you a general idea of what they are and their adaptability, but you should make sure to follow the link to the in-depth articles to learn all their ins and outs.

6.1 Estimates and segmentation

This building block will come into play mostly when you’re thinking about the market for a certain product (but make sure to read the full article for more details). Let’s take our Bain Cambridge coffee example. As we mentioned under the quantity bucket we need to understand what the market size for coffee in Cambridge would be - so we can make an estimation based on segmentation .

The key to a good estimation is the ability to logically break down the problem into more manageable pieces. This will generally mean segmenting a wider population to find a particular target group. We can start off with the population of Cambridge - which we estimate at 100.000. In reality the population is closer to 150.000 but that doesn’t matter - the estimation has to be reasonable and not accurate , so unless the interviewer gives you a reason to reconsider you can follow your instinct. We can divide that into people who do and don’t drink coffee. Given our arguments before, we can conclude that 80% of those, so 80.000 drink coffee. Then we can further segment into those who drink regularly - let’s say every day - and those who drink occasionally - let’s say once a week. Based on the assumptions before about the student population needing coffee to function, and with Cambridge having a high student population, we can assume that 80% of those drinking coffee are regular drinkers, so that would be 64.000 regular drinkers and 16.000 occasional drinkers. We can then decide whom we want to target what our strategy needs to be:

This type of estimation and segmentation can be applied to any case specifics - hence why it is a building block.

6.2 Profitability

We had several looks at this building block so far (see an in-depth look here ) as it will show up in most scenarios, since profit is a key element in any company’s strategy. As we have seen, the starting point to this analysis is to consider both the costs and revenues of a company, and try to determine whether revenues need to be improved or whether costs need to be lowered. In the coffee example, the revenues are dictated by the average price per coffe x the number of coffees sold , whereas costs can be split into fixed and variable .

Some examples of fixed costs would be the rent for the stores and the cost of the personnel and utilities, while the most obvious variable costs would be the coffee beans used and the takeaway containers (when needed). We may further split revenues in this case into Main revenues - i.e. the sales of coffee - and Ancillary revenues , which can be divided into Sales of food products (sales of pastries, sandwiches etc., each with the same price x quantity schema) and Revenues from events - i.e renting out the coffee shop to events and catering for the events themselves. Bear in mind that revenues will be heavily influenced by the penetration rate , i.e. the share of the market which we can capture.

6.3 Pricing

Helping a company determine how much they should charge for their goods or services is another theme that comes up frequently in cases. While it may seem less complicated than the other building blocks, we assure you it’s not - you will have to understand and consider several factors, such as the costs a company is incurring, their general strategic positioning, availability, market trends as well as the customers’ willingness to pay (or WTP in short) - so make sure to check out our in-depth guide here .

In our example, we may determine that the cost per cup (coffee beans, staff, rent) is £1. We want to be student friendly so we should consider how much students would want to pay for a coffee as well as how much are competitors are charging. Based on those factors, it would be reasonable to charge on average £2 per cup of coffee. It’s true that our competitors are charging £3 but they are targeting mostly the adult market, whose willingness to pay is higher, so their pricing model takes that into account as well as the lower volume of customers in that demographic.

6.4. Valuation

A variant of the pricing building block, a valuation problem generally asks the candidate to determine how much a client should pay for a specific company (the target of an acquisition) as well as what other factors to consider. The two most important factors (but not the only ones - for a comprehensive review see our Valuation article ) to consider are the net present value (in consulting interviews usually in perpetuity) and the synergies .

In short, the net present value of a company is how much profit it currently brings in, divided by how much that cash flow will depreciate in the future and can be represented with the equation below:

The synergies refer to what could be achieved should the companies operate as one, and can be divided into cost and revenue synergies .

Let’s expand our coffee example a bit to understand these. Imagine that our friend manages to open a chain of coffee shops in Cambridge and in the future considers acquiring a chain of take-out restaurants. The most straightforward example of revenue synergies would be cross-selling, in this case selling coffee in the restaurants as well as in the dedicated stores, and thus getting an immediate boost in market share by using the existing customers of the restaurant chain. A cost synergy would be merging the delivery services of the two businesses to deliver both food and coffee, thus avoiding redundancies and reducing costs associated with twice the number of drivers and vehicles.

6.5. Competitive interaction

This component of cases deals with situations where the market in which a company is operating changes and the company must decide what to do. These changes often have to do with a new player entering the market (again for more details make sure to dive into the Competitive Interaction article ).

Let’s assume that our Cambridge coffee shop has now become a chain and has flagged up to other competitors that Cambridge is a blooming market for coffee. As such, Starbucks has decided to open a few stores in Cambridge themselves, to test this market. The question which might be posed to a candidate is what should our coffee chain do. One way (and a MECE one) to approach the problem is to decide between doing something and doing nothing . We might consider merging with another coffee chain and pooling our resources or playing to our strengths and repositioning ourselves as ‘your student-friendly, shop around the corner’. Just as easily we may just wait the situation out and see whether indeed Starbucks is cutting into our market share - after all, the advantages of our product and services might speak for themselves and Starbucks might end up tanking. Both of these are viable options if argued right and depending on the further specifics of the case.

6.6. Special cases

Most cases deal with private sectors, where the overarching objective entails profit in some form. However, as hinted before, there are cases which deal with other sectors where there are other KPIs in place . The former will usually contain one or several of these building blocks whereas the latter will very likely have neither. This latter category is arguably the one that will stretch your analytical and organisational skills to the limit, since there will be very little familiarity that you can fall back on (McKinsey famously employs such cases in their interview process).

So how do we tackle the structure for such cases? The short answer would be starting from first principles and using the problem driven structure outlined above, but let’s look at a quick example in the form of a McKinsey case :

The first question addressed to the candidate is the following:

This is in fact asking us to build a structure for the case. So what should we have in mind here? Most importantly, we should start with a structure that is MECE and we should remember to do that by considering all the stakeholders . They are on the one hand the government and affiliated institutions and on the other the population. We might then consider which issues might arise for each shareholder and what the benefits for them would be, as well as the risks. This approach is illustrated in the answer McKinsey provides as well:

More than anything, this type of case shows us how important it is to practise and build different types of structures, and think about MECE ways of segmenting the problem.

7. How Do I prepare for case interviews

In consulting fashion, the overall preparation can be structured into theoretical preparation and practical preparation , with each category then being subdivided into individual prep and prep with a partner .

As a general rule, the level and intensity of the preparation will differ based on your background - naturally if you have a business background (and have been part of a consulting club or something similar) your preparation will be less intensive than if you’re starting from scratch. The way we suggest you go about it is to start with theoretical preparation , which means learning about case interviews, business and basic consulting concepts (you can do this using free resources - such as the ones we provide - or if you want a more through preparation you can consider joining our Case Academy as well).

You can then move on to the practical preparation which should start with doing solo cases and focusing on areas of improvement, and then move on to preparation with a partner , which should be another candidate or - ideally - an ex-consultant.

Let’s go into more details with respect to each type of preparation.

7.1. Solo practice

The two most important areas of focus in sole preparation are:

• Mental math

As we mentioned briefly, the best use of your time is to focus on solving cases. You can start with cases listed on MBB sites since they are clearly stated and have worked solutions as well (e.g. Bain is a good place to start) and then move to more complex cases (our Case Library also offers a range of cases of different complexities). To build your confidence, start out on easier case questions, work through with the solutions, and don't worry about time. As you get better, you can move on to more difficult cases and try to get through them more quickly. You should practice around eight case studies on your own to build your confidence.

Another important area of practice is your mental mathematics as this skill will considerably increase your confidence and is neglected by many applicants - much to their immediate regret in the case interview. Find our mental math tool here or in our course, and practice at least ten minutes per day, from day one until the day before the interview.

7.2. Preparation with a partner

There are aspects of an interview - such as asking clarifying questions - which you cannot do alone and this is why, after you feel comfortable, you should move on to practice with another person. There are two options here:

• Practicing with a peer
• Practicing with an ex-consultant

In theory they can be complementary - especially if you’re peer is also preparing for consulting interviews - and each have advantages and disadvantages. A peer is likely to practice with you for free for longer, however you may end up reinforcing some bad habits or unable to get actionable feedback. A consultant will be able to provide you the latter but having their help for the same number of hours as a peer will come at a higher cost. Let’s look at each option in more detail.

7.2.1. Peer preparation

Once you have worked through eight cases solo, you should be ready to simulate the interview more closely and start working with another person.

Here, many candidates turn to peer practice - that is, doing mock case interviews with friends, classmates or others also applying to consulting. If you’re in university, and especially in business school, there will very likely be a consulting club for you to join and do lots of case practice with. If you don’t have anyone to practice, though, or if you just want to get a bit more volume in with others, our free meeting board lets you find fellow applicants from around the world with whom to practice. We recommend practicing around 10 to 15 ‘live’ cases to really get to a point where you feel comfortable.

7.2.2. Preparation with a consultant

You can do a lot practising by yourself and with peers. However, nothing will bring up your skills so quickly and profoundly as working with a real consultant.

Perhaps think about it like boxing. You can practice drills and work on punch bags all you want, but at some point you need to get into the ring and do some actual sparring if you ever want to be ready to fight.

Practicing with an ex consultant is essentialy a simulation of an interview. Of course, it isn’t possible to secure the time of experienced top-tier consultants for free. However, when considering whether you should invest to boost your chances of success, it is worth considering the difference in your salary over even just a few years between getting into a top-tier firm versus a second-tier one. In the light of thousands in increased annual earnings (easily accumulating into millions over multiple years), it becomes clear that getting expert interview help really is one of the best investments you can make in your own future.

Should you decide to make this step, MyConsultingCoach can help, offering bespoke mentoring programmes , where you are paired with a 5+ year experienced, ex-MBB mentor of your choosing, who will then oversee your whole case interview preparation from start to finish - giving you your best possible chance of landing a job!

7.3. Practice for online interviews

Standard preparation for interview case studies will carry directly over to online cases.

However, if you want to do some more specific prep, you can work through cases solo to a timer and using a calculator and/or Excel (online cases generally allow calculators and second computers to help you, whilst these are banned in live case interviews).

Older PST-style questions also make great prep, but a particularly good simulation is the self-assessment tests included in our Case Academy course . These multiple choice business questions conducted with a strict time limit are great preparation for the current crop of online cases.

7.4. Fit interviews

As we’ve noted, even something billed as a case interview is very likely to contain a fit interview as a subset.

We have an article on fit interviews and also include a full set of lessons on how to answer fit questions properly as a subset of our comprehensive Case Academy course .

Here though, the important thing to convey is that you take preparing for fit questions every bit as seriously as you do case prep.

Since they sound the same as you might encounter when interviewing for other industries, the temptation is to regard these as “just normal interview questions”.

However, consulting firms take your answers to these questions a good deal more seriously than elsewhere.

This isn’t just for fluffy “corporate culture” reasons. The long hours and close teamwork, as well as the client-facing nature of management consulting, mean that your personality and ability to get on with others is going to be a big part of making you a tolerable and effective co-worker.

If you know you’ll have to spend 14+ hour working days with someone you hire and that your annual bonus depends on them not alienating clients, you better believe you’ll pay attention to their character in interview.

There are also hard-nosed financial reasons for the likes of McKinsey, Bain and BCG to drill down so hard on your answers.

In particular, top consultancies have huge issues with staff retention. The average management consultant only stays with these firms for around two years before they have moved on to a new industry.

In some cases, consultants bail out because they can’t keep up with the arduous consulting lifestyle of long hours and endless travel. In many instances, though, departing consultants are lured away by exit opportunities - such as the well trodden paths towards internal strategy roles, private equity or becoming a start-up founder.

Indeed, many individuals will intentionally use a two year stint in consulting as something like an MBA they are getting paid for - giving them accelerated exposure to the business world and letting them pivot into something new.

Consulting firms want to get a decent return on investment for training new recruits. Thus, they want hires who not only intend to stick with consulting longer-term, but also have a temperament that makes this feasible and an overall career trajectory where it just makes sense for them to stay put.

This should hammer home the point that, if you want to get an offer, you need to be fully prepared to answer fit questions - and to do so excellently - any time you have a case interview.

8. Interview day - what to expect, with tips

Of course, all this theory is well and good, but a lot of readers might be concerned about what exactly to expect in real life . It’s perfectly reasonable to want to get as clear a picture as possible here - we all want to know what we are going up against when we face a new challenge!

Indeed, it is important to think about your interview in more holistic terms, rather than just focusing on small aspects of analysis. Getting everything exactly correct is less important than the overall approach you take to reasoning and how you communicate - and candidates often lose sight of this fact.

In this section, then, we’ll run through the case interview experience from start to finish, directing you to resources with more details where appropriate. As a supplement to this, the following video from Bain is excellent. It portrays an abridged version of a case interview, but is very useful as a guide to what to expect - not just from Bain, but from McKinsey, BCG and any other high-level consulting firm.

8.1. Getting started

Though you might be shown through to the office by a staff member, usually your interviewer will come and collect you from a waiting area. Either way, when you first encounter them, you should greet your interviewer with a warm smile and a handshake (unless they do not offer their hand). Be confident without verging into arrogance. You will be asked to take a seat in the interviewer’s office, where the interview can then begin.

8.1.1. First impressions

In reality, your assessment begins before you even sit down at your interviewer’s desk. Whether at a conscious level or not, the impression you make within the first few seconds of meeting your interviewer is likely to significantly inform the final hiring decision (again, whether consciously or not).

Your presentation and how you hold yourself and behave are all important . If this seems strange, consider that, if hired, you will be personally responsible for many clients’ impressions of the firm. These things are part of the job! Much of material on the fit interview is useful here, whilst we also cover first impressions and presentation generally in our article on what to wear to interview .

As we have noted above, your interview might start with a fit segment - that is, with the interviewer asking questions about your experiences, your soft skills, and motivation to want to join consulting generally and that firm in particular. In short, the kinds of things a case study can’t tell them about you. We have a fit interview article and course to get you up to speed here.

8.1.2. Down to business

Following an initial conversation, your interviewer will introduce your case study , providing a prompt for the question you have to answer. You will have a pen and paper in front of you and should (neatly) note down the salient pieces of information (keep this up throughout the interview).

It is crucial here that you don’t delve into analysis or calculations straight away . Case prompts can be tricky and easy to misunderstand, especially when you are under pressure. Rather, ask any questions you need to fully understand the case question and then validate that understanding with the interviewer before you kick off any analysis. Better to eliminate mistakes now than experience that sinking feeling of realising you have gotten the whole thing wrong halfway through your case!

This process is covered in our article on identifying the problem and in greater detail in our Case Academy lesson on that subject.

8.1.3. Analysis

Once you understand the problem, you should take a few seconds to set your thoughts in order and draw up an initial structure for how you want to proceed. You might benefit from utilising one or more of our building blocks here to make a strong start. Present this to your interviewer and get their approval before you get into the nuts and bolts of analysis.

We cover the mechanics of how to structure your problem and lead the analysis in our articles here and here and more thoroughly in the MCC Case Academy . What it is important to convey here, though, is that your case interview is supposed to be a conversation rather than a written exam . Your interviewer takes a role closer to a co-worker than an invigilator and you should be conversing with them throughout.

Indeed, how you communicate with your interviewer and explain your rationale is a crucial element of how you will be assessed. Case questions in general, are not posed to see if you can produce the correct answer, but rather to see how you think . Your interviewer wants to see you approach the case in a structured, rational fashion. The only way they are going to know your thought processes, though, is if you tell them!

To demonstrate this point, here is another excellent video from Bain, where candidates are compared.

Note that multiple different answers to each question are considered acceptable and that Bain is primarily concerned with the thought processes of the candidate’s exhibit .

Another reason why communication is absolutely essential to case interview success is the simple reason that you will not have all the facts you need to complete your analysis at the outset. Rather, you will usually have to ask the interviewer for additional data throughout the case to allow you to proceed .

NB: Don't be let down by your math!

Your ability to quickly and accurately interpret these charts and other figures under pressure is one of the skills that is being assessed. You will also need to make any calculations with the same speed and accuracy (without a calculator!). As such, be sure that you are up to speed on your consulting math .

8.1.4. Recommendation

Finally, you will be asked to present a recommendation. This should be delivered in a brief, top-down "elevator pitch" format , as if you are speaking to a time-pressured CEO. Again here, how you communicate will be just as important as the details of what you say, and you should aim to speak clearly and with confidence.

For more detail on how to give the perfect recommendation, take a look at our articles on the Pyramid Principle and providing recommendations , as well the relevant lesson within MCC Academy .

8.1.5. Wrapping up

After your case is complete, there might be a few more fit questions - including a chance for you to ask some questions of the interviewer . This is your opportunity to make a good parting impression.

We deal with the details in our fit interview resources. However, it is always worth bearing in mind just how many candidates your interviewers are going to see giving similar answers to the same questions in the same office. A pretty obvious pre-requisite to being considered for a job is that your interviewer remembers you in the first place. Whilst you shouldn't do something stupid just to be noticed, asking interesting parting questions is a good way to be remembered.

Now, with the interview wrapped up, it’s time to shake hands, thank the interviewer for their time and leave the room .

You might have other interviews or tests that day or you might be heading home. Either way, if know that you did all you could to prepare, you can leave content in the knowledge that you have the best possible chance of receiving an email with a job offer. This is our mission at MCC - to provide all the resources you need to realise your full potential and land your dream consulting job!

8.2. Remote and one-way interview tips

Zoom case interviews and “one-way” automated fit interviews are becoming more common as selection processes are increasingly remote, with these new formats being accompanied by their own unique challenges.

Obviously you won’t have to worry about lobbies and shaking hands for a video interview. However, a lot remains the same. You still need to do the same prep in terms of getting good at case cracking and expressing your fit answers. The specific considerations around remote interviews are, in effect, around making sure you come across as effectively as you would in person.

8.2.1. Connection

It sounds trivial, but a successful video interview of any kind presupposes a functioning computer with a stable and sufficient internet connection.

Absolutely don’t forget to have your laptop plugged in, as your battery will definitely let you down mid-interview. Similarly, make sure any housemates or family know not to use the microwave, vacuum cleaner or anything else that makes wifi cut out (or makes a lot of noise, obviously)

If you have to connect on a platform you don’t use much (for example, if it’s on Teams and you’re used to Zoom), make sure you have the up to date version of the app in advance, rather than having to wait for an obligatory download and end up late to join. Whilst you’re at it, make sure you’re familiar with the controls etc. At the risk of being made fun of, don’t be afraid to have a practice call with a friend.

8.2.2. Dress

You might get guidance on a slightly more relaxed dress code for a Zoom interview. However, if in doubt, dress as you would for the real thing (see our article here ).

Either way, always remember that presentation is part of what you are being assessed on - the firm needs to know you can be presentable for clients. Taking this stuff seriously also shows respect for your interviewer and their time in interviewing you.

8.2.3. Lighting

An aspect of presentation that you have to devote some thought to for a Zoom interview is your lighting.

Hopefully, you long ago nailed a lighting set-up during the Covid lockdowns. However, make sure to check your lighting in advance with your webcam - bearing in mind what time if day your interview actually is. If your interview is late afternoon, don’t just check in the morning. Make sure you aren’t going to be blinded from light coming in a window behind your screen, or that you end up with the weird shadow stripes from blinds all over your face.

Natural light is always best, but if there won’t be much of that during your interview, you’ll likely want to experiment with moving some lamps around.

8.2.4. Clarity

The actual stories you tell in an automated “one-way” fit interview will be the same as for a live equivalent. If anything, things should be easier, as you can rattle off a practised monologue without an interviewer interrupting you to ask for clarifications.

You can probably also assume that the algorithm assessing your performance is sufficiently capable that it will be observing you at much the same level as a human interviewer. However, it is probably still worth speaking as clearly as possible with these kinds of interviews and paying extra attention to your lighting to ensure that your face is clearly visible.

No doubt the AIs scoring these interviews are improving all the time, but you still want to make their job as easy as possible. Just think about the same things as you would with a live Zoom interview, but more so.

9. How we can help

There are lots of great free resources on this site to get you started with preparation, from all our articles on case solving and consulting skills to our free case library and peer practice meeting board .

To step your preparation up a notch, though, our Case Academy course will give you everything you need to know to solve the most complex of cases - whether those are in live interviews, with chatbots, written tests or any other format.

Whatever kind of case you end up facing, nothing will bring up your skillset faster than the kind of acute, actionable feedback you can get from a mock case interview a real, MBB consultant. Whilst it's possible to get by without this kind of coaching, it does tend to be the biggest single difference maker for successful candidates.

You can find out more on our coaching page:

Explore Coaching

Of course, for those looking for a truly comprehensive programme, with a 5+ year experienced MBB consultant overseeing their entire prep personally, from networking and applications right through to your offer, we have our mentoring programmes.

