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Case studies.

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Case studies are stories that are used as a teaching tool to show the application of a theory or concept to real situations. Dependent on the goal they are meant to fulfill, cases can be fact-driven and deductive where there is a correct answer, or they can be context driven where multiple solutions are possible. Various disciplines have employed case studies, including humanities, social sciences, sciences, engineering, law, business, and medicine. Good cases generally have the following features: they tell a good story, are recent, include dialogue, create empathy with the main characters, are relevant to the reader, serve a teaching function, require a dilemma to be solved, and have generality.

Instructors can create their own cases or can find cases that already exist. The following are some things to keep in mind when creating a case:

  • What do you want students to learn from the discussion of the case?
  • What do they already know that applies to the case?
  • What are the issues that may be raised in discussion?
  • How will the case and discussion be introduced?
  • What preparation is expected of students? (Do they need to read the case ahead of time? Do research? Write anything?)
  • What directions do you need to provide students regarding what they are supposed to do and accomplish?
  • Do you need to divide students into groups or will they discuss as the whole class?
  • Are you going to use role-playing or facilitators or record keepers? If so, how?
  • What are the opening questions?
  • How much time is needed for students to discuss the case?
  • What concepts are to be applied/extracted during the discussion?
  • How will you evaluate students?

To find other cases that already exist, try the following websites:

  • The National Center for Case Study Teaching in Science , University of Buffalo. SUNY-Buffalo maintains this set of links to other case studies on the web in disciplines ranging from engineering and ethics to sociology and business
  • A Journal of Teaching Cases in Public Administration and Public Policy , University of Washington

For more information:

  • World Association for Case Method Research and Application

Book Review :  Teaching and the Case Method , 3rd ed., vols. 1 and 2, by Louis Barnes, C. Roland (Chris) Christensen, and Abby Hansen. Harvard Business School Press, 1994; 333 pp. (vol 1), 412 pp. (vol 2).

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Making Learning Relevant With Case Studies

The open-ended problems presented in case studies give students work that feels connected to their lives.

Students working on projects in a classroom

To prepare students for jobs that haven’t been created yet, we need to teach them how to be great problem solvers so that they’ll be ready for anything. One way to do this is by teaching content and skills using real-world case studies, a learning model that’s focused on reflection during the problem-solving process. It’s similar to project-based learning, but PBL is more focused on students creating a product.

Case studies have been used for years by businesses, law and medical schools, physicians on rounds, and artists critiquing work. Like other forms of problem-based learning, case studies can be accessible for every age group, both in one subject and in interdisciplinary work.

You can get started with case studies by tackling relatable questions like these with your students:

  • How can we limit food waste in the cafeteria?
  • How can we get our school to recycle and compost waste? (Or, if you want to be more complex, how can our school reduce its carbon footprint?)
  • How can we improve school attendance?
  • How can we reduce the number of people who get sick at school during cold and flu season?

Addressing questions like these leads students to identify topics they need to learn more about. In researching the first question, for example, students may see that they need to research food chains and nutrition. Students often ask, reasonably, why they need to learn something, or when they’ll use their knowledge in the future. Learning is most successful for students when the content and skills they’re studying are relevant, and case studies offer one way to create that sense of relevance.

Teaching With Case Studies

Ultimately, a case study is simply an interesting problem with many correct answers. What does case study work look like in classrooms? Teachers generally start by having students read the case or watch a video that summarizes the case. Students then work in small groups or individually to solve the case study. Teachers set milestones defining what students should accomplish to help them manage their time.

During the case study learning process, student assessment of learning should be focused on reflection. Arthur L. Costa and Bena Kallick’s Learning and Leading With Habits of Mind gives several examples of what this reflection can look like in a classroom: 

Journaling: At the end of each work period, have students write an entry summarizing what they worked on, what worked well, what didn’t, and why. Sentence starters and clear rubrics or guidelines will help students be successful. At the end of a case study project, as Costa and Kallick write, it’s helpful to have students “select significant learnings, envision how they could apply these learnings to future situations, and commit to an action plan to consciously modify their behaviors.”

Interviews: While working on a case study, students can interview each other about their progress and learning. Teachers can interview students individually or in small groups to assess their learning process and their progress.

Student discussion: Discussions can be unstructured—students can talk about what they worked on that day in a think-pair-share or as a full class—or structured, using Socratic seminars or fishbowl discussions. If your class is tackling a case study in small groups, create a second set of small groups with a representative from each of the case study groups so that the groups can share their learning.

4 Tips for Setting Up a Case Study

1. Identify a problem to investigate: This should be something accessible and relevant to students’ lives. The problem should also be challenging and complex enough to yield multiple solutions with many layers.

2. Give context: Think of this step as a movie preview or book summary. Hook the learners to help them understand just enough about the problem to want to learn more.

3. Have a clear rubric: Giving structure to your definition of quality group work and products will lead to stronger end products. You may be able to have your learners help build these definitions.

4. Provide structures for presenting solutions: The amount of scaffolding you build in depends on your students’ skill level and development. A case study product can be something like several pieces of evidence of students collaborating to solve the case study, and ultimately presenting their solution with a detailed slide deck or an essay—you can scaffold this by providing specified headings for the sections of the essay.

Problem-Based Teaching Resources

There are many high-quality, peer-reviewed resources that are open source and easily accessible online.

  • The National Center for Case Study Teaching in Science at the University at Buffalo built an online collection of more than 800 cases that cover topics ranging from biochemistry to economics. There are resources for middle and high school students.
  • Models of Excellence , a project maintained by EL Education and the Harvard Graduate School of Education, has examples of great problem- and project-based tasks—and corresponding exemplary student work—for grades pre-K to 12.
  • The Interdisciplinary Journal of Problem-Based Learning at Purdue University is an open-source journal that publishes examples of problem-based learning in K–12 and post-secondary classrooms.
  • The Tech Edvocate has a list of websites and tools related to problem-based learning.

In their book Problems as Possibilities , Linda Torp and Sara Sage write that at the elementary school level, students particularly appreciate how they feel that they are taken seriously when solving case studies. At the middle school level, “researchers stress the importance of relating middle school curriculum to issues of student concern and interest.” And high schoolers, they write, find the case study method “beneficial in preparing them for their future.”

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In This Article Expand or collapse the "in this article" section Case Study in Education Research

Introduction, general overview and foundational texts of the late 20th century.

  • Conceptualisations and Definitions of Case Study
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  • Choosing Cases
  • Methodology, Method, Genre, or Approach
  • Case Study: Quality and Generalizability
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  • Exemplary Case Studies and Example Case Studies
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Case Study in Education Research by Lorna Hamilton LAST REVIEWED: 21 April 2021 LAST MODIFIED: 27 June 2018 DOI: 10.1093/obo/9780199756810-0201

It is important to distinguish between case study as a teaching methodology and case study as an approach, genre, or method in educational research. The use of case study as teaching method highlights the ways in which the essential qualities of the case—richness of real-world data and lived experiences—can help learners gain insights into a different world and can bring learning to life. The use of case study in this way has been around for about a hundred years or more. Case study use in educational research, meanwhile, emerged particularly strongly in the 1970s and 1980s in the United Kingdom and the United States as a means of harnessing the richness and depth of understanding of individuals, groups, and institutions; their beliefs and perceptions; their interactions; and their challenges and issues. Writers, such as Lawrence Stenhouse, advocated the use of case study as a form that teacher-researchers could use as they focused on the richness and intensity of their own practices. In addition, academic writers and postgraduate students embraced case study as a means of providing structure and depth to educational projects. However, as educational research has developed, so has debate on the quality and usefulness of case study as well as the problems surrounding the lack of generalizability when dealing with single or even multiple cases. The question of how to define and support case study work has formed the basis for innumerable books and discursive articles, starting with Robert Yin’s original book on case study ( Yin 1984 , cited under General Overview and Foundational Texts of the Late 20th Century ) to the myriad authors who attempt to bring something new to the realm of case study in educational research in the 21st century.