You can read more here:

Comprehensive Mentoring

Account not confirmed

• Crimson Careers
• For Employers
• Harvard College
• Harvard Kenneth C. Griffin Graduate School of Arts & Sciences
• Harvard Extension School
• Premed / Pre-Health
• Families & Supporters
• Faculty & Staff
• Prospective Students
• First Generation / Low Income
• International Students
• Students of Color
• Students with Disabilities
• Undocumented Students
• Explore Interests & Make Career Decisions
• Create a Resume/CV or Cover Letter
• Expand Your Network
• Engage with Employers
• Search for a Job
• Find an Internship
• January Experiences (College)
• Find & Apply for Summer Opportunities Funding
• Prepare for an Interview
• Negotiate an Offer
• Apply to Graduate or Professional School
• Access Resources
• AI for Professional Development and Exploration
• Arts & Entertainment
• Business & Entrepreneurship
• Climate, Sustainability, Environment, Energy
• Government, Int’l Relations, Education, Law, Nonprofits
• Life Sciences & Health
• Technology & Engineering
• Still Exploring
• Talk to an Advisor

How to Succeed in a Case Study Interview

• Share This: Share How to Succeed in a Case Study Interview on Facebook Share How to Succeed in a Case Study Interview on LinkedIn Share How to Succeed in a Case Study Interview on X

Instructor: Jena Viviano

You’ve nailed the first few rounds of interviews, and now you’ve been invited to participate in a case study interview. Curious about what this next stage of the process looks like? In this course, Jena Viviano breaks it down for you, explaining the basic components of a case study interview, how to prepare, and what to do to project confidence and engage your interviewer. Learn how case study interview questions are used and why employers find them beneficial. Discover the key elements that interviewers use to evaluate your answers. Plus, learn how to formulate key questions to dig deeper into the case, develop your own framework for every case study answer, and craft a conclusion with supporting rationale that’s concise and clear. Jena also provides tips for quelling your performance anxiety, as well as sample case study questions that give you a better understanding of what to expect.

The World of Consultants, Their Clients and Business Cases

What is a case study interview and why do consultancies like to use them, at what stage of the application process can you expect the case study, what skills are case studies looking to test, what to expect on the day of the case study interview in june 2024, case study example topics, how to prepare and practice effectively for a case study interview in 2024, tips on how to perform well during the case study interview, frequently asked questions, final thoughts, case study interview guide (2024) with sample questions and answers.

Updated June 9, 2023

All products and services featured are independently selected by WikiJob. When you register or purchase through links on this page, we may earn a commission.

The case study interview is a critical piece of the employee selection process for professional service firms. For consultancies, its specific purpose is to assess aptitude for partner-track roles.

Historically, the case study interview has been used to hire associate-level employees – those who are expected to work directly with business clients and produce a stream of billable services.

In recent years, case study interviews have expanded to analyst-level employees, in organisations that are usually the target clients of consultancies, especially in tech, healthcare, eCommerce and even NGOs.

Such analyst-level employees provide internal support to senior management, researching and vetting strategic opportunities.

Practice Case Study Assessment with JobTestPrep

The case study interview typically consists of a single session, in which the candidate is presented with an authentic business scenario similar to one the firm regularly handles with its clients.

The candidate is asked to study the problem, perform analysis and render advice on how to handle the scenario. Depending on the industry the consultancy serves, the candidate may be asked to demonstrate how that advice might be implemented, and show specialized technical proficiency.

The session most commonly takes place onsite, in person, and one-to-one with the interviewer, but may be conducted remotely, or in a group setting.

No particular formal training is required to 'ace the case'. Yet most candidates find they need substantial preparation to get into the consulting mindset and sharpen the skills that interviewers are most looking for.

Prepare for Case Study Interview

Consultants are hired by senior managers of client organisations to advise on business strategy .

An effective business strategy drives competitive advantage, which in turn creates economic efficiencies that sustain multiple periods of cash generation, ultimately boosting the business value of the client organisation.

A business strategy is often characterised by a range of possible decisions, each having a unique set of risks and rewards. Deciding which path to pursue is highly momentous. Everything the client does hence comes at the expense of some opportunity it does not pursue.

The primary job of senior managers is to craft business strategy, determine the best course of action, and direct its execution. It is extremely difficult work requiring great focus, assimilation of tremendous amounts of information, intensive analysis, and serious reflection on all possible consequences.

The reality of senior managers’ jobs, however, is often much different. Their days are usually spent shuttling from one meeting to another, putting out fires, answering emails and phone calls, and in general, dealing with matters that are more urgent than important.

Time and attention are their scarcest resources, and there is never enough of either to devote to all the important aspects of business strategy.

Senior managers are fond of saying something to the effect of: “If I had just two weeks when I didn’t have to do anything else, I could do it myself”.

While that might be true, the fact is they aren’t ever likely to get even two hours, much less two weeks. Consultants provide that additional capacity senior managers so desperately need.

In some cases, that extra capacity comes in the form of expertise that the client firm doesn’t have readily available.

In others, consultants provide independent validation of business strategies, thereby assuring governing boards and executive committees that they aren’t committing their company’s fortune to a cleverly articulated hunch.

In short, successful consultants are trusted advisors and partners of their client firms’ senior managers, doing much of the work they would do if not so time-constrained.

Consultants perform research and analysis , evaluate business cases , and help manage the pipeline of business opportunities for their senior manager clients.

Over time they learn to complement their clients’ business intuition and anticipate future consulting needs.

A case study interview is a miniature simulation of a typical client engagement, centred on a business problem that a client has likely contended with.

The interview is usually conducted in a single session lasting 20 to 30 minutes, though sometimes it can be considerably longer.

During this time, candidates are briefed on a strategic decision similar to one a client has faced and will be asked to analyse the situation, interact with the interviewer, and devise a solution.

The case study interview may also include the candidate outlining a PowerPoint presentation that would be delivered to the client, and giving a verbal summary of each slide.

Most case study interviews are conducted in-person by the interviewer, with ample opportunity for interaction with the candidate.

Some case study interviews are less structured, and in these cases, it is up to the candidate to drive the interview.

Some may even be conducted remotely using a video-conferencing app, with the interviewer absent most of the time, and the candidate left alone to work on the case.

Consultancies favour case study interviews for several reasons. First and foremost, case studies represent an authentic work sample of the often fiendishly difficult work of business strategy, and the attendant tasks consultants deal with every day.

That includes gathering and analysing information, prioritising findings and determining what’s missing, creating structures to make things understandable, putting results into a greater context, understanding trade-offs, creating blueprints for implementation, and delivering presentations.

How candidates interact with the interviewer also provides insight into what sort of relationship they will have with senior managers who are paying hefty rates for the firm’s services. They are looking for evidence that candidates can communicate effectively with executives , and build durable, trusting business relationships with them.

Consultancies also like case study interviews because, as work samples, they are a valid predictor of future job performance . Additionally, the cases used in interviews are often standardised so that they can be used to compare multiple candidates according to the same criteria.

Finally, most applicants for consulting roles have high grades from top schools, a background of overachievement, and impressive work experience, and therefore cannot be differentiated on that basis. Case studies are an effective way to distinguish the best among a pool of the best.

If you need to practice consulting case interviews, try out this preparation pack from JobTestPrep .

The selection process for consultants always involves multiple stages, with the case study interview occurring later in the process, after you’ve successfully completed the so-called 'fit interviews' .

During the fit interview stage, candidates need to demonstrate that they have the temperament of a successful consultant, which is established mostly through behavioral interviewing . They also need to demonstrate that they’ll fit in well with the culture of the firm and its clients. In short, if you’ve made it this far, you have laid the groundwork to do the job.

But can you really do it? The case study interview seeks to determine whether you can apply your background, skills and achievements to future consulting work, day after day, client after client. No two consulting engagements are the same, and the work is often gruelling.

Much of the time you will find yourself stretched to the limit of your abilities. Your world will be full of unsolved problems, with no easy way to get answers. You will come to rely on the ingenuity of your colleagues as much as your own.

At the case study interview stage, the major questions the consultancy will want to answer include:

• Are you someone they would want on their team, and can depend on for insight, energy and contributions?
• Are you inherently curious, a quick learner, and eager to learn about things even if they aren’t particularly interesting to you?
• Can you think on your feet and adapt to a changing conversation?
• Do you come across as presentable, poised and confident in front of clients, most of whom are senior managers?
• Can you make presentations that are clear, relevant, logical and actionable?

Specific skills they are wanting to see are:

Analytical thinking . Especially in framing issues, breaking situations down into a range of discrete alternatives, structuring complex situations, and rendering findings into concrete business language.

Asking appropriate questions . Interviewers want to see that you respect where the limits of available information are, and can quickly determine remedies. More practically, they want assurance that you are always mindful that both you and your client are understanding one another.

Business intuition . That includes focusing on relevant areas, avoiding getting hung up on trivia, and anticipating challenges in the absence of hard data.

Communicating effectively . That includes building rapport with clients and their staff, active listening, giving clients the confidence they’ve been heard, and speaking in the language of the client.

If you need to prepare for a number of different employment tests and want to outsmart the competition, choose a Premium Membership from JobTestPrep . You will get access to three PrepPacks of your choice, from a database that covers all the major test providers and employers and tailored profession packs.

Get a Premium Package Now

The case study interview session will likely begin like a standard interview, with introductions and a small talk to help put you at ease. The location will usually be an interviewing room or a vacant conference room.

The interviewer will introduce the business situation and provide exhibits, which often include an excerpt from a financial statement, and perhaps a bullet-point summary of the facts of the case. The interviewer will ask if you have any questions, and then you will be prompted to begin working on the case.

Cases are usually self-contained, so it is unlikely you will need internet access to do research. However, you will likely have to perform calculations, and will either be provided with paper and pens or allowed to use the calculator on your mobile phone or the whiteboard in the room.

During the case, the interviewer may stay in the room to address any questions you have. The interviewer may also offer prompts, guide you to the next step, or provide hints.

Many interviewers will offer verbal or tacit feedback along the way, and it is important to pay attention to it. You may occasionally find yourself getting stuck, and it is entirely appropriate to ask questions of the interviewer to help get back on track.

At the conclusion, you may be given feedback on your overall performance, or an opportunity to debrief with the interviewer.

Common Types of Case Study Questions

Case study questions usually fall into one of the following four categories:

• Estimation questions
• Actual or theoretical client questions
• Brainteaser questions
• Graphic interpretation questions

JobTestPrep offers practice packages to prepare for assessment centre case studies .

Estimation Questions

This type of question requires you to think on your feet and work out the solution to a problem with only your own limited knowledge. Such questions include:

• How many cars are there in England?
• How many children are born each year in Europe?
• How many mobile phones will be sold in 2024?
• How many night buses are there in London?

Actual or Theoretical Client Questions

This type of question requires candidates to analyse an actual or possible client issue. Examples include:

• A well-known business wants to develop itself online. What is your advice?
• A well-known high-street cafe chain is doing badly. How do you suggest they improve?
• A company has found that its revenues are higher than ever, but the company is still operating at a loss. Why is this?
• You have been contacted by a sushi chain to help them develop a plan to enter the home delivery market in a community where another sushi chain already has a market-dominant position. You are the lead consultant for this client, what do you suggest they do?

Graphic Interpretation Questions

This type of question requires candidates to interpret data from some kind of chart or graph. The data may be actual company data, data that has been made up or data that refers to something else entirely.

Case study questions are most likely to cover general business strategy topics. Candidates can expect any of the following during their case interview:

Build a business case for developing a major new product, service, technology solution, or customer experience

Build a business case for a developing new line of business, spinning off an existing one, or creating a subsidiary business

Recommend whether to pursue a purchase, divestiture, acquisition, merger, joint venture, strategic alliance, or major partnership

Recommend whether to enter a new market and if so, by what competitive strategy (for example, cost, service, quality)

Determine how best to improve company or business unit growth, and how it might affect critical areas of the company’s financial statements, especially revenue, gross margin, EBITDA, or profitability

Determine how best to price or segment a new product or service offering Determine whether to rehabilitate a brand

Determine how to respond to a major competitive threat (for example, “Google / Amazon / Microsoft just entered our space”)

When preparing for the case study interview, it is important to keep things in perspective. You are not being assessed on your mastery of business strategy. Rather, the interviewers are looking at whether you take a critical approach to complex business problems, and can break them down into components logically, thoroughly and clearly.

They want to see whether you apply a structure to those components, one that highlights meaningful differences in choices a client may face. And they are especially interested in whether you ask insightful questions that increase everyone’s knowledge and drive the conversation toward a solid conclusion.

In light of that, here are some practical ways you can prepare for the case interview:

Step 1 . Gain a Working Understanding of the Standard Frameworks Used in the Consulting Industry

There are numerous online resources to help familiarise you or refresh your understanding.

Keep in mind these frameworks are not hacks and must be applied appropriately if you decide to use them during your case study interview.

Step 2 . Get Comfortable With Fundamental Analysis Techniques

One of the most common is MECE (mutually exclusive and collectively exhaustive), but there are several others .

But the goal is the same – lay out a range of feasible solutions with no gaps in between.

Step 3 . Sharpen Your Ability to Make Back-Of-The-Envelope Calculations

Especially financial ratios , so that you can make comparisons or decisions quickly.

Step 4 . Develop a Concise Style for Putting Business Situations and Solutions Into Narrative Form

Harvard Business Review or MIT Sloan Management Review articles contain particularly good examples of consulting solutions told as compelling stories.

Step 5 . Practice Several Actual Cases

Most of the top consulting firms offer online guidance, worked examples and actual cases.

Another good resource is your university’s careers services department. Many have extensive case interview preparation materials, and staff who can conduct a practice case study interview with you.

Step 6 . Practice Active Listening

Listening is a highly cultivated skill among senior managers. You will come across as very junior if you cut them off or act too eagerly when it’s your turn to speak.

Note that if you are answering a question in your head while the interviewer is still talking, you are not listening!

To develop your consulting case interview technique, consider practising further using online resources such as this preparation pack from JobTestPrep.

Actively engage with the interviewer . Ask questions to make sure you are both understanding matters, and being understood.

Demonstrate that you are enjoying the challenge . Consulting is gruelling work. Show that you can bring energy to a consulting engagement, and that you’re the kind of person clients would want to work with, especially when the going gets tough.

Treat the interviewer as you would one of the firm’s most valued clients . Communicate using the language of the client where appropriate.

Keep the conversation moving forward . At every step make sure that you are bringing structure to the business problem, and keeping all the issues in proper context.

What are case study interviews?

Case study interviews are used in the latter stages of the application process for top-level roles, especially in the professional services or consultancy industry.

Candidates are presented with a case study based on a realistic and relevant scenario and must study the problem, analyze the provided data and information, and present a conclusion or a recommendation.

Case study interviews are about your ability to effectively understand and analyze a business problem to produce a solution, but they are also about your thought processes and ability to communicate decisions and recommend appropriate solutions.

The case study interview will normally take place in a ‘typical’ interview environment – in-person, at the office and with either a single interviewer or a panel. In some cases, it might happen remotely or as part of a group exercise with other applicants.

In the case study interview , you are being assessed on your strategy, how adaptable and fast learning you are, and how you use critical thinking and logic to analyze information. You will also be evaluated on your general business acumen and your knowledge of the company and wider industry, alongside desirable characteristics like insight and curiosity.

When presenting your findings, the interviewer wants you to come across as confident, presentable, and poised, while being able to distill complicated ideas and solutions in the simplest form to make them both understandable and easy to implement.

What type of jobs have case study interviews?

Case study interviews have been traditionally used as a part of the application process for associate-level jobs in the consultancy industry. These roles are usually directly involved in generating income for the business by collaborating with clients in a consultant capacity, so the case study interview is an in-depth work sample.

In recent times, case study interviews are also being used in the recruitment of analysts, where strategy and business acumen are needed alongside analytical skills for success in a job that provides detailed support for senior management in terms of internal problem solving and external profit growth.

You might also expect to deal with a case study interview if you are looking for a role in IT, especially at higher levels with some level of business-wide decision making. Managers in many industries might be provided with an employee-related case study to deal with as part of the interview process to assess leadership style and understanding of typical HR processes and procedures.

How do I prepare for the case study interview?

The case study interview is not as much about getting the ‘right’ answer as it is about the process of getting there, so it is a difficult one to prepare for. However, the more you know about what to expect in the interview, the better you will be able to perform. Articles like this one on Wikijob will give you an extensive overview of the structure of a case study interview, as well as what to expect on the day.

One of the best sources of information about the case study interview is likely to be the business for which you have applied. This is especially true with the Big Four consultancy firms (PwC, Deloitte, KPMG and EY) as they use the case study in many recruitment processes and have lots of resources on their recruitment site to help candidates to get prepared.

You will also be expected to have a good working knowledge of the wider industry that you are a part of, and the company you have applied for in relation to that. Knowing more about the consultancy space, for example, will give you an idea about what the business values are, and you can use this when considering the right course of action to suggest.

You can also get excellent preparation advice from JobTestPrep , with guided practice cases and revision resources to help you get used to different types of questions, how to approach the problem, and different strategies and structures to use to answer.

The case study interview is not just about how effectively you can analyze the problem – it is also about selecting and recommending a course of action. You will need presentation skills to be able to give this information to the relevant clients if you get the job, and this means that you need to hone your skills to perform well in the interview, too.

Practice active listening, speaking clearly, and using popular presentation software like PowerPoint because you might be expected to put together and talk about a slide show to make your recommendation.

What types of case studies can be given in an interview?

The case study that you will be given in your interview is likely to be realistic and relevant to the role you have applied for. In some cases, it will be a fictitious problem based on something that you might need to do if you get the job, while in others it might be a real customer problem that you are being asked to solve.

The case studies are usually based around different strategy issues and topics that a consultant or analyst might be asked to help with, including things like:

• Acquisitions – Whether to complete a merger or create a partnership or strategic alliance
• Creation – New business, new product line, enter a new market
• Growth – How to grow a business unit or the company as a whole
• Threat – Dealing with a big company entering the space
• Development – New technology, product, or service
• Pricing – How to price and segment a new product or service

What are the common case study interview questions?

The common case study questions that you might be asked in a case study interview are about strategy, but they are also usually relevant to the role you have applied for. There are three main types of questions that you might be asked:

• Graphic interpretation – Ability to read and understand data presented in a graph or table
• Estimation – A question that challenges your ability to extrapolate from your limited knowledge to find an answer to a question like “how many cars are in England.”
• Client questions – This is the most used type of question and is based on theoretical or genuine issues that a customer of the business might have. You might be asked to help a customer achieve a move into a new market, for example.

What are the best free online resources to prepare for case study interviews?

When you are applying for a job with a company that uses case study interviews as part of the recruitment process, you will often find the best free resources to help you prepare on their career site. Making use of the resources the company provides is the best way to be prepared because you will be using the information they have provided, which is usually closely aligned to the actual content of the assessments and interviews.

For a more broad view of case study interviews including techniques and definitions, articles like this Wikijob resource will provide you with a lot of information that will help you prepare, including tips.

We recommend that anyone facing a case study interview gets access to the free resources available at JobTestPrep , with practice case studies. The Prep Packs are a paid-for source of invaluable information that includes techniques, frameworks and extra ideas that will help you work to your absolute best in the interview.

How can you prepare a presentation for a case study interview?

It is highly likely that as part of the case study interview , you will be expected to create a presentation of your results.

In some cases, this might be through an informal discussion with the interviewer, but in many cases, you will have to present your recommendation more formally so that you can be assessed on your presentation skills, communication, and confidence.

In this case, you should prepare for the presentation by practicing presentations. Some case interviews will expect you to create a slideshow of your findings and speak about them, so knowledge of software like PowerPoint will help here.

The most important preparation you can do is about how you present yourself. The interviewer wants you to be poised, confident and comfortable with what you are saying, so you can get the best results by practicing speaking clearly, taking complicated ideas, and simplifying them, and actively listening when you are asked a question. Think of any topic – work-related or not – and create a short presentation on it that could be understood by anyone, and then present it to a friend or a relative.

What is the best way to structure and layout your notes in the case study interview?

When you undertake a case study interview , you will be provided with some source material and the facility to make notes – and these notes will be pivotal in your performance, ensuring that you can make the best recommendation through detailed analysis.

The way you approach the case study will depend on several factors, but you should always create some form of ‘issue tree’ that considers the problem that needs to be solved and can be branched out into smaller questions and problems.

To do this effectively, take a good couple of pages of notes related to the data and information that is provided by the interviewer. There will likely be some extraneous information provided that could muddy the waters of your thinking but making notes will help clarify it. It is especially useful to keep numbers in mind, whether that is related to staffing, profit, or stock – this is important.

You will then need to use a couple of pages to create the issue tree structure and begin to answer some of the questions.

The final part of your note-taking should be the recommendation and the preparation that you need to do to present your findings to the interviewer.

Don’t forget that you are expected to make notes through the process, but you should also speak to the interviewer and let them know what your thought processes are – and ask for more data if you have any gaps. When they are speaking, make sure you are listening and you understand what they are saying before taking any notes – active listening is an important skill in a consultant or analyst.

How much time do you have to think about the answer in a case study interview?

In the case study interview , you are not necessarily going to be given a specific amount of time to think about your answer because the whole interview is about your thinking process.

What this means in practice is that you will be reading and analyzing the information, devising a structure and a strategy and concluding in a live environment, consulting with the interviewer to ask questions and get clarity.

By thinking aloud and making notes, you will have enough time to contemplate how you are tackling the question.

A typical case study interview can last as little as 30 minutes, but many are considerably longer at half a day or even a full day (depending on the role, the company, and the industry you have applied for).

What should I study to ace the case study interviews?

One of the first things that you need to study for the case study interview is the material that is provided by the company you have applied for – or ones in the same industry.