This section briefly considers the ways in which case study research has developed over the last forty to fifty years in educational research usage and reflects on whether the field has finally come of age, respected by creators and consumers of research. Case study has its roots in anthropological studies in which a strong ethnographic approach to the study of peoples and culture encouraged researchers to identify and investigate key individuals and groups by trying to understand the lived world of such people from their points of view. Although ethnography has emphasized the role of researcher as immersive and engaged with the lived world of participants via participant observation, evolving approaches to case study in education has been about the richness and depth of understanding that can be gained through involvement in the case by drawing on diverse perspectives and diverse forms of data collection. Embracing case study as a means of entering these lived worlds in educational research projects, was encouraged in the 1970s and 1980s by researchers, such as Lawrence Stenhouse, who provided a helpful impetus for case study work in education ( Stenhouse 1980 ). Stenhouse wrestled with the use of case study as ethnography because ethnographers traditionally had been unfamiliar with the peoples they were investigating, whereas educational researchers often worked in situations that were inherently familiar. Stenhouse also emphasized the need for evidence of rigorous processes and decisions in order to encourage robust practice and accountability to the wider field by allowing others to judge the quality of work through transparency of processes. Yin 1984 , the first book focused wholly on case study in research, gave a brief and basic outline of case study and associated practices. Various authors followed this approach, striving to engage more deeply in the significance of case study in the social sciences. Key among these are Merriam 1988 and Stake 1995 , along with Yin 1984 , who established powerful groundings for case study work. Additionally, evidence of the increasing popularity of case study can be found in a broad range of generic research methods texts, but these often do not have much scope for the extensive discussion of case study found in case study–specific books. Yin’s books and numerous editions provide a developing or evolving notion of case study with more detailed accounts of the possible purposes of case study, followed by Merriam 1988 and Stake 1995 who wrestled with alternative ways of looking at purposes and the positioning of case study within potential disciplinary modes. The authors referenced in this section are often characterized as the foundational authors on this subject and may have published various editions of their work, cited elsewhere in this article, based on their shifting ideas or emphases.

Merriam, S. B. 1988. Case study research in education: A qualitative approach . San Francisco: Jossey-Bass.

This is Merriam’s initial text on case study and is eminently accessible. The author establishes and reinforces various key features of case study; demonstrates support for positioning the case within a subject domain, e.g., psychology, sociology, etc.; and further shapes the case according to its purpose or intent.

Stake, R. E. 1995. The art of case study research . Thousand Oaks, CA: SAGE.

Stake is a very readable author, accessible and yet engaging with complex topics. The author establishes his key forms of case study: intrinsic, instrumental, and collective. Stake brings the reader through the process of conceptualizing the case, carrying it out, and analyzing the data. The author uses authentic examples to help readers understand and appreciate the nuances of an interpretive approach to case study.

Stenhouse, L. 1980. The study of samples and the study of cases. British Educational Research Journal 6:1–6.

DOI: 10.1080/0141192800060101

A key article in which Stenhouse sets out his stand on case study work. Those interested in the evolution of case study use in educational research should consider this article and the insights given.

Yin, R. K. 1984. Case Study Research: Design and Methods . Beverley Hills, CA: SAGE.

This preliminary text from Yin was very basic. However, it may be of interest in comparison with later books because Yin shows the ways in which case study as an approach or method in research has evolved in relation to detailed discussions of purpose, as well as the practicalities of working through the research process.

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Case-based learning.

Case-based learning (CBL) is an established approach used across disciplines where students apply their knowledge to real-world scenarios, promoting higher levels of cognition (see Bloom’s Taxonomy ). In CBL classrooms, students typically work in groups on case studies, stories involving one or more characters and/or scenarios.  The cases present a disciplinary problem or problems for which students devise solutions under the guidance of the instructor. CBL has a strong history of successful implementation in medical, law, and business schools, and is increasingly used within undergraduate education, particularly within pre-professional majors and the sciences (Herreid, 1994). This method involves guided inquiry and is grounded in constructivism whereby students form new meanings by interacting with their knowledge and the environment (Lee, 2012).

There are a number of benefits to using CBL in the classroom. In a review of the literature, Williams (2005) describes how CBL: utilizes collaborative learning, facilitates the integration of learning, develops students’ intrinsic and extrinsic motivation to learn, encourages learner self-reflection and critical reflection, allows for scientific inquiry, integrates knowledge and practice, and supports the development of a variety of learning skills.

CBL has several defining characteristics, including versatility, storytelling power, and efficient self-guided learning.  In a systematic analysis of 104 articles in health professions education, CBL was found to be utilized in courses with less than 50 to over 1000 students (Thistlethwaite et al., 2012). In these classrooms, group sizes ranged from 1 to 30, with most consisting of 2 to 15 students.  Instructors varied in the proportion of time they implemented CBL in the classroom, ranging from one case spanning two hours of classroom time, to year-long case-based courses. These findings demonstrate that instructors use CBL in a variety of ways in their classrooms.

The stories that comprise the framework of case studies are also a key component to CBL’s effectiveness. Jonassen and Hernandez-Serrano (2002, p.66) describe how storytelling:

Is a method of negotiating and renegotiating meanings that allows us to enter into other’s realms of meaning through messages they utter in their stories,

Helps us find our place in a culture,

Allows us to explicate and to interpret, and

Facilitates the attainment of vicarious experience by helping us to distinguish the positive models to emulate from the negative model.

Neurochemically, listening to stories can activate oxytocin, a hormone that increases one’s sensitivity to social cues, resulting in more empathy, generosity, compassion and trustworthiness (Zak, 2013; Kosfeld et al., 2005). The stories within case studies serve as a means by which learners form new understandings through characters and/or scenarios.

CBL is often described in conjunction or in comparison with problem-based learning (PBL). While the lines are often confusingly blurred within the literature, in the most conservative of definitions, the features distinguishing the two approaches include that PBL involves open rather than guided inquiry, is less structured, and the instructor plays a more passive role. In PBL multiple solutions to the problem may exit, but the problem is often initially not well-defined. PBL also has a stronger emphasis on developing self-directed learning. The choice between implementing CBL versus PBL is highly dependent on the goals and context of the instruction.  For example, in a comparison of PBL and CBL approaches during a curricular shift at two medical schools, students and faculty preferred CBL to PBL (Srinivasan et al., 2007). Students perceived CBL to be a more efficient process and more clinically applicable. However, in another context, PBL might be the favored approach.

In a review of the effectiveness of CBL in health profession education, Thistlethwaite et al. (2012), found several benefits:

Students enjoyed the method and thought it enhanced their learning,

Instructors liked how CBL engaged students in learning,

CBL seemed to facilitate small group learning, but the authors could not distinguish between whether it was the case itself or the small group learning that occurred as facilitated by the case.

Other studies have also reported on the effectiveness of CBL in achieving learning outcomes (Bonney, 2015; Breslin, 2008; Herreid, 2013; Krain, 2016). These findings suggest that CBL is a vehicle of engagement for instruction, and facilitates an environment whereby students can construct knowledge.

Science – Students are given a scenario to which they apply their basic science knowledge and problem-solving skills to help them solve the case. One example within the biological sciences is two brothers who have a family history of a genetic illness. They each have mutations within a particular sequence in their DNA. Students work through the case and draw conclusions about the biological impacts of these mutations using basic science. Sample cases: You are Not the Mother of Your Children ; Organic Chemisty and Your Cellphone: Organic Light-Emitting Diodes ;   A Light on Physics: F-Number and Exposure Time

Medicine – Medical or pre-health students read about a patient presenting with specific symptoms. Students decide which questions are important to ask the patient in their medical history, how long they have experienced such symptoms, etc. The case unfolds and students use clinical reasoning, propose relevant tests, develop a differential diagnoses and a plan of treatment. Sample cases: The Case of the Crying Baby: Surgical vs. Medical Management ; The Plan: Ethics and Physician Assisted Suicide ; The Haemophilus Vaccine: A Victory for Immunologic Engineering

Public Health – A case study describes a pandemic of a deadly infectious disease. Students work through the case to identify Patient Zero, the person who was the first to spread the disease, and how that individual became infected.  Sample cases: The Protective Parent ; The Elusive Tuberculosis Case: The CDC and Andrew Speaker ; Credible Voice: WHO-Beijing and the SARS Crisis

Law – A case study presents a legal dilemma for which students use problem solving to decide the best way to advise and defend a client. Students are presented information that changes during the case.  Sample cases: Mortgage Crisis Call (abstract) ; The Case of the Unpaid Interns (abstract) ; Police-Community Dialogue (abstract)

Business – Students work on a case study that presents the history of a business success or failure. They apply business principles learned in the classroom and assess why the venture was successful or not. Sample cases: SELCO-Determining a path forward ; Project Masiluleke: Texting and Testing to Fight HIV/AIDS in South Africa ; Mayo Clinic: Design Thinking in Healthcare

Humanities - Students consider a case that presents a theater facing financial and management difficulties. They apply business and theater principles learned in the classroom to the case, working together to create solutions for the theater. Sample cases: .


Finding and Writing Cases

Consider utilizing or adapting open access cases - The availability of open resources and databases containing cases that instructors can download makes this approach even more accessible in the classroom. Instructors can consider in particular the National Center for Case Study Teaching in Science , a database featuring hundreds of accessible STEM- and social science - based case studies.

  • Consider writing original cases - In the event that an instructor is unable to find open access cases relevant to their course learning objectives, they may choose to write their own. See the following resources on case writing: Cooking with Betty Crocker: A Recipe for Case Writing ; The Way of Flesch: The Art of Writing Readable Cases ;   Twixt Fact and Fiction: A Case Writer’s Dilemma ; And All That Jazz: An Essay Extolling the Virtues of Writing Case Teaching Notes .

Implementing Cases

Take baby steps if new to CBL - While entire courses and curricula may involve case-based learning, instructors who desire to implement on a smaller-scale can integrate a single case into their class, and increase the number of cases utilized over time as desired.

Use cases in classes that are small, medium or large - Cases can be scaled to any course size. In large classes with stadium seating, students can work with peers nearby, while in small classes with more flexible seating arrangements, teams can move their chairs closer together. CBL can introduce more noise (and energy) in the classroom to which an instructor often quickly becomes accustomed. Further, students can be asked to work on cases outside of class, and wrap up discussion during the next class meeting.

Encourage collaborative work - Cases present an opportunity for students to work together to solve cases which the historical literature supports as beneficial to student learning (Bruffee, 1993). Allow students to work in groups to answer case questions.

Form diverse teams as feasible - When students work within diverse teams they can be exposed to a variety of perspectives that can help them solve the case. Depending on the context of the course, priorities, and the background information gathered about the students enrolled in the class, instructors may choose to organize student groups to allow for diversity in factors such as current course grades, gender, race/ethnicity, personality, among other items.  

Use stable teams as appropriate - If CBL is a large component of the course, a research-supported practice is to keep teams together long enough to go through the stages of group development: forming, storming, norming, performing and adjourning (Tuckman, 1965).

Walk around to guide groups - In CBL instructors serve as facilitators of student learning. Walking around allows the instructor to monitor student progress as well as identify and support any groups that may be struggling. Teaching assistants can also play a valuable role in supporting groups.

Interrupt strategically - Only every so often, for conversation in large group discussion of the case, especially when students appear confused on key concepts. An effective practice to help students meet case learning goals is to guide them as a whole group when the class is ready. This may include selecting a few student groups to present answers to discussion questions to the entire class, asking the class a question relevant to the case using polling software, and/or performing a mini-lesson on an area that appears to be confusing among students.  

Assess student learning in multiple ways - Students can be assessed informally by asking groups to report back answers to various case questions. This practice also helps students stay on task, and keeps them accountable. Cases can also be included on exams using related scenarios where students are asked to apply their knowledge.

Barrows HS. (1996). Problem-based learning in medicine and beyond: a brief overview. New Directions for Teaching and Learning, 68, 3-12.  

Bonney KM. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains. Journal of Microbiology and Biology Education, 16(1): 21-28.

Breslin M, Buchanan, R. (2008) On the Case Study Method of Research and Teaching in Design.  Design Issues, 24(1), 36-40.

Bruffee KS. (1993). Collaborative learning: Higher education, interdependence, and authority of knowledge. Johns Hopkins University Press, Baltimore, MD.

Herreid CF. (2013). Start with a Story: The Case Study Method of Teaching College Science, edited by Clyde Freeman Herreid. Originally published in 2006 by the National Science Teachers Association (NSTA); reprinted by the National Center for Case Study Teaching in Science (NCCSTS) in 2013.

Herreid CH. (1994). Case studies in science: A novel method of science education. Journal of Research in Science Teaching, 23(4), 221–229.

Jonassen DH and Hernandez-Serrano J. (2002). Case-based reasoning and instructional design: Using stories to support problem solving. Educational Technology, Research and Development, 50(2), 65-77.  

Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. (2005). Oxytocin increases trust in humans. Nature, 435, 673-676.

Krain M. (2016) Putting the learning in case learning? The effects of case-based approaches on student knowledge, attitudes, and engagement. Journal on Excellence in College Teaching, 27(2), 131-153.

Lee V. (2012). What is Inquiry-Guided Learning?  New Directions for Learning, 129:5-14.

Nkhoma M, Sriratanaviriyakul N. (2017). Using case method to enrich students’ learning outcomes. Active Learning in Higher Education, 18(1):37-50.

Srinivasan et al. (2007). Comparing problem-based learning with case-based learning: Effects of a major curricular shift at two institutions. Academic Medicine, 82(1): 74-82.

Thistlethwaite JE et al. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23.  Medical Teacher, 34, e421-e444.

Tuckman B. (1965). Development sequence in small groups. Psychological Bulletin, 63(6), 384-99.

Williams B. (2005). Case-based learning - a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med, 22, 577-581.