As many of the major consultancy firms use case study interviews for associate-level recruitment and analysts, the case studies tend to be similar enough that the resources provided will be useful even for a job at a competitor.

You also need to be au fait with the company and the wider industry, identifying trends across businesses and the specific values of the organization you have applied for.

In terms of the case study itself, knowledge of analysis techniques and the frameworks used in consulting will be useful – even if you don’t use them in that particular case, you might need them later in the role (once you ace the interview).

Aside from confidently creating issue trees and ensuring your data gathering is Mutually Exclusive and Collectively Exhaustive (MECE), some things you will need to know include:

• Porter’s Five Forces (barriers to entry, competitive dynamics, supplier power, buyer power, threat of substitutes).
• 3 C’s (Company, Competitors, Clients)
• BCG Growth-Share Matrix
• McKinsey 7S Framework
• Affinity Diagram
• 4 Ps of Marketing (Product, Price, Promotion, Placement)
• Force Field Analysis
• Product Market Grid
• SWOT (Strengths, Weaknesses, Opportunities, Threats

Think about what is important to analyze for a business too, like profit margins, expenses, and ROI, as well as consumer metrics like User Lifetime Value and demographics.

What is the next step after a case study interview?

The case study interview is usually the last step in a recruitment process for top-level roles and will have taken place after the more traditional ‘fit’ interview where you will be asked competency-based and motivational questions.

You will have already surpassed other applicants through the initial paper sift, any aptitude or psychometric testing, and interviews to get to the case study.

This means that if you are successful in the case study interview, the next step will be a job offer or a salary discussion.

You can’t cram for a case study interview. But you can prepare in such a way that your analytical acumen, communication skills , and business intuition are all razor-sharp on the day of the interview. Furthermore, you can show that you are one of the few who can take on the consultant mindset, and appear natural doing so.

In summary, here are the steps you can take that will show you grasp the fundamentals of consulting, and have the aptitude to master them over your career:

Get familiar with the most common business case scenarios, and the important differences between them.

Develop a working method for breaking down business cases into components, and for structuring these components.

Get knowledgeable about analysis frameworks , how they can be used as problem-solving tools, and where it is appropriate to use them.

Cultivate a narrative style that gets people interested and excited about your work.

Use a conversational style that begins with asking good questions, and is driven by wanting to be the best listener in the room – not the best talker.

This article was written in partnership with LiveCareer . Since 2005, LiveCareer has been developing tools that have helped over 10 million users build stronger resumes and CVs, write persuasive cover letters, and develop better interview skills. These tools include their free resume builder and CV builder .

You might also be interested in these other Wikijob articles:

Or explore the Interview Advice / Interview Questions sections.

At home, abroad, working, interning?  Wherever you are this summer, contact OCS or make an appointment for a virtual advising session. We are available all summer! 

• Undergraduates
• Ph.Ds & Postdocs
• Prospective Students & Guests
• What is a Community?
• Student Athletes
• First Generation and/or Low Income Students
• International Students
• LGBTQ Students
• Students of Color
• Students with Disabilities
• Student Veterans
• Exploring Careers
• Advertising, Marketing & PR
• Finance, Insurance & Real Estate
• General Management & Leadership Development Programs
• Law & Legal Services
• Startups, Entrepreneurship & Freelance Work
• Environment, Sustainability & Energy
• Media & Communications
• Policy & Think Tanks
• Engineering
• Healthcare, Biotech & Global Public Health
• Life & Physical Sciences
• Programming & Data Science
• Graduate School
• Health Professions
• Business School
• Meet with OCS
• Student Organizations Workshop Request
• OCS Podcast Series
• Office of Fellowships
• Navigating AI in the Job Search Process
• Cover Letters & Correspondence
• Job Market Insights
• Professional Conduct & Etiquette
• Professional Online Identity
• Interview Preparation
• Resource Database
• Yale Career Link
• Jobs, Internships & Other Experiences
• Gap Year & Short-Term Opportunities
• Planning an International Internship
• Funding Your Experience
• Career Fairs/Networking Events
• On-Campus Recruiting
• Job Offers & Salary Negotiation
• Informational Interviewing
• Peer Networking Lists
• Building Your LinkedIn Profile
• YC First Destinations
• YC Four-Year Out
• GSAS Program Statistics
• Statistics & Reports
• Contact OCS
• OCS Mission & Policies
• Additional Yale Career Offices

Case Interview Study Samples

• Share This: Share Case Interview Study Samples on Facebook Share Case Interview Study Samples on LinkedIn Share Case Interview Study Samples on X

These case studies represent cases across firm styles (McKinsey, Bain, BCG, Deloitte, & more), including interviewer-led and interviewee-led (candidate-led) cases. The video examples demonstrate the nuances of the virtual case interview and include feedback from an MBB coach. The sessions feature consultants or consulting candidates.

Office of Career Strategy

Visiting yale.

• Open access
• Published: 29 May 2024

Cannabis use in a Canadian long-term care facility: a case study

• Lynda G. Balneaves 1 , 4 ,
• Abeer A. Alraja 1 ,
• Genevieve Thompson 1 ,
• Jamie L. Penner 1 ,
• Philip St. John 2 ,
• Daniella Scerbo 1 &
• Joanne van Dyck 3  

BMC Geriatrics volume  24 , Article number:  467 ( 2024 ) Cite this article

300 Accesses

2 Altmetric

Metrics details

Following the legalization of cannabis in Canada in 2018, people aged 65 + years reported a significant increase in cannabis consumption. Despite limited research with older adults regarding the therapeutic benefits of cannabis, there is increasing interest and use among this population, particularly for those who have chronic illnesses or are at end of life. Long-term Care (LTC) facilities are required to reflect on their care and policies related to the use of cannabis, and how to address residents’ cannabis use within what they consider to be their home.

Using an exploratory case study design, this study aimed to understand how one LTC facility in western Canada addressed the major policy shift related to medical and non-medical cannabis. The case study, conducted November 2021 to August 2022, included an environmental scan of existing policies and procedures related to cannabis use at the LTC facility, a quantitative survey of Healthcare Providers’ (HCP) knowledge, attitudes, and practices related to cannabis, and qualitative interviews with HCPs and administrators. Quantitative survey data were analyzed using descriptive statistics and content analysis was used to analyze the qualitative data.

A total of 71 HCPs completed the survey and 12 HCPs, including those who functioned as administrators, participated in the interview. The largest knowledge gaps were related to dosing and creating effective treatment plans for residents using cannabis. About half of HCPs reported providing care in the past month to a resident who was taking medical cannabis (54.9%) and a quarter (25.4%) to a resident that was taking non-medical cannabis. The majority of respondents (81.7%) reported that lack of knowledge, education or information about medical cannabis were barriers to medical cannabis use in LTC. From the qualitative data, we identified four key findings regarding HCPs’ attitudes, cannabis access and use, barriers to cannabis use, and non-medical cannabis use.

Conclusions

With the legalization of medical and non-medical cannabis in jurisdictions around the world, LTC facilities will be obligated to develop policies, procedures and healthcare services that are able to accommodate residents’ use of cannabis in a respectful and evidence-informed manner.

Peer Review reports

In October 2018, Canada became the second country to legalize non-medical cannabis [ 1 ]. Despite the increasing interest in cannabis among Canadians of all ages [ 2 ], the percentage of individuals over the age of 15 years reporting cannabis use a year following legalization remained relatively unchanged at 18% [3]. The only age group to report a significant increase in cannabis consumption was those aged 65 + years, with 7.6% reporting cannabis use in the past 3 months [ 3 ] in 2019 compared to 4% in 2018. This upward trend in cannabis use among Canadians 65 years or older was also observed in 2021 [ 4 ].

This increase may reflect a growing acceptance of cannabis among older populations who were previously dissuaded from taking cannabis due to its illegal status as well as limited accessibility through legal means. In addition, the rise in cannabis use among older adults may reflect a harm reduction approach, substituting cannabis for other recreational substances with substantial health risks, such as alcohol [ 5 ]. Moreover, the belief in the potential therapeutic benefits of cannabis [ 6 , 7 , 8 ], such as the management of pain and sleep issues, is becoming increasingly prevalent among older adults. There has been limited research, however, among older adults in Canada to understand this progressive trend in cannabis use and the influencing factors [ 9 ].

Canada has been a world leader in cannabis legalization, launching a federal medical cannabis program in 2001. Since this time, the medical cannabis program has undergone numerous revisions, including how authorization is obtained, what types of products are available, and where cannabis is purchased. Currently, Canadians can seek medical authorization from either a physician or a nurse practitioner, and access a variety of cannabis products, including dried flower, capsules, and oils, which are purchased online through a licensed producer (LP). Some individuals also apply for a personal or designated grow license to produce their own supply of dried cannabis. Outside of the medical authorization program, individuals can access non-medical cannabis through an authorized storefront. It is estimated that over 1 million Canadians are using cannabis for therapeutic purposes [4], with 247,548 individuals officially registered as of March 2022 [ 10 ]. Among the 479,400 individuals over the age of 65 who reported cannabis use in the third quarter of 2019, 52% utilized cannabis exclusively for medical reasons, and another 24% reported using cannabis for both recreational and medical purposes [ 3 ].

Despite the growing interest in cannabis as a therapeutic agent, there has been limited human research due to its illegal status in many countries, as well as the challenges posed by the complexity of the cannabis plant compared to single agent, pharmaceutical forms of cannabis (e.g., nabilone) [ 11 , 12 ]. Notwithstanding these challenges, there is emergent research on the potential role of cannabis-based medicines in the management of health conditions common among older adults, including osteoarthritis [ 13 ], sleep disorders [ 14 ], dementia [ 15 ], and Parkinson’s [ 16 , 17 ], which are also prevalent among individuals residing at long-term care (LTC) facilities. For example, several studies have found cannabis-based medicines to significantly reduce neuropsychiatric symptoms and improve quality of life among people living with Alzheimer’s Disease [ 18 , 19 , 20 ]. Cannabis may also play a significant role at end of life in not only alleviating physical symptoms, such as pain, nausea and vomiting, and appetite loss, but also addressing the emotional and existential issues that may arise [ 21 ]. It has also been proposed that cannabis may have a therapeutic role among rehabilitative populations who often reside in LTC settings, including those with spinal cord injuries [ 22 , 23 ] and traumatic brain injury [ 24 ]. The evidence base surrounding cannabis as a therapeutic agent, however, remains limited with few large randomized clinical trials conducted to date.

Cannabis is not a benign substance and may pose risk to older adults, especially those living with frailty or cognitive impairment. Given the known cognitive effects of tetrahydrocannabinol (THC), a cannabinoid found in many forms of cannabis, adults living in long-term and rehabilitative care settings may experience somnolence, confusion, and fatigue [ 25 ]. Cannabis high in THC may also negatively impact motor coordination and increase the risk of falls, especially among those with impaired balance and walking ability [ 25 ]. As research advances on cannabis, there has been growing awareness of its negative interactions with certain medications [ 26 ], which can pose a significant issue among older clients prone to polypharmacy. Lastly, numerous health conditions are contraindicated with cannabis use, including heart disease, and a personal or family history of psychosis, schizophrenia, or bipolar disorder [ 27 ].

Despite limited research with older adults regarding the therapeutic benefits of cannabis, there is increasing interest and use among this population, particularly for those who have chronic illnesses. As adults age, they are more likely to experience multimorbidity, and a significant number of older adults spend their last years of life residing in a LTC facility [ 28 , 29 ]. LTC facilities are, thus, placed in a unique position. While these facilities are considered medical institutions that provide evidence-informed supportive health care, they have also become home for individuals who are no longer able to reside safely in the community. Increasingly, these types of facilities are challenged to create home-like environments and offer residents the opportunity and autonomy to engage in potentially risky health behaviours [ 30 ]; behaviours that individuals in the community have the independence and legal right to choose, such as alcohol or tobacco consumption. With the legalization of non-medical cannabis and the growing interest in the potential of cannabis to manage challenging health conditions, it behooves LTC facilities to reflect on their care and policies related to the use of legal substances, such as cannabis, and how to address residents’ cannabis use within what they consider to be their home.

The overarching aim of this case study was to understand how one LTC facility, and its healthcare professionals (HCPs) and administrators, addressed the major policy shift in Canada related to medical and non-medical cannabis. Specific research questions included: (1) What are the experiences and perceptions of HCPs and administrators regarding the use of medical and non-medical cannabis at LTC settings?; (2) What are the perceived barriers/facilitators to medical and non-medical cannabis use at LTC facilities from the perspective of HCPs and administrators?; and (3) What are the educational needs, attitudes, and practices of HCPs at LTC facilities related to medical and non-medical cannabis?

Research design and setting

An exploratory case study design was utilized in this study. This type of case study is used to explore those situations in which the phenomenon being evaluated has no clear or single set of outcomes [ 31 ]. The case selected for this study was a large LTC facility in Western Canada. This 387-bed residential facility provides 24/7 care to a diverse population, including older adults with cognitive and physical disabilities, individuals recovering from stroke and traumatic brain injury, and those requiring end-of-life care. Individuals with these various conditions may reside in several units, including palliative care, rehabilitation, personal care home, and complex chronic care. The case study included an environmental scan of existing policies and procedures related to medical and non-medical cannabis use at the LTC facility, a quantitative survey of HCPs’ knowledge, attitudes, and practices related to medical and non-medical cannabis, and qualitative interviews with HCPs and administrators. The qualitative interviews were informed by qualitative descriptive methodology [ 32 ] and explored HCPs’ and administrators’ experiences, beliefs, perceptions regarding cannabis use in LTC, and the related barriers and facilitators.

Sample and recruitment

For the survey, a convenience sample was drawn from the entire population of accredited HCPs working in the selected facility. Eligibility criteria included being 18 + years, able to read/speak English, currently employed and providing care at the LTC facility, and able to provide informed written consent. Study participants were recruited through an emailed letter of invitation, posters placed in staff areas, and in-person presentations by a research assistant. From participants who took part in the survey, a subsample of HCPs, including administrators, who expressed interest in taking part in an interview was selected. The data collection period was from November 2021 and August 2022.

Data collection

For the environmental scan, facility administrators were approached via an emailed letter and asked to identify relevant policies and procedures related to cannabis use within their LTC facility. Policies relevant to both residents’ use of cannabis and HCPs’ practice related to medical and non-medical cannabis were requested. Provincial and federal cannabis policies were also collected.

The survey was modified from a questionnaire utilized in two national studies that examined Canadian physicians’ and nurse practitioners’ knowledge, attitudes, and perceptions of the associated barriers and facilitators related to medical cannabis use, as well as their preferences regarding medical cannabis education [ 33 , 34 ]. This survey has been found to be internally consistent, with Cronbach’s alphas of 0.70 to 0.92 reported across subscales [ 33 , 34 ]. Slight word changes were made to reflect the fact that individuals living in LTC facility are referred to as residents, not patients, and the name of the facility was used to orientate the questions towards HCPs’ attitudes and practices related to cannabis use within the LTC setting.

Survey items were added that assessed HCPs’ practices related to addressing residents’ and family members’ questions about cannabis, as well as requests for medical cannabis authorization and follow-up care. A demographic survey that assessed gender, age, professional designation, years in practice, area(s) of practice, and education related to medical cannabis was included. The survey was available in hard copy (Supplementary Material 1 ) as well as online through the software program, Qualtrics®.

An interview guide was developed by the research team, which included a facility administrator and HCP, and was informed by the literature and previous cannabis research conducted by members of the research team [ 35 ] (Supplementary Material 2 ). Due to the COVID-19 pandemic, all but one interview was conducted by the project coordinator (AAA) via Zoom, with one interview occurring over the phone. The interviews were 20–30 min in length and were digitally recorded and transcribed verbatim. Both the survey and interview were completed at times preferred by the respondents, including within and outside work time. No honoraria were provided for study participants.

Data analysis

The policies identified through the environmental scan were reviewed and summarized in table format, with similarities, contradictions and gaps identified.

Quantitative survey data was uploaded into the statistical program, SPSS® v.25. Descriptive statistics were used to summarize demographic information, knowledge about medical cannabis and related attitudes, perceived barriers and facilitators, practice experiences, and preferred educational approaches.

Perceived knowledge gap was calculated by computing the difference between perceived current and desired knowledge levels (i.e., “the level of knowledge you desire” about medical cannabis). Rather than using averages, the knowledge gap was calculated based on how much greater an individual’s desired knowledge level was compared to their current knowledge level [ 36 ]. Only response pairs (i.e., current and desired knowledge) were used, and responses where the desired level was lower than the current level were excluded. To further elucidate, the knowledge gap was calculated by having each respondent’s current knowledge level response subtracted from their desired knowledge level response.

Prior to the onset of qualitative data analysis, the accuracy of the transcripts was checked by listening to the digital recordings. Content analysis was used to analyze the qualitative data [ 37 ], with two team members (AAA and LGB) independently reading the transcripts and developing a preliminary coding scheme. Constant comparison of new and existing data ensured consistency, relevance, and comprehensiveness of emerging codes. Several strategies were applied to ensure rigour in the qualitative analysis. To increase credibility, a team member with expertise in qualitative inquiry (LGB) monitored the qualitative data and its analysis. Confirmability was addressed by using the participants’ own words throughout the process of data analysis, interpretation, and description. An audit trail was kept documenting the activities of the study, including data analysis decisions.

Environmental scan of cannabis-related policies

Administrators at the LTC facility provided the research team with the policies and procedures that addressed the management and use of medical and non-medical cannabis within the facility. The guiding policy adopted by the LTC facility was a generic policy applicable to all sites and facilities governed by a regional health authority. This policy, entitled “Patient Use of Medical Cannabis (Marijuana)” was issued in June 2020. The policy, which aimed to provide individuals with “reasonable access to medical cannabis”, outlined numerous issues that might arise with institutional cannabis use, including “ordering, labeling, packaging, storage, security, administration, documentation and monitoring requirements for the use of medical cannabis”. Key aspects of the policy are summarised in a table found in the Supplementary Material section (Supplementary Material 3 ).

Other relevant policies that were reviewed included the standards of practice issued by the provincial college of nurses and the college of physicians and surgeons [ 38 , 39 , 40 ], which provided direction to HCPs working in LTC about their scope of practice regarding medical and non-medical cannabis. The regional health authority’s smoke-free policy [ 41 ] also informed how inhaled forms of medical and non-medical cannabis were addressed, requiring residents to leave the facility grounds to smoke or vape cannabis. Lastly, the overarching federal Cannabis Act and Regulations provided guidance to both administrators and HCPs regarding the Canadian regulations specific to medical and non-medical cannabis [ 1 , 42 ]. Together, existing facility, regional, and national policies created a context in which cannabis was framed as neither a medicine nor a controlled substance, but something unique and complex that must be navigated by residents, family members and staff in LTC settings.

Quantitative survey

Demographic characteristics.

From the approximately 318 eligible HCPs employed at the LTC facility, a total of 71 participants consented and completed the survey, yielding a response rate of 22.3%. With regards to response rate by profession, pharmacists (50.0%) and social workers (42.9%) were best represented, followed by physicians (23.1%), nurses (21.0%), and PT/OT (11.4%).

Most respondents were women (71.8%), registered nurses (62.0%) and worked within the palliative care unit (76.1%) at the facility. The average age of the sample was 40.9 years and the largest proportion of the sample had worked in the LTC facility for 5 or less years. See Table  1 for additional details.

Knowledge about medical cannabis

HCPs reported being most knowledgeable about the therapeutic potential of cannabis (3.1/5.0), potential risks of medical cannabis (2.9/5.0), and the different ways to administer medical cannabis (2.9/5.0). They reported being least knowledgeable about the dosing of medical cannabis (2.0/5.0), how to create effective treatment plans related to medical cannabis (2.1/5.0), and the similarities and differences between different forms of cannabis products and prescription cannabinoid medications (2.2/5.0). The top three ranked knowledge gaps mirrored the items ranked lowest with regards to knowledge (see Table  2 ). Overall, there was high interest in gaining more medical cannabis knowledge, with all knowledge items scoring greater than 4 on desired knowledge level.

Practice experiences with medical cannabis

About half of HCPs reported providing care in the past month to a resident who was taking medical cannabis (54.9%) and a quarter (25.4%) to a resident that was taking non-medical cannabis. Over 60% had been approached by a resident and/or a family member to discuss the potential use of medical cannabis; however, few HCPs reported initiating these conversations. Moreover, when asked if they felt comfortable discussing medical cannabis, 32.4% of HCPs disagreed (data not shown). Less than 20% reported helping residents, either directly or indirectly, to use medical cannabis and a very small proportion (1.3–2.8%) reported assisting residents’ consumption of non-medical cannabis. With regards to authorizing the use of medical cannabis or prescribing cannabinoid medication, which in Canada can be done by either a physician or nurse practitioner, just over half of physicians reported supporting residents’ access to these types of treatment. See Table  3 for additional details.

Barriers to medical cannabis use in long-term care

Lack of knowledge, education or information about medical cannabis were reported to be barriers to medical cannabis use in LTC by most HCPs (81.7%). Moreover, the uncertain risks and benefits of medical cannabis and the lack of clinical guidelines were also perceived as barriers by 66.2% and 63.4% of HCPs, respectively. The complete list of barriers is presented in Table  4 .