Zak, PJ (2013). How Stories Change the Brain. Retrieved from:


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  • What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on June 22, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

  • Provide new or unexpected insights into the subject
  • Challenge or complicate existing assumptions and theories
  • Propose practical courses of action to resolve a problem
  • Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

  • Exemplify a theory by showing how it explains the case under investigation
  • Expand on a theory by uncovering new concepts and ideas that need to be incorporated
  • Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

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In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

  • Normal distribution
  • Degrees of freedom
  • Null hypothesis
  • Discourse analysis
  • Control groups
  • Mixed methods research
  • Non-probability sampling
  • Quantitative research
  • Ecological validity

Research bias

  • Rosenthal effect
  • Implicit bias
  • Cognitive bias
  • Selection bias
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  • Case Studies

Teaching Guide

  • Using the Open Case Studies Website
  • Using the UBC Wiki
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  • Case Implementation
  • Get Involved
  • Process Documentation

Case studies offer a student-centered approach to learning that asks students to identify, explore, and provide solutions to real-world problems by focusing on case-specific examples (Wiek, Xiong, Brundiers, van der Leeuw, 2014, p 434). This approach simulates real life practice in sustainability education in that it illuminates the ongoing complexity of the problems being addressed. Publishing these case studies openly, means they can be re-used in a variety of contexts by others across campus and beyond. Since the cases never “end”; at any time students from all over UBC campus can engage with their content, highlighting their potential as powerful educational tools that can foster inter-disciplinary research of authentic problems. Students contributing to the case studies are making an authentic contribution to a deepening understanding of the complex challenges facing us in terms of environmental ethics and sustainability.

The case studies are housed on the UBC Wiki, and that content is then fed into the Open Case Studies website. The UBC Wiki as a platform for open, collaborative course work enables students to create, respond to and/or edit case studies, using the built in features (such as talk pages, document history and contributor track backs) to make editing transparent. The wiki also also helps students develop important transferable skills such as selection and curation of multimedia (while attending to copyright and re-use specifications), citation and referencing, summarizing research, etc. These activities help build critical thinking, creativity, collaboration, and digital literacy.

This guide is intended to help you get started with your case study project by offering:

  • Information on how to use the UBC Wiki
  • Research that supports case studies as effective tools for active learning
  • Instructional strategies for teaching effectively with case studies
  • Sample case study assignments used by UBC instructors

The UBC Wiki is a set of webpages accessible to anyone with a CWL account and has many unique features in addition to collaborative writing including the ability to revive previous drafts, and notifications setting that can support instructors in monitoring individual student contributions, or support students to better manage their collaborative efforts on their own. Using a wiki successfully in a course, however, requires proper facilitation and support from instructors and TAs.

The following links are helpful in getting started:

General Information:

  • Navigating the Wiki:
  • Wiki Help Table of Contents:
  • Frequently Asked Questions:

Self-Guided Wiki Tutorials:

  • Getting Started With UBC Wiki - short video and links to common formatting needs.
  • Beginner:
  • Intermediate:
  • Advanced:

The idea that learning is "active" is influenced by social constructivism , which emphasizes collaboration in the active co-construction of meaning among learners. Simply put, learning happens when people collaborate and interact with authentic learning tasks and situations. These ideas are becoming increasingly prevalent in the scholarly literature on teaching and learning (see for instance, Wilson 1996) and have important implications for pedagogy, especially in the university where traditional lectures remain the dominant instructional strategy. When students are asked to respond to authentic problems and questions, they assume responsibility for the trajectory of their learning, rather than it being decided upon by the instructor. This practice, also referred to as “student-centered learning” allows the students to become “active” participants in the construction of their understandings.

One of the easiest ways to develop higher order cognitive capacities (critical thinking, problem solving, creativity etc.) is through pedagogies that support inquiry based learning, thereby allowing students the opportunity to “develop [as] inquirers and to use curiosity, the urge to explore and become researchers and lifelong learners” (Justice, Rice, Roy, Hudspith & Jenkins,2009, p. 843). Because case studies are often collaborative, they provide unique inquiry based learning opportunities that will foster active engagement in student learning, while also teaching transferable skills (teamwork, collaboration, technology literacy). That the cases never “end” and that they can be considered by students and faculty from all over the UBC community, highlights their potential as powerful educational tools that can foster inter-disciplinary research of authentic problems.

Using case studies successfully in a course requires purposefully scaffolded support from the instructor and TA's. Instructors must properly introduce assignments, as well as facilitate and monitor the progress of students while they work on assignments. This will help ensure that students understand the purpose and value of the work they are doing and will also allow instructors and TA's to provide appropriate support and guidance.

The following instructional strategies will help you teach effectively using case studies:

1. Getting Started:

  • Outline Your "Big Picture" Goals and Expectations : Communicate to students what you are hoping they will learn (Or have them tell you why they think you would ask them to work with case studies!). It is also important to discuss the quality of work you expect and offer specific examples of what that looks like. If you have any, look at exemplars of past student work, or simply evaluate existing case studies to generate a list of defining characteristics. Doing this will provide students with valuable tangible and visual examples of what you expect.
  • Define "Case Study" : Don't assume that students understand what case-studies are, especially at the undergraduate level. Take the time to talk about what a case study is and why they are powerful teaching/learning tools. This can be facilitated during a tutorial with small group discussion. See Case Study Resources.
  • Pick Case Studies Purposefully : If you are planning on having students evaluate case studies, make sure to read them in advance and have a clear understanding of why you chose it. This will help facilitate discussion and field student questions.
  • Set the Context for the Evaluating or Creating the Case Study : Whether you are having students write the case studies themselves, or you are having them examine an existing case, it is important to set the parameters for how you want students to approach the problem. For instance, you may have them evaluate the case from the perspective of an industry professional, a community group or member, or even from their own perspective of university students. Whatever you choose, make sure you communicate this clearly.
  • Set the Parameters for Evaluating or Creating the Case Study : Clearly outline all the information you want students to find out, and how you want it reported. You may want students to focus on some areas and disregard others, or you may want them to consider all the facts equally. Whatever you choose, make sure you communicate this clearly.

2. Use, Revise, and/or Create

  • Use the case studies as they are : One way to use the case studies in courses is to have students read and discuss them as they are. They can be read on the open case studies website, downloaded from the wiki and embedded into another website, or downloaded in PDF or Microsoft Word format (see this guide for how to embed or download the case studies)
  • If you are only making minor edits such as fixing a broken link or a typo, please go ahead. You could add a note about this to the "discussion" page to explain (see the tab at the top of each wiki page).
  • You could add a section at the bottom of the case study with a perspective on it from your discipline. Some of the case studies already have sections at the bottom that are titled "What would a ___ do?" You can add a new one of those to give a different disciplinary perspective.
  • If you want to make more substantial changes, it would be best if you copied and pasted the wiki content into a new page so as to preserve the original. The original version may be used in other courses by the instructor/students who created it, so making significant changes could be a problem! And those changes might be reverted by the original instructor and students (wiki pages keep all past versions, and those changes can easily be reverted). If you would like to substantially revise a case study, please contact Christina Hendricks, who can help you get started and then get the new version into the collection: [email protected]
  • Create new case studies : We are always looking for new case studies for the collection! If you think you would like to write one, or involve your students in writing one, please contact Christina Hendricks: [email protected]

3. Guiding Case Study Discussions:

  • Ask open-ended questions : Open-ended questions cannot be answered using "yes" or "no". Be careful when wording discussion questions, allowing them to be as open as possible.
  • Listen Actively : Actively listen to students by paraphrasing what they have said to you and saying it back (e.g. "What I heard is....Is this what you meant?"). This will help you pay close attention to what they say and clarify any possible miscommunication.
  • Role Play : Ask students to take on the perspective of different interested parties in considering the case study.
  • Compare and Contrast : Ask students to compare and contrast cases in similar areas from the open case study collection. Discuss whether there are similar problems or possible solutions for the cases.

4. Staying on Track:

  • Develop a Protocol for Collaboration : Have students outline how they will collaborate at the start of the assignment to ensure that the work is shared evenly and that each student has a purposeful role.
  • Set Benchmark Assignments : Make sure students stay on track by requiring smaller assignments or assessments along the way. This can be as simple as coming to tutorial with a portion of the case-study written for peer critique and analysis.
  • Give Students Adequate Time : Allow students enough time to read and consider case-studies thoughtfully. The more time you can provide, the less overwhelmed students will feel. This will encourage them to go deeper with their case study and their learning.
  • Forestry : In this assignment, students in a graduate course wrote their own case studies. This link provides information on the assignment, a handout given to the students, and a grading rubric: Short-Term Assignment: What is Illegal Logging? - Teacher Guide
  • Political Science : Students in a third-year political science class responded to a case study written by the instructor. They worked in groups to create action plans for climate change problems. This link provides information on the assignment as well as a handout given to the students: Class Activity: Action Plans for Climate Change - Teacher Guide
  • Education : Teacher candidates in the Faculty of Education respond to case studies written by students. They discuss a case study and respond to questions with the goal of identifying the issues raised, perspectives involved and possible ways forward. The goal is to support decision making related to online presence and social media engagement. Digital Tattoo Case Studies for Student Teachers Facilitators' Guide

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Case Study Compilation

The SEL Integration Approach  Case Study Compilation  was developed with and for educators who work in a K-12 school setting, including teachers, paraprofessionals, counselors, SEL Directors, teacher leaders, & school principals, to provide examples of practice related to three questions:

  • What does it mean to focus on social-emotional development and the creation of positive learning environments?
  • How can educators integrate their approaches to social, emotional, and academic development?
  • What does it look, sound, and feel like when SEL is effectively embedded into all elements of the school day?

case study in education sample

When read one at a time, the case studies offer snapshots of social-emotional learning in action; they describe daily routines, activities, and teachable moments within short vignettes. When read together, the case studies provide a unique picture of what it takes for a school to integrate social, emotional, and academic learning across grade levels, content areas, and other unique contexts.

The Case Study Compilation includes:

  • Eleven case studies:  Each case study highlights educator ‘moves’ and strategies to embed social-emotional skills, mindsets, and competencies throughout the school day and within academics. They each  conclude with a reflection prompt that challenges readers to examine their own practice. The case studies are written from several different perspectives, including teachers in the classroom and in distance learning environments, a school counselor, and district leaders.
  • Reflection Guide for Professional Learning:  The Reflection Guide offers an entry point for educators to think critically about their work with youth in order to strengthen their practice. School leaders or other partners may choose to use this Reflection Guide in a variety of contexts, including coaching conversations and staff professional development sessions.

View our accompanying Quick Reference Guide , Companion Guides , and Educator & School Leader Self-Reflection Tools .

“We must resist thinking in siloed terms when it comes to social-emotional learning (SEL), academics, and equity. Rather, these elements of our work as educators and partners go hand in hand.”

HEAD & HEART, TransformEd & ANet

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Enrich your students’ educational experience with case-based teaching

The NCCSTS Case Collection, created and curated by the National Center for Case Study Teaching in Science, on behalf of the University at Buffalo, contains nearly a thousand peer-reviewed case studies on a variety of topics in all areas of science.

Cases (only) are freely accessible; subscription is required for access to teaching notes and answer keys.

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Development of the NCCSTS Case Collection was originally funded by major grants to the University at Buffalo from the National Science Foundation , The Pew Charitable Trusts , and the U.S. Department of Education .

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What Is a Case Study?

An in-depth study of one person, group, or event

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

case study in education sample

Cara Lustik is a fact-checker and copywriter.

case study in education sample

Verywell / Colleen Tighe

Benefits and Limitations

Types of case studies, how to write a case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in various fields, including psychology, medicine, education, anthropology, political science, and social work.

The purpose of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, it is important to follow the rules of APA format .  

A case study can have both strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult to impossible to replicate in a lab. Some other benefits of a case study:

  • Allows researchers to collect a great deal of information
  • Give researchers the chance to collect information on rare or unusual cases
  • Permits researchers to develop hypotheses that can be explored in experimental research

On the negative side, a case study:

  • Cannot necessarily be generalized to the larger population
  • Cannot demonstrate cause and effect
  • May not be scientifically rigorous
  • Can lead to bias

Researchers may choose to perform a case study if they are interested in exploring a unique or recently discovered phenomenon. The insights gained from such research can help the researchers develop additional ideas and study questions that might be explored in future studies.

However, it is important to remember that the insights gained from case studies cannot be used to determine cause and effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of  Freud's work and theories were developed through the use of individual case studies. Some great examples of case studies in psychology include:

  • Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
  • Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
  • Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language could be taught even after critical periods for language development had been missed. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse had denied her the opportunity to learn language at critical points in her development.

This is clearly not something that researchers could ethically replicate, but conducting a case study on Genie allowed researchers the chance to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might utilize:

  • Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those living there.
  • Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
  • Explanatory case studies : These   are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
  • Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
  • Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
  • Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic cast study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers utilize depends on the unique characteristics of the situation as well as the case itself.

There are also different methods that can be used to conduct a case study, including prospective and retrospective case study methods.

Prospective case study methods are those in which an individual or group of people is observed in order to determine outcomes. For example, a group of individuals might be watched over an extended period of time to observe the progression of a particular disease.

Retrospective case study methods involve looking at historical information. For example, researchers might start with an outcome, such as a disease, and then work their way backward to look at information about the individual's life to determine risk factors that may have contributed to the onset of the illness.

Where to Find Data

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

  • Archival records : Census records, survey records, and name lists are examples of archival records.
  • Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
  • Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
  • Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
  • Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
  • Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

  • Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
  • Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
  • Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
  • Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research. 

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Here are a few additional pointers to keep in mind when formatting your case study:

  • Never refer to the subject of your case study as "the client." Instead, their name or a pseudonym.
  • Read examples of case studies to gain an idea about the style and format.
  • Remember to use APA format when citing references .

A Word From Verywell

Case studies can be a useful research tool, but they need to be used wisely. In many cases, they are best utilized in situations where conducting an experiment would be difficult or impossible. They are helpful for looking at unique situations and allow researchers to gather a great deal of information about a specific individual or group of people.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines that you are required to follow. If you are writing your case study for professional publication, be sure to check with the publisher for their specific guidelines for submitting a case study.

Simply Psychology. Case Study Method .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal.  The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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Writing A Case Study

Case Study Examples

Barbara P

20+ Unique Case Study Examples in 2023

16 min read

Published on: Jun 26, 2019

Last updated on: Oct 17, 2023

Case Study Examples

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Many students face challenges when writing a case study.