Education about medical cannabis

Most of the HCPs agreed that additional education on medical cannabis would increase their comfort with discussing this treatment option with residents and family members (87.4%; data not shown). With regards to indirectly or directly administering medical cannabis to a resident, most HCPs for which this fell within their scope of practice also reported they would feel more comfortable if they had further education (59.2% and 56.4%, respectively; data not shown).

Over half of HCPs had not received any prior education related to medical cannabis (54.9%). Those that had, received it from conferences or workshops (65.6%), books or journal articles (43.8%) or through a colleague (37.5%). While almost half the sample (49.3%) reported receiving information from peer-reviewed sources, nearly a quarter received information about medical cannabis from a non-peer reviewed source or from a resident or family member. Some participants also received information from a cannabis industry source. Table  5 provides additional details.

The preferred sources of medical cannabis education were online learning programs (i.e., continuing education) (74.6%), monographs (66.2%), and topic-specific one-pagers (64.8%). See Fig.  1 for further details.

Percentage of respondents indicating prefered method of cannabis education*

Qualitative findings

A total of 12 HCPs were interviewed regarding their perceptions and experiences related to medical and non-medical cannabis in the LTC facility. This included 3 HCPs who were administrators, 6 nurses, 1 physician, 1 social worker and 1 pharmacist. Four main themes were identified.

Attitudes regarding medical cannabis: cautious support

There were mixed attitudes regarding the potential role of medical cannabis in general and in LTC populations. While some HCPs felt medical cannabis was a “good idea” for which there was beginning research regarding its health benefits, other HCPs believed additional high-quality evidence was needed prior to medical cannabis becoming a therapeutic option.

I think it’s [medical cannabis] the fair option, it helps some people, but it doesn’t help others. So, I think we need a bit more evidence and a bit more research and having it available sort of allows for that research to occur (Physician; PC07).

There appeared to be greater acceptance for medical cannabis use by individuals at end of life compared to those not considered immediately palliative (i.e., living with dementia, stroke, or traumatic brain injury), the latter of which comprise the majority of the people living in LTC settings. For individuals receiving palliative care, some HCPs perceived medical cannabis to be beneficial in managing pain, nausea, and anxiety, as well as reducing the use of other medications that may be problematic (e.g., opioids) due to their side effects. The potential value of medical cannabis in “adding quality of life and living” at the end of life was also mentioned.

I’m working on the palliative care unit right now. A lot of patients that I’ve seen use it [medical cannabis] for anxiety purposes, or for nausea… some people find beneficial. So, I’ve seen it – people find it helpful for those reasons, and then they have to take less of their other medications. So, if it’s worked well for them and that’s what they prefer to do, then I think it should be an option for people, especially if some people find it beneficial. (Registered nurse; PC03)

Within the context of LTC, several HCPs also spoke of the importance of respecting residents’ autonomy and previous experiences taking medical cannabis. The reality of a LTC facility being a resident’s “home” was particularly influential in HCPs’ support of medical cannabis being included as part of a holistic approach to care.

I guess because people live at [LTC facility’s name], that is their home and if they were at home in the community, they would be able to access it [medical cannabis]. (Registered nurse, PC02)

I think it’s a part of people’s lives. And I think if we’re allowing people to have certain things and keeping it as part of their treatment because if you look at a holistic view, preventing somebody from doing something that they’ve been doing for many years is not going to help them be accepting of other types of therapies. (Pharmacist, PC09)

Some HCPs also perceived medical cannabis as offering an alternative to medical treatments that were not consistently effective in managing challenging health conditions, such as dementia and agitation.

HCPs’ attitudes towards medical cannabis varied across different products and routes of administration. Given the existing smoke-free policy at the facility, HCPs were more supportive of edibles, oils, oral sprays or topical creams and lotions than any form of inhaled medical cannabis (i.e., smoking and vaping). They were concerned not only about lung health, environmental exposure, and maintaining a scent-free facility, but also about how to safely manage vulnerable residents travelling off the facility’s property to smoke or vape.

Medical cannabis access and use: concern, confusion, and limited conversations

According to HCPs interviewed, most residents using medical cannabis obtained their authorization prior to moving to LTC. Individuals who sought authorization after arriving at the facility struggled to have their requests acknowledged or addressed by the health care team. As one nurse shared:

I do remember I had a resident that did ask about it [medical cannabis]. And whenever it was kind of brought up, it didn’t seem to be acknowledged all the time. Or there were people who didn’t like the idea of having a resident on it. (Registered nurse; PC06)

Conversations about medical cannabis were perceived to be severely limited by the culture surrounding medical cannabis at the LTC facility. The lack of open discussion about medical cannabis was seen by some to create conflict and negatively impact the development of trust between residents, family members, and the health care team: “ Without that discussion, it does create conflict within the team and between the physician and family, and perhaps that could impact the trusting relationship” (Administrator; PA03). Further, several HCPs expressed the belief that conversations about non-pharmacological forms of medical cannabis could not be initiated by them due to policy issues; residents who expressed interest but did not have prior authorization were instead directed towards pharmaceutical forms of cannabis.

There have been residents who have asked about using cannabis. And as I said, you can’t initiate it, if they’re going to get it on their own, fair enough. That’s pretty much been the experience I’ve had with residents with just non-pharmaceutical medical cannabis . (Physician, PC07)

The only HCP-initiated conversations about medical cannabis mentioned were those occurring between pharmacists and residents, which focused on the potential side effects, benefits, and “red flags” to watch out for, such as allergic reactions.

HCPs shared that for those residents with authorization, they or a support person were responsible for ordering the medical cannabis product from an LP, which would then send the product to either the resident at the LTC facility or to their support person’s home. The cannabis product was then stored in a locked drawer in the resident’s room if they were self-administering or in a medication room if nursing staff were assisting with administration. According to one pharmacist, the pharmacy department was not permitted, due to existing federal regulations, to either directly order or dispense medical cannabis:

No, we don’t dispense any cannabis. It’s considered resident’s own. So, we don’t acquire it for them. They have to directly be the holders of it and have it provided to them directly. And I think that has more to do with the regulations within Canada, the resident has to have certain type of documentation in order to have medical cannabis. So, it’s directly to them, we’re not able to order it for them or anything like that on their behalf. (Pharmacist; PC09)

With regards to the type of medical cannabis products permitted in the facility, due to non-smoking policies and concerns about safety issues and the “smell”, combustible forms and inhaled routes of administration (i.e., joints, vaporizers, vape pens) were not allowed; instead, ingestible forms were mentioned most frequently by HCPs.

There was some confusion and concerns expressed regarding the storage and disposal of medical cannabis, which may have reflected changes in facility policies over time. Some HCPs expressed concerns about the storage of cannabis in residents’ rooms and the lack of “safeguards” to limit potential diversion and allow an accurate “count” of medical cannabis.

We have to go into our Pyxis machine to retrieve a key to open that drawer. So, by going by that you’re able to know who’s actually accessed the key, but once the key is out you have no idea how many people have used that key and accessed that drawer before it’s gone back. You have no way of knowing how much cannabis has been taken out [of the drawer] or used, because you know there’s no way to measure it. So that’s a huge problem, I find. (Registered nurse; PC01)

This nurse was particularly concerned about the potential risk of being accused of diversion:

I’m not worried about people abusing it, it’s more the worry of being accused. You know, like, if a resident says, ‘why is my cannabis running out already, I thought I had enough for a few more weeks?’ and we’re like, ‘I don’t know’, right? There’s the potential for that sort of thing to happen. (Registered nurse; PC01)

There was also a perception that there was a lack of direction from the facility regarding the appropriate disposal of medical cannabis. Most believed residents or family members were expected to remove any unused product once the resident was no longer at the facility. When such disposal was not possible, the policy was to destroy the cannabis product in a manner similar to narcotics or other controlled substances. However, variations in practice occurred with some HCPs described “throwing it in the trash” or using a medical waste disposal bin with or without a witness.

Barriers to medical cannabis use: safety, stigma and lack of knowledge

Numerous barriers to the use of medical cannabis by LTC residents were identified by HCPs. Foremost, the policies related to how cannabis products were ordered, accessed, stored, and administered were perceived to be complicated and created barriers to residents wanting to take medical cannabis, particularly those without family support. The inability of the LTC facility to order medical cannabis on behalf of a resident was perceived to be especially problematic, as described by one registered nurse:

I know when it became legal, there were a few residents who have inquired about it, but they didn’t have the family resources in place to be able to get it because I believe there’s some hoops that you have to go through to be able to have it medically prescribed in getting it on to the unit. And so, the ones who were interested in it didn’t have those supports in place, so they weren’t able to get it prescribed for them. (Registered nurse; PC05)

The lack of awareness and understanding of the regional policies related to medical cannabis by some of the clinical staff was also seen as being problematic. As one registered nurse shared:

My only concern is that there’s a lot of rules around being able to administer and how it’s [medical cannabis] administered, which can again make things a bit complicated. I would say that’s probably my biggest concern is just it’s hard to remember everything that you have to do when you’re trying to administer it or helping a resident. So, you don’t get involved. (Registered nurse; PC06)

Several HCPs attributed the lack of awareness about cannabis policy to the onset of the COVID-19 pandemic, which overshadowed all other health issues within their facility: “ Everybody’s been so focused on COVID for a year and a half that there hasn’t been really time to really think about or educate on other things. ” (Registered nurse; PC01).

HCPs suggested that more “straight forward” and tailored policies were needed that simplified how medical cannabis was managed. Having facility-specific policies would acknowledge the uniqueness of the LTC population, who may have cognitive impairment, limited social support, and complex healthcare plans. As one nurse shared: “ If it’s a dementia patient, they can’t really administer it on their own. So how do we follow the policy to help the patient take the cannabis? How would we know when they would want to take it PRN?” (Registered nurse; PC03). It was also recommended that the policy that prevented the facility from directly ordering and supplying medical cannabis required revision so that LTC residents were not reliant on family members to gain access. Lastly, several HCPs suggested that medical cannabis policies need to be well advertised and additional training developed for clinical staff to enhance their awareness and comfort level in providing appropriate and supportive care.

There needs to be a training session… staff have to read through them [cannabis policies] and get instructions about them, sort of like a self-learning activity. But that is not part of what we do when orienting. (Registered nurse; PC02)

Another perceived barrier frequently mentioned by HCPs was their lack of knowledge regarding the potential risks and benefits of medical cannabis. There was limited understanding about the effects of medical cannabis, how it may interact with other medications and health conditions, what side effects could arise, as well as basic information about starting dose, titration, and difference between THC and cannabidiol (CBD). Without such information, HCPs were perceived to be very hesitant about recommending or supporting medical cannabis as a treatment alternative for LTC residents:

There’s lots of unknown, that’s the problem. If there were more specifics about the recreational and the medical use of cannabis, then I think health care professionals would be more likely to want to provide it to the residents. But if not, then that’s kind of what’s hindering health care professionals to provide it. (Registered nurse; PC08)

There was also substantial discussion by HCPs regarding the “stigma” that they perceived to exist within the facility regarding medical cannabis. As described by one pharmacist: “ I think the understanding of cannabis, regardless of if it’s medical or anything, it’s still considered in many people’s minds as an illicit drug. It hasn’t shaken that. And I think there’s a lot of stereotypes around the type of people that use cannabis” (Pharmacist; PC09). The stigmatization of medical cannabis was perceived to be particularly pronounced among the medical staff, which led to what was described as a “hands-off approach” with regards to authorizing medical cannabis.

Almost all HCPs and administrators interviewed recommended that education programming and resources for HCPs be developed to address the lingering stigma associated with cannabis and the knowledge gaps that exist about medical cannabis and associated policies. Several participants recommended that education initiatives should first target physicians, who were responsible for authorizing medical cannabis in the facility. Physicians were perceived to need education on when and for whom medical cannabis would be appropriate, the latest evidence regarding efficacy and safety (i.e., drug interactions), and what their obligations and responsibilities were as the authorizing HCP. Participants also thought that all HCPs could benefit from additional training regarding medical cannabis, including the different types of cannabinoids and products, the process of titration, and dosing. Some of the nurses interviewed also expressed the need for education about the legal implications of medical cannabis and their role regarding provision and administration:

I think the legal implications of cannabis use, I think that would be a good focus for the nursing group – so that they understood what their obligations were, what they could be held accountable for, those kinds of things. (Administrator; PA02)

Finally, numerous HCPs spoke of the need for “safeguards” and clear policies and procedures to ensure that clinical staff were aware of what type of medical cannabis products residents were taking, what was the “right dose”, and the possibility of cannabis interacting with other medications. As shared by one pharmacist:

So that we know that this patient is on it because there are potential drug interactions with other things that patients are taking. So, we just have to be cautious and aware that patients are doing this. Because especially right now with studies, there haven’t been a lot of great studies on drug interactions. (Pharmacist; PC09)

Non-medical cannabis use: balancing autonomy and safety

HCPs were asked about their attitudes and experiences about residents’ use of non-medical cannabis in the facility. Two disparate points of view became apparent – those that perceived non-medical cannabis as a legal substance that should be available to LTC residents given the facility was their home and those that saw non-medical cannabis as a stigmatized substance that could lead to problematic use and disruptions in the care environment.

Because it is somebody’s home and so you’re trying to honour and match what their lifestyle and aspects of their life at home were and matching that here [LTC facility]. The bad is, while it is somebody’s home, it’s the next person’s home too, and so it’s trying to balance that, right? In an institutional setting, trying to make it as home-like as possible but, at the same time, you know, monitoring and matching for what everyone’s needs are. (Registered nurse; PA01)

Professionally, I think that it creates issues in terms of trying to police the use of recreational cannabis. In terms of smoking cigarette tobacco, that’s an issue in itself. We’re a non-smoking facility. So, adding cannabis to the mix creates issues…having staff perhaps exposed or other people exposed if people are using cannabis indoors or where they’re not supposed. Or if they want to access and use cannabis outside, who’s going to take them for that? Because that creates exposure too for staff or others who may have to escort them. (Registered nurse; PA03)

HCPs frequently mentioned the complexity of managing residents’ non-medical use of cannabis given the facility’s non-smoking policy that required residents to leave the facility grounds to use inhaled forms of cannabis. With staff unable to transport residents outside, concerns were raised regarding the safety of residents, particularly in the winter months, and who would be responsible for their transfer in and out of the facility as well as monitoring how much cannabis was consumed. In addition, residents’ access to non-medical cannabis was again dependent on having a support person that was able and willing to transport the product to the facility, posing a potential equity issue for some residents:

If someone’s wanting to go smoke outside, then mobility might be an issue. If they don’t have the right wheelchair or family to take them outside for that. If they have the access. Like, if they need family to go and buy it and bring it to them, that could be more of an access issue depending on their family support. (Registered nurse; PC03)

There was specific concern expressed for individuals in the rehabilitation units who may have pre-existing substance use issues. For these individuals, HCPs were concerned that allowing access to non-medical cannabis could add to an already complex care plan. In addition, with many vulnerable residents living at the facility, concerns were raised regarding them being “incredibly suggestible” to others encouraging their consumption of cannabis:

These people – they have an addiction. For sure they’re making choices, but those choices are influenced by physical withdrawal or influenced by stress; they’re influenced by lots of things. So, I would hate to put residents in a position where that was one other [non-medical cannabis] thing they had to contend with during the rehab stay. (Administrator, PA02)

The use of cannabis for therapeutic and recreational purposes is becoming more prevalent within older adult populations, both in the community as well as within healthcare institutions. There has also been growing interest in the possible role of medical cannabis for select chronic, rehabilitative, and palliative health conditions, frequently found among individuals residing within LTC settings. LTC facilities, thus, face the complex practice and policy implications associated with a substance that has been surrounded in controversy for close to a century. This case study is among the first to explore in one LTC facility in Western Canada how cannabis use is being addressed following the legalization of non-medical cannabis products, and what challenges exist. It provides an important snapshot of the complexities surrounding cannabis use in LTC and a foundation for future research.

Cannabis use in LTC settings: a clash of cultures

One challenge experienced by people residing in LTC facilities is the tension that exists between social and medical models of care that most facilities are founded on. Historically, LTC facilities have operated as what Goffman [ 43 ] termed “total institutions”, places where every aspect of a person’s life was controlled by others, paternalism dominated, and the medical needs of people were what drove care practices. Aspects of the total institution still exist, as noted in this case study, whereby cannabis use is in the control of the HCPs; it is dispensed during medication administration times rather than being freely available for use by the resident when they so desire as would be in a person’s home. In trying to create more home-like environments and meet the broad range of social and emotional needs of residents, resident-centred care practices and relational models of care have emerged [ 44 ]. Within this milieu, resident autonomy and choice are at the forefront and HCPs are there to assist, rather than take control of residents’ daily lives. In the most ideal settings, behaviours that are considered ‘risky’, like alcohol consumption, are treated as social experiences, not care tasks to be managed [ 45 ]. The tension arises, however, that despite the desire to be resident-centred, most LTC facilities are highly regulated by governments, putting limits to resident choice and, therefore, their autonomy [ 45 ]. While HCPs in our study acknowledged that residents should have the right to use medical or non-medical cannabis, the regional and institutional policies surrounding safety and the rights of other residents and staff to not be exposed to potentially risky behaviour underscored many of their views. LTC facilities would be wise to consider the principles of dignity of risk [ 46 ] with relation to cannabis consumption/use along the frail elderly population that reside in the home.

Cannabis policies and LTC: one size doesn’t fit all

The cannabis policies developed at the advent of legalization, without consideration of the unique populations and healthcare challenges that exist within LTC facilities, created numerous barriers to residents accessing and using cannabis, as well as for HCPs attempting to provide appropriate care. One of the most significant challenges experienced by LTC residents in our study was the inability to obtain a medical cannabis authorization from a physician working in the facility. Another significant challenge was the regional policy that medical cannabis could not be couriered directly to the LTC pharmacy; instead, the resident or their support persons were responsible for ordering and bringing cannabis products into the facility. Both challenges created enormous inequity in which residents that lacked the physical and cognitive ability to obtain authorization and order medical cannabis from an LP or were without a support person willing and able to obtain medical cannabis on their behalf, were unable to access medical cannabis. Given the nature of LTC populations, these policies led to only a few residents being able to access and use medical cannabis as part of their care.

Another policy that had substantial safety implications for residents wanting to use inhaled forms of cannabis was the regional and institutional no smoking policies that prevented both tobacco and cannabis products from being consumed within the centre as well as on the grounds. As a result, residents had to make their own way, or be accompanied by a support person, to walk approximately 300 m to the public sidewalk where they were allowed to smoke or vape cannabis. With the LTC facility located in a region where winter temperatures can reach − 35 Celsius and sidewalks are covered in snow and ice, this poses significant risk for residents who may be at heightened risk of falls and utilizing assisted walking devices. Similar safety implications of smoke-free policies have been identified in previous research [ 47 ].

Lastly, the policies surrounding the storage and self-administration of medical cannabis for those residents with the physical and emotional capacity (or with a support person willing to administer) may pose potential safety and liability risks and contribute to the concerns held by some HCPs about the use of cannabis in LTC. While residents’ autonomy must be respected, as well as their own expertise with regards to medical cannabis use, the value of standardized medication protocols to ensure the safety of residents as well as to inform care decisions must be acknowledged. The tension experienced in balancing LTC residents’ autonomy with health and safety concerns in the context of substance use has been cited in a recent scoping review [ 48 ] as well as prior research that has examined the use of tobacco in residential care settings [ 49 ].

The policy-related challenges identified by study participants suggest that consultations with LTC residents, families and HCPs are urgently needed to develop and refine cannabis policies that address the needs and reality of individuals living and receiving care in LTC. Future policy reviews must balance LTC residents’ autonomy with the safety issues associated with cannabis use (i.e., dignity of risk), particularly among older adults and those with cognitive and physical impairments. Approaching cannabis policies and procedures in LTC from a harm reduction perspective [ 50 ] with regards to supporting safer consumption of medical cannabis (e.g., route of administration, designated consumption areas) may also be important. Further, the unique context of LTC must also be acknowledged in that for many residents, a LTC facility is their home, and will continue to be so until the end of their lives. But the shared nature of a LTC setting requires that some boundaries be established to protect all residents, as well as those working within LTC. From a staff perspective, a review of policies related to the administration and documentation of cannabis use is needed to protect them from claims of diversion as well as other medicolegal challenges.

Cannabis knowledge gap and stigma in LTC

Across both the quantitative and qualitative data, the gap in knowledge regarding cannabis and the need for continuing education for HCPs working in LTC were readily apparent. When HCPs are unfamiliar about the various forms of medical cannabis, appropriate dosing and titration schedules, and routes of administration, they are hindered in their ability to engage in shared decision making with LTC residents as well as provide high-quality care [ 51 , 52 , 53 , 54 ]. Education is particularly needed that is tailored to the unique risks and benefits of medical cannabis use among LTC populations, including those living with physical and cognitive impairment. Older adults may be more sensitive to the side effects of cannabis due to changes in how medications and drugs are metabolised, and the predominance of polypharmacy among those residing in LTC may further complicate how individuals respond to cannabis [ 55 ]. Therefore, HCPs working in LTC must be aware of how cannabis use may impact individuals’ mobility, memory, and behaviour, as well as the potential for dependency, particularly among those who have experienced substance use issues in the past.