Most people don't realize that there are specific guidelines to follow when writing a case study. If you don't know where to start, it's easy to get overwhelmed and give up before you even begin.

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We've collected over 20+ free case study examples with solutions from top industry experts. These samples with solutions will help you win over your panel and score high marks on your case studies.

So, what are you waiting for? Let's dive in and learn the secrets to writing a successful case study.

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What is a Case Study?

A case study is a research method used to study a particular individual, group, or situation in depth. It involves analyzing and interpreting data from a variety of sources to gain insight into the subject being studied. 

Case studies are commonly used in fields such as psychology, business, and education to understand complex issues and develop solutions. They typically include detailed descriptions of the subject, background information, and an analysis of the key issues involved. 

The goal of a case study is to provide a comprehensive understanding of the subject, as well as to identify potential solutions or recommendations.

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How Long Should a Case Study Be?

What you need to include in your story will depend on the type of discipline. For example, a kitchen remodeling company could tell its entire story with pictures. Whereas this approach may not be suitable for a software invoicing solution.

Consider this pro advice while crafting your case study:

  • Most sources indicate that it should consist of 500-1500 words.
  • To ensure that your message is concise and crystal clear, add a brief snapshot section of 100 words or less.

Want to understand the basics of the case study? Click right here to learn: Case study

What Is a Marketing Case Study?

This type of case study focuses on a particular marketing challenge or problem. It analyzes the strategies used to overcome the challenge and achieve a successful outcome. 

Marketing case studies can be used to showcase effective marketing tactics, as well as to learn from failures and avoid common pitfalls. They often include details about the target audience, marketing channels used, and metrics to measure success. 

Marketing case studies are commonly used in business courses to help students understand marketing challenges and develop strategies.

Marketing Case Study Examples

Marketing case studies are real-life stories that showcase how a business solved a problem. They often discuss how a business achieved a goal using a specific marketing strategy or tactic.

They typically describe a challenge faced by a business, the solution implemented, and the results achieved.

The purpose of a marketing case study is to demonstrate a business's expertise and ability to solve problems. This is done to show their potential to customers.

Here are some examples that show how companies use case studies as a means of marketing and promotion:

1- "Chevrolet Discover the Unexpected" by Carol H. Williams 

This case study explores Chevrolet's DTU Journalism Fellows program. The case study uses the initials "DTU" to generate interest and encourage readers to learn more. There are multiple types of media such as images and videos used to explain the challenges faced. The case study concludes with an overview of the achievements that were met:

Key points from the case study include:

  • Using a well-known brand name in the title can create interest.
  • Combining different media types, such as headings, images, and videos, can help engage readers and make the content more memorable.
  • Providing a summary of the key achievements at the end of the case study can help readers better understand the project's impact.

2- “The Met” by Fantasy

Fantasy's case study for the Metropolitan Museum of Art, titled "The Met," provides a clear and simple showcase of the museum's website redesign. The case study emphasizes the features and interface of the website by showcasing each section of the interface individually, allowing the readers to concentrate on the significant elements.

For those who prefer text, each feature includes an objective description. The case study also includes a "Contact Us" call-to-action at the bottom of the page, inviting visitors to get in touch with the company.

Key points from this case study include:

  • Keeping the case study simple and clean can help readers focus on the most important aspects.
  • Presenting the features and solutions with a visual showcase can be more effective than writing a lot of text.
  • Including a clear call-to-action at the end of the case study can encourage visitors to contact the company for more information.

3- "In-Depth Performance Marketing Case Study," by Switch

This impressive case study presented by an international marketing agency, Switch, effectively communicates its client's success without revealing their name. To keep non-marketers in the loop, Switch includes a glossary of terms. The case study is presented in a fourteen-page PDF that's easy to skim, featuring big fonts and white space. Each page covers a different strategy, making it easy to navigate.

To provide readers with an overview of the client's requirements and reasons for approaching Switch, the Switch case study employs titles such as "Scenario," "Approach," and "In-Depth Performance Marketing Case Study" at a higher level. The PDF also features a CTA page and contact information for prospective clients.

Key points from the Switch case study:

  • Include a glossary of terms to make specialized information accessible to non-specialists.
  • Make your case study easy to navigate by using titles and separating sections.
  • Close with a CTA page and include contact information for prospective clients.

4- “Better Experiences for All” by Herman Miller

Herman Miller's minimalist approach to furniture design translates to their case study page for a Dubai hospital. The page features a captivating video with closed-captioning and expandable text for accessibility.

The case study presents a wealth of information in a concise format, enabling users to comprehend the intricacies of the strategy with ease. It concludes with a client testimonial and a list of furniture items purchased from the brand.

Key points from the case study:

  • Make sure your case study is user-friendly by including accessibility features like closed captioning and expandable text.
  • Include a list of products that were used in the project to guide potential customers.

5- “NetApp” by Evisort

The NetApp case study by Evisort is an excellent example of an informative, thorough, and compelling case study. Evisort starts off the case study with an at-a-glance overview of the client, NetApp. This approach helps to focus the attention on the client rather than the company or team.

The case study features client quotes and delves into the obstacles that NetApp encountered during the COVID pandemic. By highlighting how its services helped NetApp during tough times, Evisort demonstrates its value as a partner to their clients.

To make the case study accessible in a wider variety of formats, Evisort provides access to download their study in PDF format. This is an important consideration for making the case study easy to share and reference.

Key points from the Evisort example:

  • Provide an overview of the company in the client’s words and put focus on the customer. 
  • Highlight how your services can help clients during challenging times.
  • Make your case study accessible by providing it in various formats.

6- "Red Sox Season Campaign," by CTP Boston

The case study for the Red Sox Season Campaign by CTP Boston showcases a perfect blend of different media, such as video, text, and images. Upon visiting the page, the video plays automatically, and as you scroll, you'll find more videos featuring Red Sox players, social media images, and print ads that can be enlarged with a click.

The page features a clean and cohesive design that is visually appealing and invites viewers to appreciate CTP's well-rounded campaign for Boston's beloved baseball team. At the bottom, the page includes a call-to-action that encourages viewers to learn how CTP can create a similar campaign for their own brand.

Key points to take away:

  • Including a variety of media such as video, images, and text can make your case study more engaging and compelling.
  • Include a call-to-action at the end of your study that encourages viewers to take the next step towards becoming a customer or prospect.

7- “Zapier Case Study” by Ryan Berg

Ryan Berg's SEO case study on Zapier is an excellent example of an explanatory case study that can be used for marketing purposes. The study provides a comprehensive breakdown of Zapier's SEO strategy and how they created over 25,000 unique landing pages to improve their search rankings for different search terms.

One of Zapier's key strategies involved targeting relevant long-tail keywords such as "app A + app B integration," which helped them generate significant organic traffic over the long term. By analyzing the success of industry leaders and breaking down their strategies, businesses can borrow their brand power and credibility.

Explanatory case studies like this one are particularly useful when clients are not comfortable with sharing detailed information about their growth tactics. Such case studies can demonstrate a company's expertise and credibility to potential clients, proving their ability to help them succeed in their industry.

  • Targeting relevant long-tail keywords is an effective strategy for generating organic traffic.
  • Analyzing the success of industry leaders can provide valuable insights for developing a successful strategy.
  • Explanatory case studies can demonstrate a company's expertise and credibility to potential clients.

8- “Video Marketing Case Study” by L’Oréal and YouTube

The case study on L’Oréal and YouTube showcases the success of their video marketing campaign to launch a new product. The global marketing team members explain how they strategically used YouTube ads to achieve impressive results, including establishing the new product as the second-best in its category and generating 34% of all mass sales among online retailers. 

The case study provides a detailed breakdown of the various stages of the campaign, from awareness to loyalty, highlighting the effective use of YouTube at each step. It serves as a great example of a third-person implementation case study that demonstrates the power of video marketing.

Key points for learning:

  • Use YouTube ads strategically for different stages of a campaign, from awareness to loyalty.
  • Effective use of video marketing can lead to impressive results, such as establishing a new product as a leading player in its category and generating significant sales.
  • Third-person implementation case studies can showcase your expertise and the success of your marketing strategies to potential clients.

9- “Airbnd + Zendesk” by Zendesk

The case study by Zendesk, titled "Airbnb + Zendesk: building a powerful solution together" showcases a true partnership between Airbnb and Zendesk. The article begins with an intriguing opening statement, "Halfway around the globe is a place to stay with your name on it. At least for a weekend," and uses stunning photographs of beautiful Airbnb locations to captivate readers.

Instead of solely highlighting Zendesk's product, the case study is crafted to tell a good story and highlight Airbnb's service in detail. This strategy makes the case study more authentic and relatable.

Key points to take away from this case study:

  • Use client's offerings' images rather than just screenshots of your own product or service.
  • To begin the case study, it is recommended to include a distinct call to action. For instance, Zendesk presents two alternatives, namely to initiate a trial or seek a solution.

10- “Influencer Marketing” by Trend and WarbyParker

The case study from Trend and Warby Parker highlights the potential of influencer marketing, even when working with a limited budget. The "Wearing Warby" campaign involved influencers wearing Warby Parker glasses during their daily activities, providing a glimpse of the brand's products in use. 

This strategy helped to make the brand more relatable to the influencers' followers. Although the case study does not delve deeply into the tactics used, it demonstrates the effectiveness of third-person case studies in showcasing the results of a campaign.

  • Influencer marketing can be effective even with a limited budget.
  • Showcasing products being used in everyday life can make a brand more approachable and relatable.
  • Third-person case studies can be useful in highlighting the success of a campaign.

Marketing Case Study

Marketing Case Study Templates

Struggling to understand the correct case study format ? Check this case study format guide and perfect structure your case study today.

Business Case Study Examples

A business case study examines a business’s specific challenge or goal and how it should be solved. Business case studies usually focus on a number of details related to the initial challenge and proposed solution. 

To help you out, here are some samples of business case studies.

Here are some more business case study examples:

Business Case Study on How Social Media led to Potential Customer Loss

Business Case Study Template on the Two Sides of Blog Posts In 2023

Typically, a business case study discovers one of your customer's stories and how you solved a problem for them. It will allow your prospects to see how your solutions address their needs. 

Sales Case Study Examples

Case studies are important tools for sales teams to learn from in order to improve their own performance. By examining sales successes, teams can gain insights into effective strategies and create action plans to employ similar tactics.

By researching case studies of successful sales campaigns, sales teams can more accurately identify challenges and develop solutions. 

Interview Case Study Examples

When seeking to answer complex questions, case studies are an invaluable tool. This type of analysis dives deeply into a specific subject, taking a close look at factors like demographics . 

So, interview case studies provide businesses with invaluable information. This data allows them to make informed decisions related to certain markets or subjects.

Interview case study PDF


Successful interviews provide a snapshot of individuals' perspectives. This helps inform businesses seeking to expand their services or create better products for their target audience. 

Watch this video to learn the correct analysis of a business case study.

Case Study Examples Medical

Medical case studies are an essential part of medical education. They help students to understand how to diagnose and treat patients. 

Here are some medical case study examples pdf to help you.

Medical Case Study Example

Nursing Case Study Examples

Want to understand the various types of case studies? Check out our types of case study blog to select the perfect type.

Case Study Examples Psychology

Case studies are a great way of investigating individuals with psychological abnormalities. This is why a case study is a very common assignment in psychology courses. By examining all the aspects of your subject’s life, you discover the possible causes of exhibiting such behavior. 

For your help, here are some interesting psychology case study examples:

Psychology Case Study Examples PDF

Mental Health Patient Case Study Examples

Case Study Examples for Students In Daily Life

Case studies are a common requirement for students in various courses. But writing them can be tough, especially if you’re new to them. That's why we've gathered some examples from different fields that you may use as a guide. 

Here are some of the examples that can help you write yours:

Software Engineering Case Study Sample

Qualitative Research Case Study Sample

Software Quality Assurance Case Study

Social Work Case Study Sample

Ethical Case Study PDF

Case Study Examples PDF

These examples can guide you on how to structure and format your own case studies.

Now that you have read multiple case study examples, hop on to our tips.

Tips to Write a Good Case Study

Here are some note-worthy tips to craft a  winning case study 

  • Define the purpose of the case study This will help you to focus on the most important aspects of the case. The case study objective helps to ensure that your finished product is concise and to the point.
  • Choose a real-life example. One of the best ways to write a successful case study is to choose a real-life example. This will give your readers a chance to see how the concepts apply in a real-world setting.
  • Keep it brief. This means that you should only include information that is directly relevant to your topic and avoid adding unnecessary details.
  • Use strong evidence. To make your case study convincing, you will need to use strong evidence. This can include statistics, data from research studies, or quotes from experts in the field.
  • Edit and proofread your work. Before you submit your case study, be sure to edit and proofread your work carefully. This will help to ensure that there are no errors and that your paper is clear and concise.

There you go!

All about case study examples at your fingertips! We are sure that by now you have all the key essential guidelines of various case studies with samples. So grab your pen and start crafting a winning case study right away!

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Barbara P (Literature, Marketing)

Dr. Barbara is a highly experienced writer and author who holds a Ph.D. degree in public health from an Ivy League school. She has worked in the medical field for many years, conducting extensive research on various health topics. Her writing has been featured in several top-tier publications.

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case study in education sample

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  • Education Case Study
  • Samples List

An case study examples on education is a prosaic composition of a small volume and free composition, expressing individual impressions and thoughts on a specific occasion or issue and obviously not claiming a definitive or exhaustive interpretation of the subject.

Some signs of education case study:

  • the presence of a specific topic or question. A work devoted to the analysis of a wide range of problems in biology, by definition, cannot be performed in the genre of education case study topic.
  • The case study expresses individual impressions and thoughts on a specific occasion or issue, in this case, on education and does not knowingly pretend to a definitive or exhaustive interpretation of the subject.
  • As a rule, an essay suggests a new, subjectively colored word about something, such a work may have a philosophical, historical, biographical, journalistic, literary, critical, popular scientific or purely fiction character.
  • in the content of an case study samples on education , first of all, the author’s personality is assessed - his worldview, thoughts and feelings.

The goal of an case study in education is to develop such skills as independent creative thinking and writing out your own thoughts.

Writing an case study is extremely useful, because it allows the author to learn to clearly and correctly formulate thoughts, structure information, use basic concepts, highlight causal relationships, illustrate experience with relevant examples, and substantiate his conclusions.