Beyond basic education regarding cannabis and its effects, HCPs must also become aware and informed about existing federal, regional, and institutional policies as well as professional practice standards regarding both medical and non-medical cannabis. The study findings highlighted the uncertainty many HCPs experienced regarding how medical and non-medical cannabis was to be accessed, authorized, administered, stored, and disposed within the LTC facility and what was within their professional scope of practice. Legal concerns about liability, workplace safety, and diversion were also raised.

It is important that future cannabis education programs targeting LTC settings also address the underlying stigma and stereotypes that still surround cannabis use [ 56 , 57 ], despite the existence of a medical cannabis program in Canada for over 20 years and the recent legalization of non-medical cannabis. Experiential training that promotes non-judgmental communication that avoids stigmatizing language (e.g., user, addict, marijuana) and considers both the risks and benefits of cannabis use, particularly within the context of end-of-life care, will help address the stigma that HCPs and LTC residents and families may hold towards cannabis.

With the legalization of cannabis in many regions around the world, it is imperative that undergraduate health professional training programs include information about both medical and non-medical cannabis. Currently, there is a knowledge gap among HCPs due to the lack of standardized curriculum for medical cannabis across nursing or medical schools [ 35 , 58 ]. Understanding such foundational knowledge such as the endocannabinoid system, the different forms and types of cannabis, and the potential health effects will enable physicians, nurses, pharmacists and other HCPs to engage in informed conversations with individuals and families both within and beyond LTC [ 33 ]. In addition, the development of continuing education programs focused on cannabis will ensure practicing HCPs have current knowledge about cannabis, including existing policies and programs relevant to medical and non-medical cannabis. For example, the Canadian Coalition for Seniors’ Mental Health created asynchronous e-learning modules to provide evidence-based knowledge for various clinicians [ 59 ].

Non-medical cannabis use in LTC: it’s legal but…

Despite non-medical cannabis being a legal substance for over three years in Canada at the time of the case study, the use of non-medical cannabis by LTC residents was considered controversial amongst the HCPs interviewed. Not only were HCPs limited in their ability to support the use of non-medical cannabis due to regional policies that prohibited non-medical cannabis consumption at any healthcare facility and surrounding grounds but concerns about potential safety risks and disruptions to the care environment made some HCPs hesitant about supporting residents’ use of non-medical cannabis.

Notwithstanding these challenges, at least a quarter of HCPs surveyed reported providing care to a LTC resident who used non-medical cannabis, which suggests that regulatory and policy changes are required to ensure there is equity across LTC residents who may express interest in non-medical cannabis, as well as to address the unique safety and care issues associated with recreational cannabis use in LTC populations. Similar to medical cannabis, LTC residents’ autonomy must be considered in future policy changes related to non-medical cannabis to facilitate care that is free from stigma and bias, respects residents’ rights to make informed decisions and to live with risk, and to create a home-like environment where residents can engage in activities that were an important part of their lives before entering LTC.

Lessons can be drawn from literature that has examined the use of other legal substances, such as alcohol and tobacco in LTC [ 48 , 60 ], and the need to develop person-centered care plans that ensure the safety of the individual, fellow residents, and the healthcare team.

Limitations

Like all case studies, the findings cannot be extrapolated to other LTC settings and populations. Given that this study was undertaken in Canada, which has a socialized healthcare system and legalized both medical and non-medical cannabis, the experiences and attitudes of HCPs who participated may be unique and limit the generalizability of the findings. However, there are lessons to be learned regarding the challenges that residents in LTC facilities face in using medical and non-medical cannabis, as well as the potential need for both education and policy reform to better support HCPs in providing appropriate, safe, and person-centred care of LTC residents. In addition, the collection of both quantitative and qualitative data allowed triangulation during the data analysis and helped improved the rigor of the findings [ 61 ]. Recruitment and data collection for this study also occurred during the height of the COVID-19 pandemic. Therefore, the response rate was lower than desired and there was limited diversity among study participants with regards health profession designation. However, the proportion of physicians, nurses, pharmacists, and other allied health professions reflected the overall staff composition of the LTC facility.

Implications for future research

Beyond the policy and practice implications discussed earlier, the study findings also point to the urgent need for research focused on cannabis use among populations commonly found within LTC settings. The lack of evidence regarding the potential health effects of cannabis in the management of diseases such as dementia, arthritis, Parkinson’s, traumatic brain injury, and multiple sclerosis led many of the HCPs interviewed to be hesitant about authorizing and supervising cannabis use for LTC residents living with these conditions. While there is a growing number of studies being undertaken focused on medical cannabis, many are limited by their sample size and study design. It is only through high-quality clinical trials that evaluate the efficacy and safety of medical cannabis that a change in practice will occur.

Future medical cannabis research must also be developed in a manner that is inclusive of older adults and those living in LTC. The exclusion of such populations from clinical research has been previously identified as problematic [ 62 ], resulting in research findings that lack generalizability and pose challenges in determining the applicability of research to older adults who may be living with numerous co-morbidities and using multiple medications. While the inclusion of older adults in medical cannabis clinical trials may be more methodologically and ethically challenging, it will lead to evidence that will inform both future policies and practices.

Lastly, our case study offers insight into the reality and challenges of cannabis use by residents of one LTC facility. Additional research across different jurisdictions is needed to explore how LTC settings are addressing cannabis use and to learn from their experiences. We encourage the continued use of mixed methods study designs to ensure the experiences and perspectives of residents, family members and HCPs are captured alongside administrative data related to medical and non-medical cannabis use.

With the legalization of medical and non-medical cannabis in jurisdictions around the world, LTC facilities will be obligated to develop policies, procedures and healthcare services that are able to accommodate residents’ use of cannabis in a respectful and evidence-informed manner. Balancing the safety concerns against the potential therapeutic value of cannabis, as well as considering residents’ autonomy and the home-like environment of LTC, will be important considerations in how cannabis use is addressed and regulated. Our case study highlights the lack of knowledge, inequities, and stigma that continue to surround cannabis in LTC. There is an urgent need for research that not only explores the potential risks and benefits of cannabis, but also informs the development of more nuanced and equitable policies and education resources that will support reasonable and informed access to medical and non-medical cannabis for older adults and others living in LTC.

Data availability

The datasets generated and analysed during the current study are not publicly available due to the small sample size drawn from one health care facility but are available from the corresponding author on reasonable request.

Abbreviations

Cannabidiol

Healthcare provider

Long–term care

Tetrahydrocannabinol

Licensed Producer

Government of Canada. Cannabis Act (S.C. 2018, c.16). 2018. http://canlii.ca/t/5392s retrieved on 2019-10-07.

Sandhu HS, Anderson LN, Busse JW. Characteristics of canadians likely to try or increase cannabis use following legalization for nonmedical purposes: a cross-sectional study. CMAJ Open. 2019;7(2):E399–404.

Article   PubMed   PubMed Central   Google Scholar  

Statistics Canada. National Cannabis Survey, third quarter 2019. https://www150.statcan.gc.ca/n1/daily-quotidien/191030/dq191030a-eng.htm

Statistics Canada. Research to Insights: Cannabis in Canada. 2023. https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2023006-eng.htm

Lau N, Sales P, Averill S, Murphy F, Sato SO, Murphy S. A safer alternative: cannabis substitution as harm reduction. Drug Alcohol Rev. 2015;34(6):654–9.

Bobitt J, Qualls SH, Schuchman M, Wickersham R, Lum HD, Arora K, et al. Qualitative analysis of cannabis use among older adults in Colorado. Drugs Aging. 2019;36(7):655–66.

Article   PubMed   Google Scholar  

Reynolds IR, Fixen DR, Parnes BL, Lum HD, Shanbhag P, Church S, et al. Characteristics and patterns of marijuana use in community-dwelling older adults. J Am Geriatr Soc. 2018;66(11):2167–71.

Baumbusch J, Sloan Yip I. Exploring new use of cannabis among older adults. Clin Gerontol. 2021;44(1):25–31.

Tumati S, Lanctôt KL, Wang RD, Li A, Davis A, Herrmann N. Medical cannabis use among older adults in Canada: self-reported data on types and amount used, and perceived effects. Drugs Aging. 2022;39(2):153–63.

Government of Canada. Data on cannabis for medical purposes. 2022. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/medical-purpose.html

Cooper ZD, Abrams DI, Gust S, Salicrup A, Throckmorton DC. Challenges for clinical cannabis and cannabinoid research in the United States. J Natl Cancer Inst Monogr. 2021;2021(58):114–22.

Piomelli D, Solomon R, Abrams D, Balla A, Grant I, Marcotte T, et al. Regulatory barriers to research on cannabis and cannabinoids: a proposed path forward. Cannabis Cannabinoid Res. 2019;4(1):21–32.

O’Brien M, McDougall JJ. Cannabis and joints: scientific evidence for the alleviation of osteoarthritis pain by cannabinoids. Curr Opin Pharmacol. 2018;40:104–9.

Babson KA, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep. 2017;19(4):23.

Hillen JB, Soulsby N, Alderman C, Caughey GE. Safety and effectiveness of cannabinoids for the treatment of neuropsychiatric symptoms in dementia: a systematic review. Ther Adv Drug Saf. 2019;10:2042098619846993.

Chagas MHN, Zuardi AW, Tumas V, Pena-Pereira MA, Sobreira ET, Bergamaschi MM, et al. Effects of cannabidiol in the treatment of patients with Parkinson’s disease: an exploratory double-blind trial. J Psychopharmacol. 2014;28(11):1088–98.

Shohet A, Khlebtovsky A, Roizen N, Roditi Y, Djaldetti R. Effect of medical cannabis on thermal quantitative measurements of pain in patients with Parkinson’s disease. Eur J Pain. 2017;21(3):486–93.

Article   CAS   PubMed   Google Scholar  

Herrmann N, Ruthirakuhan M, Gallagher D, Verhoeff NPLG, Kiss A, Black SE, et al. Randomized placebo-controlled trial of nabilone for agitation in Alzheimer’s disease. Am J Geriatr Psychiatry. 2019;27(11):1161–73.

Shelef A, Barak Y, Berger U, Paleacu D, Tadger S, Plopsky I, et al. Safety and efficacy of medical cannabis oil for behavioral and psychological symptoms of dementia: an open label, add-on, pilot study. J Alzheimer’s Dis. 2016;51(1):15–9.

Article   CAS   Google Scholar  

Volicer L, Stelly M, Morris J, Mclaughlin J, Volicer BJ. Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer’s disease. Int J Geriatr Psychiatry. 1997;12(9):913–9.

Cyr C, Arboleda MF, Aggarwal SK, Balneaves LG, Daeninck P, Néron A, et al. Cannabis in palliative care: current challenges and practical recommendations. Ann Palliat Med. 2018;7(4):463–77.

Pooyania S, Ethans K, Szturm T, Casey A, Perry D. A randomized, double-blinded, crossover pilot study assessing the effect of nabilone on spasticity in persons with spinal cord injury. Arch Phys Med Rehabil. 2010;91(5):703–7.

Wilsey B, Marcotte TD, Deutsch R, Zhao H, Prasad H, Phan A. An exploratory human laboratory experiment evaluating vaporized cannabis in the treatment of neuropathic pain from spinal cord injury and disease. J Pain. 2016;17(9):982–1000.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Grenier K, Ponnambalam F, Lee D, Lauwers R, Bhalerao S. Cannabis in the treatment of traumatic brain injury: a primer for clinicians. Can J Neurol Sci. 2019;47(1):11–7.

Minerbi A, Hauser W, Fitzcharles MA. Medical cannabis for older patients. Drugs Aging. 2019;36(1):39–51.

MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Int Med. 2018;49:12–9.

Bertram JR, Porath A, Seitz D, Kalant H, Krishnamoorthy A, Nickerson J, et al. Canadian guidelines on cannabis use disorder among older adults. Can Geriatr J. 2020;23(1):135–42.

Banerjee S. Multimorbidity–older adults need health care that can count past one. Lancet. 2015;385(9968):587–9.

Bom J, Bakx P, Rellstab S. Well-being right before and after a permanent nursing home admission. Health Econ. 2022;31(12):2558–74.

Calkins M, Brush J. Honoring individual choice in long-term residential communities when it involves risk: a person-centered approach. J Gerontol Nurs. 2016;42(8):12–7.

Yin R. Case study research and applications: design and methods. 6th ed. Thousand Oaks, CA: Sage; 2018.

Google Scholar  

Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–40.

Balneaves LG, Alraja A, Ziemianski D, McCuaig F, Ware M. A national needs assessment of Canadian nurse practitioners regarding cannabis for therapeutic purposes. Cannabis Cannabinoid Res. 2018;3(1):66–73.

Ziemianski D, Capler R, Tekanoff R, Lacasse A, Luconi F, Ware MA. Cannabis in medicine: a national educational needs assessment among Canadian physicians. BMC Med Educ. 2015;15:50–2.

Article   Google Scholar  

Balneaves LG, Alraja AA. Guarding their practice: a descriptive study of Canadian nursing policies and education related to medical cannabis. BMC Nurs. 2019;18(1):66.

Fox RD. Revisiting discrepancy analysis in continuing medical education: a conceptual model 1983. J Contin Health Prof. 2011;31(1):71–6.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

College of Registered Nurses of Manitoba. Medical cannabis: Guidelines for Manitoba nurses. 2019. https://www.crnm.mb.ca/uploads/document/document_file_247.pdf?t=1549645011

College of Registered Nurses of Manitoba. Practice direction: RN(NP) authorization of medical cannabis. 2018. https://www.crnm.mb.ca/uploads/document/document_file_252.pdf?t=1538755351

The College of Physicians & Surgeons of Manitoba. Standard of practice: Cannabis for medical purpose. 2020. https://cpsm.mb.ca/assets/Standards of Practice/Standard of Practice Authorizing Cannabis for Medical Purposes.pdf.

Winnipeg Regional Health Authority. Smoke-Free Policy. 2014. https://wrha.mb.ca/files/wrha-policy-10-00-010.pdf

Government of Canada. Cannabis regulations (SOR/2018 – 144) [. 2018. https://laws-lois.justice.gc.ca/eng/Regulations/SOR-2018-144/index.html

Goffman E. Asylums: essays on the social situations of mental patients and other inmates. Oxford, England: Doubleday (Anchor); 1961.

White-Chu EF, Graves WJ, Godfrey SM, Bonner A, Sloane P. Beyond the medical model: the culture change revolution in long-term care. J Am Med Dir Assoc. 2009;10(6):370–8.

Chivers S. Make mine a double. In: Armstrong P, Daly T, editors. Exercising choice in long-term residential care. Montreal, QC: RR Donnelley; 2017. pp. 55–8.

Woolford MH, de Lacy-Vawdon C, Bugeja L, Weller C, Ibrahim JE. Applying dignity of risk principles to improve quality of life for vulnerable persons. Int J Geriatr Psychiatry. 2020;35(1):122–30.

Schultz ASH, Finegan B, Nykiforuk CIJ, Kvern MA. A qualitative investigation of smoke-free policies on hospital property. CMAJ. 2011;183(18):2085–6.

De Graaf L, Janssen M, Roelofs T, Luijkx K. Substance use and misuse of older adults living in residential care facilities: a scoping review from a person-centred care approach. Ageing Soc. 2021;43(6):1–27.

Adler G, Greeman M, Parker H, Kuskowski M. Self-determination and residents who smoke. J Social Work Long-Term Care. 2002;1(4):19–30.

Lau N, Sales P, Averill S, Murphy F, Sato SO, Murphy S. Responsible and controlled use: older cannabis users and harm reduction. Int J Drug Policy. 2015;26(8):709–18.

Clobes TA, Palmier LA, Gagnon M, Klaiman C, Arellano M. The impact of education on attitudes toward medical cannabis. PEC Innov. 2022;1:100009.

Croker JA, Bobitt J, Sanders S, Arora K, Mueller K, Kaskie B. Cannabis and end-of-life care: a snapshot of hospice planning and experiences among Illinois medical cannabis patients with a terminal diagnosis. Am J Hosp Palliat Med. 2022;39(3):345–52.

Hachem Y, Abdallah SJ, Rueda S, Wiese JL, Mehra K, Rup J, et al. Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices. BMC Complement Med Ther. 2022;22(1):1–12.

Hope J, Schoonhoven L, Griffiths P, Gould L, Bridges J. I’ll put up with things for a long time before I need to call anybody: face work, the Total Institution and the perpetuation of care inequalities. Sociol Health Illn. 2022;44(2):469–87.

Williams AR. Ethical dilemmas in counseling older adults on cannabis use: less science, more quandaries. Generations J. 2020;44(4):1–5.

Skliamis K, Benschop A, Korf DJ. Cannabis users and stigma: a comparison of users from European countries with different cannabis policies. Eur J Crimin. 2022;19(6):1483–500.

Troup LJ, Erridge S, Ciesluk B, Sodergren MH. Perceived stigma of patients undergoing treatment with cannabis-based medicinal products. Int J Env Res Public Health. 2022;19(12).

Evanoff AB, Quan T, Dufault C, Awad M, Bierut LJ. Physicians-in-training are not prepared to prescribe medical marijuana. Drug Alcohol Depend. 2017;180:151–5.

Canadian Coalition for Seniors’ Mental Health. Cannabis and older adults. https://ccsmh.ca/cannabis-and-older-adults-project/

Grossi A, Holmes A, Ibrahim JE. Use of alcohol in long term care settings: a comparative analysis of personal choice, public health advice and the law. J Am Med Dir Assoc. 2021;22(1):9–e141.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011;11:100.

Crome P, Lally F, Cherubini A, Oristrell J, Beswick AD, Clarfield AM, et al. Exclusion of older people from clinical trials: professional views from nine European countries participating in the PREDICT study. Drugs Aging. 2011;28(8):667–77.

Download references

Acknowledgements

The authors would like to thank the healthcare professionals that graciously took the time to share their thoughts about cannabis use in long-term care settings. In addition, Ms. Sina Barkman, Chief Human Resources Officer, Riverview Health Centre, helped the research team navigate the complexity of conducting research in long-term care settings during the COVID-19 pandemic.

Funding for this study was received from the Riverview Health Centre Foundation.

Author information

Authors and affiliations.

College of Nursing, University of Manitoba, Winnipeg, MB, Canada

Lynda G. Balneaves, Abeer A. Alraja, Genevieve Thompson, Jamie L. Penner & Daniella Scerbo

Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

Philip St. John

Riverview Health Centre, Winnipeg, MB, Canada

Joanne van Dyck

College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada

Lynda G. Balneaves

You can also search for this author in PubMed   Google Scholar

Contributions

“L.G.B, G.T, J.P and P.StJ. conceptualised the study. A.A.A. and D.S. engaged in recruitment and data collection activities. L.G.B. and A.A.A. analysed and interpreted the quantitative and qualitative data and developed a first draft of the manuscript, with assistance from G.T. All authors read and approved the final manuscript.”

Corresponding author

Correspondence to Lynda G. Balneaves .

Ethics declarations

Ethics approval and consent to participate.

Ethical approval for the study was obtained from the University of Manitoba Research Ethics Board (R1-2021:011 (HS24693)) and was approved by the Riverview Health Centre Research Committee. Implied consent was received from participants who completed the survey and written informed consent was obtained from all participants who completed an interview. We confirm that all methods were performed in accordance with the relevant ethical guidelines and regulations, (i.e., Tri-Council Policy Statement).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Balneaves, L.G., Alraja, A.A., Thompson, G. et al. Cannabis use in a Canadian long-term care facility: a case study. BMC Geriatr 24 , 467 (2024). https://doi.org/10.1186/s12877-024-05074-2

Download citation

Received : 11 July 2023

Accepted : 13 May 2024

Published : 29 May 2024

DOI : https://doi.org/10.1186/s12877-024-05074-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Medical cannabis
• Non-medical cannabis
• Long-term care
• Residential care
• Older adults

BMC Geriatrics

ISSN: 1471-2318

• Submission enquiries: [email protected]
• General enquiries: [email protected]

McKinsey Case Interview & PEI - 6 Things You Need to Know

• Last Updated January, 2024

Rebecca Smith-Allen

Former McKinsey Engagement Manager

If you’re interested in a career in management consulting, McKinsey & Company is probably on your list of firms to apply to. It’s the oldest consulting firm, established in 1926 by James McKinsey, a University of Chicago professor and expert in management accounting.

Today, the firm employs 30 thousand professionals working in 130 cities around the world. McKinsey regularly ranks at the top of lists of strategy consulting firms and is hired by businesses, governments, and non-profit organizations to help solve their toughest problems.

It’s difficult to get a job offer from McKinsey.

Like its top management consulting competitors, Bain and BCG, McKinsey typically hires only 1% of candidates who apply. In particular, McKinsey case interviews are tough to crack…but not impossible.

If you’re interested in trying to beat the odds, this article will tell you what you need to know to succeed. We’ll tell you:

What’s different about McKinsey,

6 things candidates recruiting with McKinsey should know,

We’ll provide a mock McKinsey case interview video, and

Provide tips on acing your McKinsey interview.

Let’s get started!

What’s Different About McKinsey? 6 Things Candidates Should Know

1. consultants are hired for either the generalist track or a specialist track.

Generalists at McKinsey are consultants who could be staffed to help clients in any industry and dealing with any type of business problem. Specialists are consultants with a particular area of expertise.

Areas of specialization within McKinsey  include digital and advanced analytics, marketing and sales, business turn around, operations,  software development and design, and implementation.

2. Consultants Work On-Site At The Client 4 Days A Week.

Most consultants travel a lot and at McKinsey, this is definitely the case. Consider whether regular plane flights and hotel stays are right for you.

3. McKinsey Cases Are Interviewer-Led Rather Than Candidate-Led.

Candidates are still expected to identify key issues to be addressed to solve the business problem presented by their interviewer and outline a plan to explore these issues. After they do that, their McKinsey interviewer is likely to tell the candidate which issue they’d like to discuss first. Other management consulting firms, like Bain and BCG typically let candidates steer their case interview.

4. Interviewers Assess Fit As Part Of Every Interview With Personal Experience Interview (PEI) Questions.

While all strategy firms ask candidates Consulting Behavioral Interview Questions  to assess their fit with their firm, many have one interviewer focus entirely on fit while others focus entirely on a case study question. 

McKinsey interviewers split their interview time between the case and PEI in every interview.

5. McKinsey Looks For Personal Impact And Entrepreneurial Drive In Candidates.

This is in addition to the structured problem solving and leadership skills that McKinsey, as well as other top consulting firms, look for in candidates.

6. Mckinsey Recruiting Uses Solve - a Gamified Digital Assessment.

McKinsey’s Solve Game was launched to broaden the firm’s reach to find the best talent regardless of geography as well as provide deeper insight into candidates’ problem-solving skills.

Keep reading for a deeper dive into these topics.

Generalist versus Specialist Track Roles

When the management consulting industry was first founded, simply having an MBA and expertise in solving business problems was enough to set a consultant apart. Consultants hired by McKinsey could expect to be staffed on a case in any industry and solving any type of problem.

To help clients solve these types of business problems effectively, McKinsey hires people with years of experience in functional specialties. These include advanced analytics, marketing and sales, business turn around, operations, software development and design, and implementation.

Specialists work alongside generalists on projects to leverage their functional expertise across the work of the team. The specialist practices are growing faster than generalist roles and get fewer applications, so if you have the right kind of expertise and apply to the practice, you may have a better chance of landing an interview.

How McKinsey Interviews Differ from Bain and BC

There are two main ways that McKinsey’s interviews differ from those of other top management consulting firms. McKinsey uses interviewer-led case interviews while other firms use candidate-led case interviews.

In the “fit” portion of the interview, McKinsey uses the personal experience interview and each interviewer you meet with in all rounds will assess fit.

Interviewer-led Cases

At the start of any McKinsey case study, candidates need to go through 4 phases to solve the business problem the interviewer has given them in a structured manner: the opening, structure, analysis, and closing. 

In a candidate-led case interview, candidates will pick which part of the problem they want to dive into first and proceed with it. In McKinsey’s interviewer-led cases, the interviewer will pick the first part of the business problem they want the candidate to address.

Is the interviewer-led case interview easier or harder than the candidate-led one?

If you’ve structured the business problem well, breaking the problem down into the MECE  issues that require further analysis, it should not matter who picks which aspect of the problem to address first. What is helpful is knowing what to expect in your case interview so that you don’t start down one path just to be redirected by your McKinsey interviewer.  You don’t want anything to throw you in the middle of your case!

For more information on these 4 phases of answering a case interview question, see  Case Interview Prep .

Behavioral Interview Questions - The McKinsey PEI

As mentioned above, fit or personal experience interview (PEI) questions are part of every McKinsey interview. 

How else is the PEI different?

While other top management consulting firms focus on bringing the best creative problem-solving to their clients’ problems (BCG is notable here), McKinsey is interested in candidates’ personal impact and entrepreneurial spirit.

McKinsey interviewers look for these characteristics in answers to PEI questions. Because of this, it’s good to have some insight into why the firm thinks these characteristics are important.

Personal Impact

McKinsey says this about personal impact on its career website:

McKinsey does not want to create PowerPoint presentations with elegant solutions that sit on an executive’s shelf, not implemented.

Personal impact means that McKinsey consultants work shoulder-to-shoulder, on-site with client executives, developing solutions that don’t just solve a business problem in theory but also do it in practice. This can require facing resistance to change in the client’s organization head-on and persuading people to reassess long-held beliefs.

During the PEI, questions like the following will be asked to assess personal impact:

•   Tell me about a team you worked on when you needed to change someone’s mind on a topic that was important to them, or
•   Tell me about a time when you needed to rely on your communication skills to solve a difficult interpersonal situation.

This belief that personal impact is key to developing an implementable solution is what drives McKinsey consultants to spend 4 days a week on client site.

Entrepreneurial Drive

McKinsey says this about entrepreneurial drive on its career website:

McKinsey doesn’t hire consultants who can only implement solutions they’ve seen in previous businesses. They want people who are willing to try new things, take solutions to new industries or new types of problems.

The McKinsey problem solving approach treats each client problem as unique. Each solution should push thinking about best-practices.

In addition to personal impact and entrepreneurial drive, McKinsey also assesses leadership using the PEI. We won’t address this in detail because this is similar to other consulting firms, but you can find more about how McKinsey assesses leadership in our page on  McKinsey PEI Questions.

It also includes What McKinsey Is Looking For and provides a list of 11 Common PEI Questions.

Nail the case & fit interview with strategies from former MBB Interviewers that have helped 89.6% of our clients pass the case interview.

The McKinsey Interview Process - Traditional and Recent Changes

The traditional recruiting process.

For years, McKinsey focused on a group of core schools to find new analyst (undergraduate hires) and associate (MBA hires) candidates. 

While the firm now recruits from a broader set of schools as well as more diverse candidates, recruiting at these core schools still starts in much the same way. McKinsey consultants conduct on-campus presentations and coffee chats to talk to potential candidates about what it’s like to work in the management consulting industry and at McKinsey, in particular.

If the firm hosts an event at your campus, you should attend to make personal connections and to find out first-hand if a career at McKinsey is right for you. If there are no events at your school or if you’re already employed, check out the company’s career site for articles and videos that will tell you what it’s like to work at McKinsey and what it takes to get an offer.

Candidates submit their resumes (and optional cover letters) to the firm’s recruiting department via their school’s department of career services and on the firm website. Candidates who are invited to interview typically have their first round interviews on campus.

During first round interviews, candidates meet with 2 interviewers back-to-back. Candidates who pass first round interviews are invited to a McKinsey office for second round interviews.

In second round interviews, candidates meet with 3 interviewers. Unless a candidate’s interviewers are split in their decision, second round interviews are also final round interviews.

In each round of interviews, McKinsey interviewers walk candidates through a business problem and asks a series of  McKinsey PEI Questions , aimed at evaluating their potential fit with the organization. 

The Recruiting Process for Candidates at Non-core School and Experienced Hires

Candidates from non-core schools submit their resumes (and optional cover letters) directly to the recruiting department of the 3 offices they’d like to work in.

If they are invited to interview, candidates who live relatively close to a McKinsey office will be invited for in-person first round interviews. Others will be asked to do their first round McKinsey interviews via video conference.

Candidates already working in another industry or those working at another consulting firm submit their resumes (and optional cover letters) directly to the recruiting department of the three offices they’d like to work in. They will typically have a phone interview before the “first round” of in-person interviews.

In both cases, once candidates are passed to second round interviews the recruiting process is the same as for core school candidates.

Solve, The McKinsey Problem Solving Game

McKinsey is reaching out to more candidates outside of their traditional core schools to diversify its recruiting. As part of that, it’s launched  Solve , an online game  that assesses candidates’ problem-solving skills.  Solve is both more fun and gives candidates from non-core schools a better shot at getting a McKinsey interview than they’ve had in the past.

Example McKinsey Case Interview - Video

Below, we have 4 videos in which My Consulting Offer founder, Davis Nguyen, walks you  through each segment of a McKinsey case interview from beginning to end. 

Mock McKinsey Case Interview - Opening the Case

The key thing to do in the opening of a McKinsey case study is to repeat back the question so you’re sure you understand the problem you are solving. Then, ask questions to begin to get more information.

Mock McKinsey Case Interview - Structuring the Case

In the structure section of McKinsey Case Interviews, create a MECE list of important issues you will analyze to solve the client’s problem.

Mock McKinsey Case Interview - The Case Analysis

In the analysis section of a McKinsey case study, you’ll need to do analysis to evaluate the best option for your client. This may require interpreting data from charts or graphs provided by your interviewer or doing calculations based on numbers you’re given.

Mock McKinsey Case Interview - Concluding the Case

In the conclusion of McKinsey case interviews, you’ll need to pull your analysis together into a persuasive recommendation for the client. Restate the question you were asked to solve, lay out key findings from each section of your case structure, and show how your analysis points to the course of action the client should take.

Now that you’ve watched our sample McKinsey case interview, you should be ready to start practicing for your own interviews. 

Here are 5 tips on making the most of your preparation time:

5 Tips on Acing Your McKinsey Interview

• Practice casing with another person. Answering case interview questions does not come naturally and it is not enough to practice on your own since casing requires having a dialogue. Give yourself as much time to practice mock interviews as possible by starting early.
• Record yourself during mock interviews  using your computer or phone. Study these videos to see how you can improve your performance in each phase of the case interview. Aim to make your answers more fluent and conversational.
• Practice sample McKinsey interview-led case interviews. Use  McKinsey-specific case interview examples  below to make sure you’re not just familiar with cases, but with McKinsey cases. Make sure you are comfortable with being redirected at times. 
• Brainstorm several  stories to answer common personal experience interview questions. You can find a list of these common questions here .
• Find out more about the  McKinsey Solve Game  before you take it. 

After reading this article, you should have a good understanding of what McKinsey’s recruiting process looks like and how McKinsey case interviews are different from other management consulting firms. 

Still have questions?

If you have more questions about McKinsey case interviews, the PEI, or working at McKinsey, leave them in the comments below. One of My Consulting Offer’s case coaches will answer them.

People interested in this topic have also found the following pages helpful:

• Why McKinsey?
• McKinsey PEI Questions
• McKinsey Problem Solving Game
• Case Interview Examples

Help with Consulting Interview Prep

Thanks for turning to My Consulting Offer for advice on case study interview prep. 

My Consulting Offer has helped almost 89.6% of the people we’ve worked with get a job in management consulting.  

We want you to be successful in your consulting case interviews too.

Leave a Comment Cancel reply

Save my name, email, and website in this browser for the next time I comment.

© My CONSULTING Offer

3 Top Strategies to Master the Case Interview in Under a Week

We are sharing our powerful strategies to pass the case interview even if you have no business background, zero casing experience, or only have a week to prepare.

No thanks, I don't want free strategies to get into consulting.

We are excited to invite you to the online event., where should we send you the calendar invite and login information.

• Open access
• Published: 05 June 2024

Current status and ongoing needs for the teaching and assessment of clinical reasoning – an international mixed-methods study from the students` and teachers` perspective

• F. L Wagner 1 ,
• M. Sudacka 2 ,
• A. A Kononowicz 3 ,
• M. Elvén 4 , 5 ,
• S. J Durning 6 ,
• I. Hege 7 &
• S. Huwendiek 1  

BMC Medical Education volume  24 , Article number:  622 ( 2024 ) Cite this article

Metrics details

Clinical reasoning (CR) is a crucial ability that can prevent errors in patient care. Despite its important role, CR is often not taught explicitly and, even when it is taught, typically not all aspects of this ability are addressed in health professions education. Recent research has shown the need for explicit teaching of CR for both students and teachers. To further develop the teaching and learning of CR we need to improve the understanding of students' and teachers' needs regarding content as well as teaching and assessment methods for a student and trainer CR curriculum.

Parallel mixed-methods design that used web-surveys and semi-structured interviews to gather data from both students (n survey  = 100; n interviews  = 13) and teachers (n survey  = 112; n interviews  = 28). The interviews and surveys contained similar questions to allow for triangulation of the results. This study was conducted as part of the EU-funded project DID-ACT ( https://did-act.eu ).

Both the surveys and interview data emphasized the need for content in a clinical reasoning (CR) curriculum such as “gathering, interpreting and synthesizing patient information”, “generating differential diagnoses”, “developing a diagnostic and a treatment plan” and “collaborative and interprofessional aspects of CR”. There was high agreement that case-based learning and simulations are most useful for teaching CR. Clinical and oral examinations were favored for the assessment of CR. The preferred format for a train-the-trainer (TTT)-course was blended learning. There was also some agreement between the survey and interview participants regarding contents of a TTT-course (e.g. teaching and assessment methods for CR). The interviewees placed special importance on interprofessional aspects also for the TTT-course.

Conclusions

We found some consensus on needed content, teaching and assessment methods for a student and TTT-course in CR. Future research could investigate the effects of CR curricula on desired outcomes, such as patient care.

Peer Review reports

Introduction

Clinical reasoning (CR) is a universal ability that mobilizes integration of necessary fundamental knowledge while delivering high-quality patient care in a variety of contexts in a timely and effective way [ 1 , 2 ]. Daniel et al. [ 3 ] define it as a “skill, process or outcome wherein clinicians observe, collect, and interpret data to diagnose and treat patients”. CR encompasses health professionals thinking and acting in patient assessment, diagnostic, and management processes in clinical situations, taking into account the patient ‘s specific circumstances and preferences [ 4 ]. How CR is defined can vary between health professions, but there are also similarities [ 5 ]. Poor CR is associated with low-quality patient care and increases the risk of medical errors [ 6 ]. Berner and Graber [ 7 ] suggested that the rate of diagnostic error is around 15%, underlining the threat that insufficient CR ability poses to patient safety as well as increasing healthcare costs [ 8 ]. Despite the importance of CR, it appears to be rarely taught or assessed explicitly, often only parts of the CR process are covered in existing curricula, and there seems to be a lack of progression throughout curricula (e.g. [ 9 , 10 , 11 , 12 , 13 , 14 ].). Moreover, teachers are often not trained to explicitly teach CR, including explaining their own reasoning to others [ 10 , 11 , 12 ] although this appears to be an important factor in the implementation of a CR curriculum [ 15 ]. Some teachers even question whether CR can be explicitly taught [ 16 ]. Considering these findings, efforts should be made to incorporate explicit teaching of CR into health care professions curricula and training for teachers should be established based on best evidence. However, to date, little is known about what a longitudinal CR curriculum should incorporate to meet the needs of teachers and students.

Insights regarding teaching CR were provided from a global survey by Kononowicz et al. [ 10 ], who reported a need for a longitudinal CR curriculum. However, the participants in their study were mainly health professions educators, leaving the needs of students for a CR curriculum largely unknown. As students are future participants of a CR curriculum, their needs should also be investigated. Kononowicz et al. [ 10 ] also identified a lack of qualified faculty to teach CR. A train-the-trainer course for CR could help reduce this barrier to teaching CR. To the best of our knowledge, in addition to the work by Kononowicz et al. [ 10 ], no research exists yet that addresses the needs of teachers for such a course, and Kononowicz et al. [ 10 ] did not investigate their needs beyond course content. Recently, Gupta et al. [ 12 ] and Gold et al. [ 13 ] conducted needs analyses regarding clinical reasoning instruction from the perspective of course directors at United States medical schools, yet a European perspective is missing. Thus, our research questions were the following:

What aspects of clinical reasoning are currently taught and how important are they in a clinical reasoning curriculum according to teachers and students?

What methods are currently used to teach and assess clinical reasoning and which methods would be ideal according to teachers and students?

In what study year does the teaching of clinical reasoning currently begin and when should it ideally begin according to teachers and students?

How should a train-the-trainer course for teachers of clinical reasoning be constructed regarding content and format?

In this study, we used a convergent parallel mixed-methods design [ 17 ] within a pragmatic constructivist case study approach [ 18 ]. We simultaneously collected data from students and educators using online questionnaires and semi-structured interviews to gain deeper insight into their needs on one particular situation [ 19 ]– the development of a clinical reasoning curriculum—to address our research questions. To help ensure that the results of the survey and the interviews could be compared and integrated, we constructed the questions for the survey and the interviews similarly with the exception that in the interviews, the questions were first asked openly. The design was parallel both in that we collected data simultaneously and also constructed the survey and interviews to cover similar topics. We chose this approach to obtain comprehensive answers to the research questions and to facilitate later triangulation [ 17 ] of the results.

Context of this study

We conducted this study within the EU-funded (Erasmus + program) project DID-ACT (“Developing, implementing, and disseminating an adaptive clinical reasoning curriculum for healthcare students and educators”; https://did-act.eu ). Institutions from six European countries (Augsburg University, Germany; Jagiellonian University in Kraków, Poland; Maribor University, Slovenia; Örebro University, Sweden; University of Bern, Switzerland; EDU, a higher medical education institution based in Malta, Instruct GmbH, Munich, Germany) with the support of associate partners (e.g., Prof. Steven Durning, Uniformed Services University of the Health Sciences, USA; Mälardalen University, Sweden.) were part of this project. For further information, see https://did-act.eu/team-overview/team/ . In this project, we developed an interprofessional longitudinal clinical reasoning curriculum for students in healthcare education and a train-the-trainer course for health profession educators. The current curriculum (for a description of the curriculum, see Hege et al. [ 20 ]) was also informed by this study. This study was part of the Erasmus + Knowledge Alliance DID-ACT (612,454-EPP-1–2019-1-DE-EPPKA2-KA).

Target groups

We identified two relevant target groups for this study, teachers and students, which are potential future users and participants of a train—the—trainer (TTT-) course and a clinical reasoning curriculum, respectively. The teacher group also included individuals who were considered knowledgeable regarding the current status of clinical reasoning teaching and assessment at their institutions (e.g. curriculum managers). These specific participants were individually selected by the DID-ACT project team to help ensure that they had the desired level of expertise. The target groups included different health professions from a large number of countries (see Table  1 ), as we wanted to gather insights that are not restricted to one profession.

Development of data collection instruments

Development of questions.

The questions in this study addressed the current status and needs regarding content, teaching, and assessment of clinical reasoning (CR). They were based on the questions used by Kononowicz et al. [ 10 ] and were expanded to obtain more detailed information. Specifically, regarding CR content, we added additional aspects (see Table 8 in the Appendix for details). The contents covered in this part of the study also align with the five domains of CR education (clinical reasoning concepts, history and physical examination, choosing and interpreting diagnostic tests, problem identification and management and shared decision-making) that were reported by Cooper et al. [ 14 ]. It has been shown that there are similarities between professions regarding the definition of CR (e.g. history taking or an emphasis on clinical skills), while nurses placed greater importance on a patient-centered approach [ 5 ]. We aimed to cover as many aspects of CR in the contents as possible to represent these findings. We expanded the questions on CR teaching formats to cover a broader range of formats. Furthermore, two additional assessment methods were added to the respective questions. Finally, one aspect was added to the content questions for a train-the-trainer course (see Table 8 in the Appendix ). As a lack of qualified faculty to teach CR was identified in the study by Kononowicz et al. [ 10 ], we added additional questions on the specific needs for the design of a CR train-the-trainer course beyond content. Table 8 in the Appendix shows the adaptations that we made in detail.

We discussed the questions within the interprofessional DID-ACT project team and adapted them in several iterative cycles until the final versions of the survey questionnaire and the interview guide were obtained and agreed upon. We tested the pre-final versions with think-alouds [ 21 ] to ensure that the questions were understandable and interpreted as intended, which led to a few changes. The survey questionnaires and interview-guides can be found at https://did-act.eu/results/ and accessed via links in table sections D1.1a (survey questions) and D1.1b (interview guides), respectively. Of these questions, we included only those relevant to the research questions addressed in this study. The questions included in this study can be found in the Appendix in Table8.

Teachers were asked questions about all content areas, but only the expert subgroup was asked to answer questions on the current situation regarding the teaching and assessment of clinical reasoning at their institutions, as they were considered the best informed group on the matter. Furthermore, students were not asked questions on the train-the-trainer course. Using the abovementioned procedures, we also hoped to improve the response rate as longer surveys were found to be associated with lower response rates [ 22 ].

We created two different versions of the interview guide, one for teachers and one for students. The student interview guide did not contain questions on the current status of clinical reasoning teaching and assessment or questions about the train-the-trainer course. The interview guides were prepared with detailed instructions to ensure that the interviews were conducted in a comparable manner at all locations. By using interviews, we intended to obtain a broad picture of existing needs. Individual interviews further allowed participants to speak their own languages and thus to express themselves naturally and as precisely as possible.

Reflexivity statement

Seven researchers representing different perspectives and professions form the study team. MS has been a PhD candidate representing the junior researcher perspective, while also experienced researchers with a broad background in clinical reasoning and qualitative as well as quantitative research are part of the team (SD, SH, AK, IH, ME, FW). ME represents the physiotherapist perspective, SD, SH, and MS represent the medical perspective. We discussed all steps of the study in the team and made joint decisions.

Data collection and analysis

The survey was created using LimeSurvey software (LimeSurvey GmbH). The survey links were distributed via e-mail (individual invitations, posts to institutional mailing lists, newsletters) by the DID-ACT project team and associate partners (the target groups received specific links to the online-survey). The e-mail contained information on the project and its goals. By individually contacting persons in the local language, we hoped to increase the likelihood of participation. The survey was anonymous. The data were collected from March to July 2020.

Potential interview participants were contacted personally by the DID-ACT project team members in their respective countries. We used a convenience sampling approach by personally contacting potential interview partners in the local language to motivate as many participants as possible. With this approach we also hoped to increase the likelihood of participation. The interviews were conducted in the local languages also to avoid language barriers and were audio-recorded to help with the analysis and for documentation purposes. Most interviews were conducted using online meeting services (e.g. Skype or Zoom) because of restrictions due to the ongoing coronavirus pandemic that occurred with the start of data collection at the beginning of the DID-ACT project. The data were collected from March to July 2020. All interview partners provided informed consent.

Ethics approval and consent to participate

We asked the Bern Ethics Committee to approve this multi-institutional study. This type of study was regarded as exempt from formal ethical approval according to the regulations of the Bern Ethics Committee (‘Kantonale Ethikkommission Bern’, decision Req-2020–00074). All participants voluntarily participated and provided informed consent before taking part in this study.

Data analysis

Descriptive analyses were performed using SPSS statistics software (version 28, 2021). Independent samples t-tests were computed for comparisons between teachers and students. When the variances of the two groups were unequal, Welch’s test was used. Bonferroni correction of significance levels was used to counteract alpha error accumulation in repeated tests. The answers to the free text questions were screened for recurring themes. There were very few free-text comments, typically repeating aspects from the closed questions, hence, no meaningful analysis was possible. For this reason, the survey comments are mentioned only where they made a unique contribution to the results.

The interviews were translated into English by the partners. An overarching summarizing qualitative content analysis [ 23 ] of the data was conducted. A summarizing content analysis is particularly useful when the content level of the material is of interest. Its goal is to reduce the material to manageable short texts in a way that retains the essential meaning [ 23 ]. The analysis was conducted first by two of the authors of the study (FW, SH) and then discussed by the entire author team. The analysis was carried out as an iterative process until a complete consensus was reached within the author team.

The results from the surveys and interviews were compared and are presented together in the results section. The qualitative data are reported in accordance with the standards for reporting qualitative research (SRQR, O’Brien et al. [ 24 ]).

Table 1 shows the professional background and country of the interviewees and survey samples. The survey was opened by 857 persons, 212 (25%) of whom answered the questions included in this study. The expert sub-group of teachers who answered the questions on the current status of clinical reasoning teaching and assessment encompassed 45 individuals.

Content of a clinical reasoning curriculum for students

The survey results show that “Gathering, interpreting, and synthesizing patient information”, is currently most extensively taught, while “Theories of clinical reasoning” are rarely taught (see Table  2 ). In accordance with these findings, “Gathering, interpreting, and synthesizing patient information” received the highest mean importance rating for a clinical reasoning curriculum while “Theories of clinical reasoning” received the lowest importance rating. Full results can be found in Table 9 in the Appendix .

Teachers and students differed significantly in their importance ratings of two content areas, “Gathering, interpreting, and synthesizing patient information” ( t (148.32) = 4.294, p  < 0.001, d  = 0.609) and “Developing a problem formulation/hypothesis” ( t (202) = 4.006, p  < 0.001, d  = 0.561), with teachers assigning greater importance to both of these content areas.

The results from the interviews are in line with those from the survey. Details can be found in Table 12 in the Appendix .

Clinical reasoning teaching methods

The survey participants reported that, most often, case-based learning is currently applied in the teaching of clinical reasoning (CR). This format was also rated as most important for teaching CR (see Table  3 ). Full results can be found in Table 10 in the Appendix .

Teachers and students differed significantly in their importance ratings of Team-based learning ( t (202) = 3.079, p  = 0.002, d  = 0.431), with teachers assigning greater importance to this teaching format.

Overall, the interviewees provided very similar judgements to the survey participants. Next to the teaching formats shown in Table  3 , some of them would employ blended learning, and clinical teaching formats such as bedside teaching and internships were also mentioned. Details can be found in the Appendix in Table 13. In addition to the importance of each individual teaching format, it was also argued that all of the formats can be useful because they all are meant to reach different objectives and that there is not one single best format for teaching CR.

Start of clinical reasoning teaching in curricula

Most teachers (52.5%) reported that currently, the teaching of clinical reasoning (CR) starts in the first year of study. Most often (46.4%) the participants also chose the first study year as the optimal year for starting the teaching CR. In accordance with the survey results, the interviewees also advocated for an early start of the teaching of CR. Some interview participants who advocated for a later start of CR teaching suggested that the students first need a solid knowledge base and that once the clinical/practical education starts, explicit teaching of CR should begin.

Assessment of clinical reasoning

The survey results suggest that currently written tests or clinical examinations are most often used, while Virtual Patients are used least often (see Table  4 ). Despite written tests being the most common current assessment format, they received the lowest importance rating for a future longitudinal CR curriculum. Full results can be found in Table 11 in the Appendix .

Teachers and students differed significantly in their importance ratings of clinical examinations ( t (161.81) = 2.854, p  = 0.005, d  = 0.413) and workplace-based assessments ( t (185) = 2.640, p = 0.009, d  = 0.386) with teachers assigning greater importance to both of these assessment formats.

The interviewees also placed importance on all assessment methods but found it difficult to assess CR with written assessment methods. The students seemed to associate clinical examinations more with practical skills than with CR. Details can be found in the Appendix in Table 14. Two of the interview participants mentioned that CR is currently not assessed at their institutions, and one person mentioned that students are asked to self-reflect on their interactions with patients and on potential improvements.

Train-the-trainer course

The following sections highlight the results from the needs analysis regarding a train-the-trainer (TTT-) course. The questions presented here were posed only to the teachers.

Most survey participants reported that there is currently no TTT- course on clinical reasoning at their institution but that they think such a course is necessary (see Table  5 ). The same was also true for the interviewees (no TTT- course on clinical reasoning existing but need for one).

In the interviews, 22 participants (78.6%) answered that a TTT-course is necessary for healthcare educators, two participants answered that no such course was necessary, and two other participants were undecided about its necessity. At none of the institutions represented by the interviewees, a TTT-course for teaching clinical reasoning exists.

When asked what the best format for a clinical reasoning TTT- course would be (single answer question), the majority of the survey participants favored a blended learning / flipped classroom approach, a combination of e-learning and face-to-face meetings. (see Table  6 ).

In the survey comments it was noted that blended-learning encompasses the benefits of both self-directed learning and discussion/learning from others. It would further allow teachers to gather knowledge about CR first in an online learning phase where they can take the time they need before coming to a face-to-face meeting.

The interviewees also found a blended-learning approach particularly suitable for a TTT-course. An e-learning course only was seen as more critical because teachers may lack motivation to participate in an online-only setting, while a one-time face-to-face meeting would not provide enough time. In some interviews, it was emphasized that teachers should experience themselves what they are supposed to teach to the students and also that the trainers for the teachers need to have solid education and knowledge on clinical reasoning.

Table 7 shows the importance ratings of potential content of a TTT-course generated from the survey. To elaborate on this content, comments by the interviewees were added. On average, all content was seen as (somewhat) important with teaching methods on the ward and/or clinic receiving the highest ratings. Some interviewees also mentioned the importance of interprofessional aspects and interdisciplinary understanding of CR. In the survey comments, some participants further expressed their interest in such a course.

Finally, the interviewees were asked about the ideal length of a clinical reasoning TTT-course. The answers varied greatly from 2–3 hours to a two-year educational program, with a tendency toward 1–2 days. Several interviewees commented that the time teachers are able to spend on a TTT-course is limited. This should be considered in the planning of such a course to make participation feasible for teachers.

In this study, we investigated the current status of and suggestions for teaching and assessment of clinical reasoning (CR) in a longitudinal curriculum as well as suggestions for a train-the-trainer (TTT-) course for CR. Teachers and students were invited to participate in online-surveys as well as semi-structured interviews to derive answers to our research questions. Regarding the contents of a CR curriculum for students, the results of the surveys and interviews were comparable and favoured content such as gathering, interpreting, and synthesizing patient information, generating differential diagnoses, and developing a diagnostic and a treatment plan. In the interviews, high importance was additionally placed on collaborative and interprofessional aspects of CR. Case-based learning and simulations were seen as the most useful methods for teaching CR, and clinical and oral examinations were favoured for the assessment of CR. The preferred format for a TTT-course was blended learning. In terms of course content, teaching and assessment methods for CR were emphasized. In addition to research from the North American region [ 11 ], this study provides results from predominantly European countries that support the existing findings.

Content of a clinical reasoning curriculum

Our results revealed that there are still aspects of clinical reasoning (CR), such as “Errors in the clinical reasoning process and strategies to avoid them” or “Interprofessional aspects of CR” that are rarely taught despite their high importance, corroborating the findings of Kononowicz et al. [ 10 ]. According to the interviewees, students should have basic knowledge of CR before they are taught about errors in the CR process and strategies to avoid them. The lack of teaching of errors in CR may also stem from a lack of institutional culture regarding how to manage failures in a constructive way (e.g. [ 16 , 25 ]), making it difficult to explicitly address errors and strategies to avoid them. Although highly relevant in the everyday practice of healthcare professions and underpinned by CR theoretical frameworks (e.g., distributed cognition [ 26 ]), interprofessional and collaborative aspects of CR are currently rarely considered in the teaching of CR. The interviews suggested that hierarchical distance and cultural barriers may contribute to this finding. Sudacka et al. [ 16 ] also reported cultural barriers as one reason for a lack of CR teaching. Generally, the interviewees seemed to place greater importance on interprofessional and collaborative aspects than did the survey-participants This may have been due to differences in the professions represented in the two modalities (e.g., a greater percentage of nurses among the interview participants, who tend to define CR more broadly than physicians [ 5 ]).

“Self-reflection on clinical reasoning performance and strategies for future improvement”, “Developing a problem formulation/hypothesis” and “Aspects of patient-participation in CR” were rated as important but are currently rarely taught, a finding not previously reported. The aspect “Self-reflection on clinical reasoning performance and strategies for future improvement”, received high importance ratings, but only 25% of the survey-participants answered that it is currently taught to a great extent. The interviewees agreed that self-reflection is important and added that ideally, it should be guided by specific questions. Ogdie et al. [ 27 ] found that reflective writing exercises helped students identify errors in their reasoning and biases that contributed to these errors.

“Gathering, interpreting, and synthesizing patient information” and “Developing a problem formulation/hypothesis” were rated significantly more important by teachers than by students. It appears that students may be less aware yet of the importance of gathering, interpreting, and synthesizing patient information in the clinical reasoning process. There was some indication in the interviews that the students may not have had enough experience yet with “Developing a problem formulation/hypothesis” or associate this aspect with research, possibly contributing to the observed difference.

Overall, our results on the contents of a CR curriculum suggest that all content is important and should be included in a CR curriculum, starting with basic theoretical knowledge and data gathering to more advanced aspects such as errors in CR and collaboration. Two other recent surveys conducted in the United States among pre-clerkship clinical skills course directors [ 12 ] and members of clerkship organizations [ 13 ] came to similar conclusions regarding the inclusion of clinical reasoning content at various stages of medical curricula. How to fit the content into already dense study programs, however, can still be a challenge [ 16 ].

In addition to case-based learning and clinical teaching, human simulated patients and Team-based learning also received high importance ratings for teaching clinical reasoning (CR), a finding not previously reported. Lectures, on the other hand, are seen as the least important to teach CR (see also Kononowicz et al. [ 10 ]), as they mainly deliver factual knowledge according to the interviewees. High-fidelity simulations (mannequins) and Virtual Patients (VPs) are rarely used to teach CR at the moment and are rated less important compared to other teaching formats. Some interviewees see high-fidelity simulations as more useful for teaching practical skills. The lower importance rating of VPs was surprising given that this format is case-based, provides a safe environment for learning, and is described in the literature as a well-suited tool for teaching CR [ 28 , 29 ]. Considering that VPs seemed to be used less often at the institutions involved in this study, the lack of experience with this format may have led to this result.

Teachers rated Team-based learning as significantly more important for teaching clinical reasoning than students. In the interviews, many students seemed not to be familiar with Team-based learning, possibly explaining the lower ratings the students gave this format in the survey.

Taken together, our results suggest that there is not one best format for teaching all aspects of clinical reasoning but rather that the use of all teaching formats is justified depending on the specific content to be taught and goals to be achieved. However, there was agreement that a safe learning environment where no patients can be harmed is preferred for teaching clinical reasoning, and that discussions should be possible.

There was wide agreement that clinical reasoning (CR) teaching should start in the first year of study in the curriculum. However, a few participants of this study argued that students first need to develop some general knowledge before CR is taught. Rencic et al. [ 11 ] reported that according to internal medicine clerkship directors, CR should be taught throughout all years of medical school, with a particular focus during the clinical teaching years. A similar remark was made by participants in a survey among pre-clerkship clinical skills course directors by Gupta et al. [ 12 ] where the current structure of some curricula (e.g. late introduction of the pathophysiology) was regarded as a barrier to introducing CR from the first year of study on [ 12 ].

Our results show that the most important format for assessing clinical reasoning (CR) that is also currently used to the greatest extent are clinical examinations (e.g. OSCE), consistent with Kononowicz et al. [ 10 ]. The interviewees emphasized that CR should ideally be assessed in a conversation or discussion where the learners can explain their reasoning. Given this argument, all assessment formats enabling a conversation are suitable for assessing CR. This is reflected in our survey results, where assessment formats that allow for a discussion with the learner received the most favourable importance ratings, including oral examinations. In agreement with Kononowicz et al. [ 10 ], we also found that written tests are currently used most often to assess CR but are rated as least important and suitable only for the assessment of some aspects of CR. Daniel et al. [ 3 ] argued that written exams such as MCQs, where correct answers have to be selected from a list of choices, are not the best representation of real practical CR ability. Thus, there still seems to be potential for improvement in the way CR is assessed.

Teachers rated clinical examinations and workplace-based assessments significantly higher than students. Based on the interviews, the students seemed to associate clinical examinations such as OSCEs more with a focus on practical skills than CR, potentially explaining their lower ratings of this format.

What a clinical reasoning train-the-trainer course should look like

Our results show a clear need for a clinical reasoning (CR) train-the-trainer course (see also Singh et al. [ 15 ]), which currently does not exist at most institutions represented in this study, corroborating findings by Kononowicz et al. [ 10 ]. A lack of adequately trained teachers is a common barrier to the introduction of CR content into curricula [ 12 , 16 ]. According to our results such a course should follow a blended learning/flipped classroom approach or consist of a series of face-to-face meetings. A blended-learning course would combine the benefits of both self-directed learning and the possibility for trainers to discuss with and learn from their peers, which could also increase their motivation to participate in such a course. An e-learning only course or a one-time face-to-face meeting were considered insufficient. The contents “Clinical reasoning strategies” and “Common errors in the clinical reasoning process” were given greater importance for the trainer-curriculum than for the students-curriculum, possibly reflecting higher expectations of trainers as “CR experts” compared with students. There was some agreement in the interviews that ideally, the course should not be too time-consuming, with participants tending towards an overall duration of 1–2 days, considering that most teachers usually have many duties and may not be able or willing to attend the course if it were too long. Lack of time was also identified as a barrier to attending teacher training [ 12 , 13 , 16 ].

Strengths and limitations

The strengths of this study include its international and interprofessional participants. Furthermore, we explicitly included teachers and students as target groups in the same study, which enables a comparison of different perspectives. Members of the target groups not only participated in a survey but were also interviewed to gain in-depth knowledge. A distinct strength of this study is its mixed-methods design. The two data collection methods employed in parallel provided convergent results, with responses from the web survey indicating global needs and semi-structured interviews contributing to a deeper understanding of the stakeholder groups’ nuanced expectations and perspectives on CR education.

This study is limited in that most answers came from physicians, making the results potentially less generalizable to other professions. Furthermore, there were participants from a great variety of countries, with some countries overrepresented. Because of the way the survey-invitations were distributed, the exact number of recipients is unknown, making it impossible to compute an exact response rate. Also, the response rate of the survey was rather low for individuals who opened the survey. Because the survey was anonymous, it cannot completely be ruled out that some individuals participated in both interviews and survey. Finally, there could have been some language issues in the interview analysis, as the data were translated to English at the local partner institutions before they were submitted for further analysis.

Our study provides evidence of an existing need for explicit clinical reasoning (CR) longitudinal teaching and dedicated CR teacher training. More specifically, there are aspects of CR that are rarely taught that our participants believe should be given priority, such as self-reflection on clinical reasoning performance and strategies for future improvement and aspects of patient participation in CR that have not been previously reported. Case-based learning and clinical teaching methods were again identified as the most important formats for teaching CR, while lectures were considered relevant only for certain aspects of CR. To assess CR, students should have to explain their reasoning, and assessment formats should be chosen accordingly. There was also still a clear need for a CR train-the-trainer course. In addition to existing research, our results show that such a course should ideally have a blended-learning format and should not be too time-consuming. The most important contents of the train-the-trainer course were confirmed to be teaching methods, CR strategies, and strategies to avoid errors in the CR process. Examples exist for what a longitudinal CR curriculum for students and a corresponding train-the-trainer course could look like and how these components could be integrated into existing curricula (e.g. DID-ACT curriculum [ 20 ], https://did-act.eu/integration-guide/ or the described curriculum of Singh et al. [ 15 ]). Further research should focus on whether and to what extent the intended outcomes of such a curriculum are actually reached, including the potential impact on patient care.

Availability of data and materials

All materials described in this manuscript generated during the current study are available from the corresponding author on reasonable request without breaching participant confidentiality.

Connor DM, Durning SJ, Rencic JJ. Clinical reasoning as a core competency. Acad Med. 2020;95:1166–71.

Article   Google Scholar  

Young M, Szulewski A, Anderson R, Gomez-Garibello C, Thoma B, Monteiro S. Clinical reasoning in CanMEDS 2025. Can Med Educ J. 2023;14:58–62.

Google Scholar  

Daniel M, Rencic J, Durning SJ, Holmboe E, Santen SA, Lang V, Gruppen LD. Clinical reasoning assessment methods: a scoping review and practical guidance. Acad Med. 2019;94:902–12.

Scott IA. Errors in clinical reasoning: causes and remedial strategies. BMJ. 2009. https://doi.org/10.1136/bmj.b1860 .

Huesmann L, Sudacka M, Durning SJ, Georg C, Huwendiek S, Kononowicz AA, Schlegel C, Hege I. Clinical reasoning: what do nurses, physicians, and students reason about. J Interprof Care. 2023;37:990–8.

Norman GR, Eva KW. Diagnostic error and clinical reasoning. Med Educ. 2010;44:94–100.

Berner E, Graber M. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121:2–23.

Cooper N, Da Silva AL, Powell S. Teaching clinical reasoning. In: Cooper N, Frain J, editors. ABC of clinical reasoning. 1st ed. Hoboken, NJ: John Wiley & Sons Ltd; 2016. p. 44–50.

Elvén M, Welin E, Wiegleb Edström D, Petreski T, Szopa M, Durning SJ, Edelbring S. Clinical reasoning curricula in health professions education: a scoping review. J Med Educ Curric Dev. 2023. https://doi.org/10.1177/23821205231209093 .

Kononowicz AA, Hege I, Edelbring S, Sobocan M, Huwendiek S, Durning SJ. The need for longitudinal clinical reasoning teaching and assessment: results of an international survey. Med Teach. 2020;42:457–62.

Rencic J, Trowbridge RL, Fagan M, Szauter K, Durning SJ. Clinical reasoning education at US medical schools: results from a national survey of internal medicine clerkship directors. J Gen Intern Med. 2017;32:1242–6.

Gupta S, Jackson JM, Appel JL, Ovitsh RK, Oza SK, Pinto-Powell R, Chow CJ, Roussel D. Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors. Diagnosis. 2021;9:59–68.

Gold JG, Knight CL, Christner JG, Mooney CE, Manthey DE, Lang VJ. Clinical reasoning education in the clerkship years: a cross-disciplinary national needs assessment. PLoS One. 2022;17:e0273250.

Cooper N, Bartlett M, Gay S, Hammond A, Lillicrap M, Matthan J, Singh M. UK Clinical Reasoning in Medical Education (CReME) consensus statement group. Consensus statement on the content of clinical reasoning curricula in undergraduate medical education. Med Teach. 2021;43:152–9.

Singh M, Collins L, Farrington R, Jones M, Thampy H, Watson P, Grundy J. From principles to practice: embedding clinical reasoning as a longitudinal curriculum theme in a medical school programme. Diagnosis. 2021;9:184–94.

Sudacka M, Adler M, Durning SJ, Edelbring S, Frankowska A, Hartmann D, Hege I, Huwendiek S, Sobočan M, Thiessen N, Wagner FL, Kononowicz AA. Why is it so difficult to implement a longitudinal clinical reasoning curriculum? A multicenter interview study on the barriers perceived by European health professions educators. BMC Med Educ. 2021. https://doi.org/10.1186/s12909-021-02960-w .

Hingley A, Kavaliova A, Montgomery J, O’Barr G. Mixed methods designs. In: Creswell JW, editor. Educational research: planning, conducting, and evaluating quantitative and qualitative research. 4th ed. Boston: Pearson; 2012. p. 534–75.

Merriam SB. Qualitative research and case study applications in education. In: from" case study research in education.". Sansome St. Revised and Expanded. San Francisco, CA: Jossey-Bass Publishers; 1998.

Cleland J, MacLeod A, Ellaway RH. The curious case of case study research. Med Educ. 2021;55:1131–41.

Hege I, Adler M, Donath D, Durning SJ, Edelbring S, Elvén M, Wiegleb Edström D. Developing a European longitudinal and interprofessional curriculum for clinical reasoning. Diagnosis. 2023;10:218–24.

Collins D. Pretesting survey instruments: an overview of cognitive methods. Qual Life Res. 2003;12:229–38.

Liu M, Wronski L. Examining completion rates in web surveys via over 25,000 real-world surveys. Soc Sci Comput Rev. 2018;36:116–24.

Mayring P, Fenzl T. Qualitative inhaltsanalyse. In: Baur N, Blasius J, editors. Handbuch methoden der empirischen Sozialforschung. Wiesbaden: Springer VS; 2019. p. 633–48.

Chapter   Google Scholar  

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89:1245–51.

Edmondson AC. Learning from failure in health care: frequent opportunities, pervasive barriers. BMJ Qual Saf. 2004;13 Suppl 2:ii3-ii9.

Merkebu J, Battistone M, McMains K, McOwen K, Witkop C, Konopasky A, Durning SJ. Situativity: a family of social cognitive theories for understanding clinical reasoning and diagnostic error. Diagnosis. 2020;7:169–76.

Ogdie AR, Reilly JB, Pang WG, Keddem S, Barg FK, Von Feldt JM, Myers JS. Seen through their eyes: residents’ reflections on the cognitive and contextual components of diagnostic errors in medicine. Acad Med. 2012;87:1361–7.

Berman NB, Durning SJ, Fischer MR, Huwendiek S, Triola MM. The role for virtual patients in the future of medical education. Acad Med. 2016;91:1217–22.

Plackett R, Kassianos AP, Mylan S, Kambouri M, Raine R, Sheringham J. The effectiveness of using virtual patient educational tools to improve medical students’ clinical reasoning skills: a systematic review. BMC Med Educ. 2022. https://doi.org/10.1186/s12909-022-03410-x .

Download references

Acknowledgements

We want to thank all participants of the interviews and survey who took their time to contribute to this study despite the ongoing pandemic in 2020. Furthermore, we thank the members of the DID-ACT project team who supported collection and analysis of survey and interview data.

The views expressed herein are those of the authors and not necessarily those of the Department of Defense, the Uniformed Services University or other Federal Agencies.

This study was partially supported by the Erasmus + Knowledge Alliance DID-ACT (612454-EPP-1–2019-1-DE-EPPKA2-KA).

Author information

Authors and affiliations.

Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland

F. L Wagner & S. Huwendiek

Center of Innovative Medical Education, Department of Medical Education, Jagiellonian University, Kraków, Poland

Faculty of Medicine, Department of Bioinformatics and Telemedicine, Jagiellonian University, Kraków, Poland

A. A Kononowicz

School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden

Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden

Uniformed Services University of the Health Sciences, Bethesda, MD, USA

S. J Durning

Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany

You can also search for this author in PubMed   Google Scholar

Contributions

FW and SH wrote the first draft of the manuscript. All authors critically revised the manu-script in several rounds and approved the final manuscript.

Corresponding author

Correspondence to F. L Wagner .

Ethics declarations

This type of study was regarded as exempt from formal ethical approval according to the regulations of the Bern Ethics Committee (‘Kantonale Ethikkommission Bern’, decision Req-2020–00074). All participants voluntarily participated and provided informed consent before taking part in this study.

Consent for publication

All authors consent to publication of this manuscript.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Wagner, F., Sudacka, M., Kononowicz, A. et al. Current status and ongoing needs for the teaching and assessment of clinical reasoning – an international mixed-methods study from the students` and teachers` perspective. BMC Med Educ 24 , 622 (2024). https://doi.org/10.1186/s12909-024-05518-8

Download citation

Received : 16 January 2024

Accepted : 06 May 2024

Published : 05 June 2024

DOI : https://doi.org/10.1186/s12909-024-05518-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Clinical reasoning

BMC Medical Education

ISSN: 1472-6920

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Exclusive: Biden tells Muir he wouldn't pardon son Hunter, says Trump got 'fair trial'

President Biden is in Normandy commemorating the 80th anniversary of D-Day.

President Joe Biden said he would not pardon his son Hunter amid an ongoing felony gun trial during a wide-ranging exclusive interview with ABC News anchor David Muir at the Normandy American Cemetery on the 80th anniversary of D-Day.

Muir asked Biden on Thursday if he would accept the outcome of his son's trial in Wilmington, Delaware, to which the president said, "Yes." Biden also said "yes" when asked by Muir if he would rule out a pardon for Hunter.

Hunter Biden, the president's only surviving son, is on trial in Delaware on three felony charges related to his efforts to obtain a firearm in 2018 while allegedly addicted to drugs. It's a historic trial, as no son of a sitting president has faced a criminal trial before. Hunter Biden pleaded not guilty last October after being indicted by special counsel David Weiss.

For more from Muir's interview with President Biden, watch ABC's "World News Tonight with David Muir" at 6:30 p.m. ET.

During the interview with Muir in Normandy, France, the president also touched on opponent Donald Trump's own historic trial, after Trump became the first former president to be convicted on felony charges. Trump, convicted of 34 counts of falsifying business records, has baselessly called his guilty verdict a politically motivated witch hunt.

Biden accused Trump of seeking to undermine the rule of law.

"He's trying to undermine it," Biden told Muir. "He got a fair trial. The jury spoke."

MORE | Exclusive: Biden tells ABC's David Muir US weapons will not be used to strike Moscow, Kremlin

Biden also addressed his new executive action to close the border to asylum seekers between official points of entry. It came months after Republicans in Congress killed a bipartisan border security deal at the behest of former President Trump.

"Do you wish you had done it sooner?" Muir asked Biden.

"No," Biden said.

The president also talked with Muir about Israel's military operations against Hamas in Gaza, of which he has grown increasingly critical. Biden has called on Israeli Prime Minister Benjamin Netanyahu to credibly consider the safety of civilians in the southern Gazan town of Rafah.

"I think he's listening to me," Biden said of Netanyahu.

Related Topics

• HUNTER BIDEN

Exclusive: Biden says US weapons will not be used to strike Moscow

American held in Turks and Caicos speaks out after returning home

Teen injured in NW Side drive-by shooting: CPD | EXCLUSIVE VIDEO

Mom of boy killed defending her from stabbing attack breaks silence

Top stories.

Worker killed in fall at UChicago hospital ID'd, another injured

Former suburban HS student sues, accuses teacher of sexual assault

• 2 hours ago

5 CPD officers, 1 civilian injured in Englewood crash: CFD

California man charged with stabbing woman outside Union Station: CPD

YouTuber arrested, video shows fireworks shot from helicopter at Lambo

Cook Co Assessor to correct thousands of errors in south, west suburbs

South Side march brings attention to missing, murdered women of color

Strange fungus turns cicadas into 'sex-crazed zombies'

• Skip to main content
• Keyboard shortcuts for audio player

Weekend Edition Sunday

• Latest Show

Sunday Puzzle

• Corrections

Listen to the lead story from this episode.

Politics chat: How voters are responding to Trump's felony conviction

by  Ayesha Rascoe ,  Mara Liasson

The Americas

Mexico votes for a new president after a campaigning season plagued by violence.

by  Eyder Peralta ,  Ayesha Rascoe

Middle East

Aid workers in gaza say nowhere is safe after israeli attacks on 'humanitarian zones'.

by  Hadeel Al-Shalchi

Girls in the U.S. are getting their period earlier. Here's what parents should know

by  Ayesha Rascoe ,  Maria Godoy

Bookstores have come under attack in Ukraine. But interest in reading is only growing

by  Joanna Kakissis

25 years ago, Napster changed how we listen to music forever

by  Ayesha Rascoe

What locals think of the proposal to build U.S.'s tallest building in Oklahoma City

by  Graycen Wheeler

Sunday Puzzle NPR hide caption

Sunday Puzzle: Second in Line

by  Will Shortz

Movie Interviews

A new animated film follows a lonely dog and his robot friend in new york city.

by  Ayesha Rascoe ,  Matthew Schuerman ,  Andrew Craig

Conservative media sows doubt about the verdict in Trump's felony convictions

by  Ayesha Rascoe ,  David Folkenflik

Supreme Court judge accused of bias towards Trump declines to recuse himself from case

by  Ayesha Rascoe ,  Matthew Schuerman ,  Hiba Ahmad

Some states are adopting a new form of reading instruction to combat falling scores

by  Juma Sei

A new movie tells the story of Kemba Smith Pradia, race and incarceration

Strange news, meet abby lampe, two-time champion of the cheese-wheel-chasing race, meet abby lampe, two-time champion of the chees-wheel-chasing race, 100 years ago, indigenous people were granted u.s. citizenship by law.

by  Sandhya Dirks

The first professional women's hockey league in the U.S. has a winner

Music interviews, jon lampley, a veteran of stephen colbert's talk show, releases his debut album.

by  D. Parvaz ,  Ayesha Rascoe ,  Ryan Benk

Searching for a song you heard between stories? We've retired music buttons on these pages. Learn more here.

• International

Fauci testifies on the origins of Covid-19

By Antoinette Radford, Maureen Chowdhury, Elise Hammond, Carma Hassan and Jen Christensen

Key takeaways from Dr. Anthony Fauci's testimony at House hearing on Covid-19 pandemic

From CNN's Jen Christensen, Elise Hammond, Antoinette Radford and Maureen Chowdhury

Dr. Anthony Fauci, the former director of the National Institute of Allergy and Infectious Diseases (NIAID), testified Monday at a House subcommittee hearing about the US response to the Covid-19 pandemic and the origins of the virus.

The hearing was Fauci’s first public testimony on Capitol Hill since his retirement from government service. It turned contentious at times as Republicans grilled Fauci over a wide range of topics, including the basis for public health recommendations during the pandemic and email use by public health officials.

Here are key takeaways from the hearing:

• US still needs to be better prepared for next pandemic: Fauci said there are still some things the US needs to work on to be ready for another pandemic, saying in “some respects” the country is better prepared to deal with a health crisis than in 2020, “but in others, I am still disappointed.” One thing that he hopes the US will do better moving forward is tightening communication between the federal response and local public health officials.
• Republicans grill Fauci over public health official’s use of email: Fauci testified Monday that he has not used his personal email to conduct business, and he was not aware before a congressional investigation that a former senior adviser at the National Institutes of Health had used an unofficial email. The House Oversight select subcommittee on the coronavirus pandemic previously released a series of  private   emails  that Republicans argue show that some NIH officials deleted emails and tried to get around requirements to disclose information through public records laws.
• Fauci testifies about possible origins of virus that caused Covid-19: Fauci testified that in early 2020, he was informed through phone calls with two scientists that they and others were concerned that the virus that causes Covid-19 could have been manipulated in the lab. The day after those calls, Fauci said several international virologists examined it further and found that “several who at first were concerned about lab manipulation became convinced that the virus was not deliberately manipulated.” Scientists found the most likely scenario, Fauci said, was a virus that transferred from an animal to a human, “although they still kept an open mind.”
• Fauci details threats he and his family have received: Fauci detailed the threats he received during his time as the director of the NIAID, describing threats against him and his family. “Everything from harassments from emails, texts, letters of myself, my wife, my three daughters. There have been credible death threats leading to the arrest of two individuals – and credible death threats means someone who clearly was on their way to kill me. And it’s required my having protective services essentially all the time.”
• 6-foot social distance guideline: Fauci clarified that the 6-foot guidance for social distancing given during the beginning of the Covid-19 pandemic did not come from him, but from the US Centers for Disease Control and Prevention. Fauci, who repeated the guidance during the pandemic, once said that there was no science behind it — but he meant that there were no clinical trials to back it up. He added that he believed the CDC used studies about droplets years ago as reasoning for the 6-foot guidelines.

Fauci says he supports suspending funding to EcoHealth Alliance

CNN's Jen Christensen

Dr. Anthony Fauci said on Monday he supports suspending US grant funding to EcoHealth Alliance , a New York-based virus research organization that has been tied to question and controversy around the origins of the virus that causes Covid-19.

The US Department of Health and Human Services in May suspended funding to EcoHealth Alliance and proposed the group be blocked from receiving federal funds in the future, possibly for years.

Asked on Monday if he supposed the suspension and debarment of EcoHealth Alliance, Fauci responded “yes.” 

Before the pandemic, the US gave a $120,000 grant to EcoHealth Alliance with a subaward that funded work at the Wuhan Institute of Virology. In April 2020, the National Institutes of Health terminated the grant.

Fauci said that he later learned that the White House had called to tell the NIH to cancel the grant. Asked Monday if he agreed or disagreed with the decision at the time, he said that wasn’t his problem with the request.

“It wasn’t a question of agreeing or disagreeing. It was like, ‘Can we really do that? I don’t think that you can do that.’ And as it turned out I was right, because the general counsel of HHS said, 'By the way, you can’t do that. You’ve got to restore the grant,' ” Fauci testified.

The grant was reinstated, then suspended pending a compliance review.

Fauci said once he learned that there were compliance issues with the grant, the National Institute of Allergy and Infectious Diseases was told to stay out of it.

Since that time, NIH found numerous violations of grant policies by EcoHealth and has since blocked funding to the Wuhan Institute of Virology and suspended and proposed blocking NIH funding to EcoHealth as an institution and Dr. Peter Daszak individually.

In a May letter to EcoHealth Alliance and its president, Dr. Peter Daszak, HHS lists 30 pieces of evidence some dating back to 2013 to support its decision. HHS said in a memo that EcoHealth failed to “adequately monitor” virus growth experiments at the Wuhan Institute of Virology, notify the NIH that viruses studied there “appeared to grow beyond permissible thresholds” laid out in a grant or provide requested information in a timely manner.

In a statement last month, a spokeperson for EcoHealth Alliance said the organization was “disappointed by HHS’ decision" and that it would contest the decision.

GOP subcommittee chair and ranking member wrap up hearing with closing statements

From CNN's Maureen Chowdhury

In his closing statement, Ranking Member Raul Ruiz thanked Dr. Anthony Fauci for his testimony and for his decades of service to the nation in dealing with various epidemics and pandemics.

He also blasted Republicans for pushing extreme narratives for political gain.

"Over the past four years you have been personally targeted by extreme narratives of the origins of the Covid-19 pandemic and the US governments response to it," Ruiz said. "These extreme narratives have been the bedrock of this subcommittees Republican-led probe and have been undermined by what's been found through interviews and by thousands of documents that have been reviewed."

Ruiz added that the evidence found that "Dr. Fauci did not fund research through the EcoHealth Alliance Grant that caused the Covid-19 pandemic, Dr. Fauci did not lie about gain of function research in Wuhan China, Dr. Fauci did not orchestrate a campaign to suppress the lab-leak theory."

Subcommittee Chair Brad Wenstrup also thanked Fauci for coming voluntarily to testify.

He went on to say that the hearing was an opportunity to learn more about the government's Covid-19 response and how the government can improve and do better. He said that while there some things that were done well, there were some wrongdoings in the office where Fauci served.

Wenstrup highlighted that moving forward, clarity is important in order to improve messaging.

"I think what I'm most concerned about as we go forward as a country and from our agencies is that we an be trusted and that we are better in our messaging and talk about clarity," Wenstrup said.

Officials will evaluate "cost-benefit ratio" of vaccine mandates in analysis of pandemic response, Fauci says

From CNN's Elise Hammond

When evaluating the United States’ handling of the Covid-19 pandemic, public health officials will take a closer look at “the cost-benefit ratio” of things like vaccine mandates, Dr. Anthony Fauci said.

Fauci was answering a question about whether issuing mandates could have led to vaccine hesitancy.

“That’s something that I think we need to go back now, when we do an after-the-event evaluation about whether or not given the psyche of the country and the pushback that you get from those types of things — we need to reevaluate the cost-benefit ratio of those types of things,” Fauci said.

Earlier in the hearing, Fauci defended the government’s use of vaccines as saving “hundreds of thousands of lives in the United States and millions of lives throughout the world.

US still needs to close communication gaps to be better prepared for next pandemic, Fauci says

Dr. Anthony Fauci said there are still some things the United States needs to work on to be more prepared for another pandemic in the aftermath of Covid-19.

The former director of the National Institute of Allergy and Infectious Diseases (NIAID) said in “some respects” the country is better prepared to deal with a health crisis than in 2020, “but in others, I am still disappointed.”

Fauci was answering a question from Florida Democratic Rep. Jared Moskowitz, who served as the Director of the Florida Division of Emergency Management during the pandemic. The lawmaker said he felt that states were not ready to deal with Covid-19.

“I think one of the things that was really a problem with the response was the degree of divisiveness that we had in the country about a lack of a coherent response where we were having people, for reasons that had nothing to do with public health or science, refusing to adhere to public health intervention measures,” Fauci said.

One thing that he hopes the US will do better moving forward is tightening communication between the federal response and local public health officials.

He said there was a “disconnect between the healthcare system and the public health system” during Covid-19 in the US. Specifically, the Centers for Disease Control (CDC) could not demand information from local agencies, which caused a lag in sharing data.

“We were at a disadvantage,” Fauci said, adding that the CDC is working on ways to fix this pain point.

California lawmaker whose parents died of Covid-19 thanks Fauci for life-saving policies

California Democratic Rep. Robert Garcia, who said both of his parents died from Covid-19, thanked Dr. Anthony Fauci for putting in policies that saved lives during the pandemic.

Garcia said his mother was a health care worker and she and his step-father both died from Covid-19.

“I lost both of my parents during the pandemic, so I take this very personally," he said, condemning other lawmakers “who are tasked to be responsible and actually help the American people” attack medical professionals, Garcia said.

The comments came after heated remarks from Republican Rep. Marjorie Taylor Greene who criticized mask mandates and called for Fauci to be put in prison.

“Your quote-unquote so-called science that the gentlewoman is referring to has saved millions of lives in this country and around the world,” Garcia said. “It’s important to note that my opinion is that you are an American hero and your team has done more to save lives than all 435 members of this body on both sides of the aisle.”

GOP chairman has to remind Marjorie Taylor Greene to be respectful as she refuses to call Fauci a doctor

CNN's Haley Talbot

GOP Chairman Brad Wenstrup had to remind Georgia Republican Rep. Marjorie Taylor Greene to be respectful after she insisted that she would not refer to Dr. Anthony Fauci by the title of doctor and would only refer to him as "Mr. Fauci."

"You're not doctor, you're Mr. Fauci in my few minutes," Greene said.

In response, Wenstrup ordered Greene to address Fauci as a doctor. “I have instructed her to address him as doctor,” Wenstrup said. 

“I’m not addressing him as doctor,” she shot back.  

Several Democratic lawmakers jumped in to criticize Greene over her refusal to address Fauci as a doctor.

Wenstrup then asked members to “afford all other members the respect they are entitled” and to “refrain from using rhetoric that could be construed as an attack on the motives or character of another member or the witness.”

Fauci: NIH official using unofficial email is an "aberrancy and an outlier"

Dr. Anthony Fauci testified Monday that he has not used his personal email to conduct business, and he was not aware before a congressional investigation that a former senior adviser at the National Institutes of Health had used unofficial email.

“What you saw, I believe, with Dr. Morens was aberrancy and an outlier,” Fauci testified on Monday, referring to a former senior adviser at NIH. “The individuals at the NIH and NIAID are a very committed group of individuals and this one instance that you point out is an aberrancy and an outlier.”

The House Oversight Select Subcommittee on the Coronavirus Pandemic previously released a series of  private emails  that Republican members of the committee argue show that some NIH officials deleted emails and tried to get around requirements to disclose information through public records laws.

In a memo  published at the end of May , committee members said Dr. David Morens, a former senior adviser to Fauci, engaged in “nefarious behavior.” The committee points to email that Morens sent another colleague that suggests he would send email to Fauci’s private account and “there is no worry about FOIAs.” FOIA is the Freedom of Information Act, the law that gives the public the right to obtain federal records, including emails sent within government agencies. Morens’ email goes on to say that he can also hand information to Fauci to avoid it being a part of the public record.

“He is too smart to let colleagues send him stuff that could cause trouble,” Morens said in a 2021 email to Peter Daszak, the president of EcoHealth Alliance, a nonprofit virus research organization linked to controversy about the origins of the virus that causes Covid-19. The US Department of Health and Human Services suspended funding to the group in May.

Fauci details threats he and his family have received

From CNN's Antoinette Radford

Anthony Fauci detailed the threats he received during his time as the director of the National Institute of Allergy and Infectious Diseases, describing death threats against him and threats against his wife and daughters.

Democratic Rep. Debbie Dingell asked Fauci to explain what some of the threats were, where he replied:

“Everything from harassments from emails, texts, letters of myself, my wife, my three daughters. There have been credible death threats leading to the arrest of two individuals – and credible death threats means someone who clearly was on their way to kill me. And it’s required my having protective services essentially all the time," Fauci said.

Fauci said he feared that the threats against public health workers during the Covid-19 pandemic would serve as a “powerful disincentive” for the best and brightest candidates to take up the profession.

“They say to themselves, 'I don’t want to go there. Why should I get involved in that?'” he said.

“They’re reluctant to put themselves and their family through what they see their colleagues being put through,” he testified.

Please enable JavaScript for a better experience.