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Examples List on Education Case Study


Hertz CEO Kathryn Marinello with CFO Jamere Jackson and other members of the executive team in 2017

Top 40 Most Popular Case Studies of 2021

Two cases about Hertz claimed top spots in 2021's Top 40 Most Popular Case Studies

Two cases on the uses of debt and equity at Hertz claimed top spots in the CRDT’s (Case Research and Development Team) 2021 top 40 review of cases.

Hertz (A) took the top spot. The case details the financial structure of the rental car company through the end of 2019. Hertz (B), which ranked third in CRDT’s list, describes the company’s struggles during the early part of the COVID pandemic and its eventual need to enter Chapter 11 bankruptcy. 

The success of the Hertz cases was unprecedented for the top 40 list. Usually, cases take a number of years to gain popularity, but the Hertz cases claimed top spots in their first year of release. Hertz (A) also became the first ‘cooked’ case to top the annual review, as all of the other winners had been web-based ‘raw’ cases.

Besides introducing students to the complicated financing required to maintain an enormous fleet of cars, the Hertz cases also expanded the diversity of case protagonists. Kathyrn Marinello was the CEO of Hertz during this period and the CFO, Jamere Jackson is black.

Sandwiched between the two Hertz cases, Coffee 2016, a perennial best seller, finished second. “Glory, Glory, Man United!” a case about an English football team’s IPO made a surprise move to number four.  Cases on search fund boards, the future of malls,  Norway’s Sovereign Wealth fund, Prodigy Finance, the Mayo Clinic, and Cadbury rounded out the top ten.

Other year-end data for 2021 showed:

  • Online “raw” case usage remained steady as compared to 2020 with over 35K users from 170 countries and all 50 U.S. states interacting with 196 cases.
  • Fifty four percent of raw case users came from outside the U.S..
  • The Yale School of Management (SOM) case study directory pages received over 160K page views from 177 countries with approximately a third originating in India followed by the U.S. and the Philippines.
  • Twenty-six of the cases in the list are raw cases.
  • A third of the cases feature a woman protagonist.
  • Orders for Yale SOM case studies increased by almost 50% compared to 2020.
  • The top 40 cases were supervised by 19 different Yale SOM faculty members, several supervising multiple cases.

CRDT compiled the Top 40 list by combining data from its case store, Google Analytics, and other measures of interest and adoption.

All of this year’s Top 40 cases are available for purchase from the Yale Management Media store .

And the Top 40 cases studies of 2021 are:

1.   Hertz Global Holdings (A): Uses of Debt and Equity

2.   Coffee 2016

3.   Hertz Global Holdings (B): Uses of Debt and Equity 2020

4.   Glory, Glory Man United!

5.   Search Fund Company Boards: How CEOs Can Build Boards to Help Them Thrive

6.   The Future of Malls: Was Decline Inevitable?

7.   Strategy for Norway's Pension Fund Global

8.   Prodigy Finance

9.   Design at Mayo

10. Cadbury

11. City Hospital Emergency Room

13. Volkswagen

14. Marina Bay Sands

15. Shake Shack IPO

16. Mastercard

17. Netflix

18. Ant Financial

19. AXA: Creating the New CR Metrics

20. IBM Corporate Service Corps

21. Business Leadership in South Africa's 1994 Reforms

22. Alternative Meat Industry

23. Children's Premier

24. Khalil Tawil and Umi (A)

25. Palm Oil 2016

26. Teach For All: Designing a Global Network

27. What's Next? Search Fund Entrepreneurs Reflect on Life After Exit

28. Searching for a Search Fund Structure: A Student Takes a Tour of Various Options

30. Project Sammaan

31. Commonfund ESG

32. Polaroid

33. Connecticut Green Bank 2018: After the Raid

34. FieldFresh Foods

35. The Alibaba Group

36. 360 State Street: Real Options

37. Herman Miller

38. AgBiome

39. Nathan Cummings Foundation

40. Toyota 2010

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Elevating community voices through inclusive science communication: a case study of the we are water program in the southwestern united states.

  • 1 Cooperative Institute for Research in Environmental Sciences, University of Colorado Boulder, United States

The final, formatted version of the article will be published soon.

Science communication plays a pivotal role in cultural engagement and life-long science learning. However, historically marginalized communities remain undervalued in these efforts due to practices that prioritize specific individuals, such as those who are affluent, collegeeducated, able-bodied, and already scientifically engaged. Science communicators can avoid these practices by acknowledging the intersecting historical and cultural dimensions surrounding science beyond those of the majority culture and practicing inclusive science communication efforts. Here, we define and describe the importance of inclusive science communication and outline how we use an asset-based community engagement framework in a place-based education program's communication practices with rural communities in the Southwestern United States. We describe how we designed our communication spaces, found our voice, and effectively communicate with non-English speaking and bilingual communities. We provide examples from the We are Water program, demonstrating how we utilize inclusive science communication practices to engage more widely with diverse communities and create space for community voices to be heard and shared. We conclude that the use of inclusive science communication strategies and an asset-based community engagement framework has allowed the We are Water program to connect with rural communities while communicating in a way that elevates historically marginalized voices, creates space for communities to share their own experiences through memories and stories, and honors diverse perspectives and ways of knowing.

Keywords: science communication1, asset-based community engagement2, cultural responsiveness3, inclusive science communication4, place-based education5, equity6, inclusion7, public engagement8

Received: 28 Apr 2023; Accepted: 02 Nov 2023.

Copyright: © 2023 Marsh, Gold and Rongstad Strong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ms. Casey L. Marsh, Cooperative Institute for Research in Environmental Sciences, University of Colorado Boulder, Boulder, United States

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  • Published: 03 November 2023

Continuing medical education in China: evidence from primary health workers’ preferences for continuing traditional Chinese medicine education

  • Hao Yan 1 ,
  • Zhaoran Han 1 ,
  • Hanlin Nie 1 ,
  • Wanjin Yang 1 ,
  • Stephen Nicholas 2 , 3 , 4 , 5 ,
  • Elizabeth Maitland 6 ,
  • Weihan Zhao 1 ,
  • Yong Yang 7 &
  • Xuefeng Shi 1 , 8  

BMC Health Services Research volume  23 , Article number:  1200 ( 2023 ) Cite this article

Metrics details

Continuing Medical Education (CME) is an important part of the training process for health workers worldwide. In China, training in Traditional Chinese Medicine (TCM) not only improves the expertise of medical workers, but also supports the Chinese Government’s policy of promoting TCM as an equal treatment to western medicine. CME, including learning Traditional Chinese Medicine Technologies (TCMTs), perform poorly and research into the motivation of health workers to engage in CME is urgently required. Using a discrete choice experiment, this study assessed the CME learning preferences of primary health workers, using TCMT as a case study of CME programs.

We conducted a discrete choice experiment among health workers in Shandong Province, Guizhou Province, and Henan provinces from July 1, 2021 to October 1, 2022 on the TCMT learning preferences of primary health workers. The mixed logit model and latent class analysis model were used to analyze primary health workers’ TCMT learning preferences.

A total of 1,063 respondents participated in this study, of which 1,001 (94.2%) passed the consistency test and formed the final sample. Our key finding was that there were three distinct classes of TCMT learners. Overall, the relative importance of the seven attributes impacting the learning of TCMTs were: learning expenses, expected TCMT efficacy, TCMT learning difficulty, TCMT mode of learning, TCMT type, time required to learn, and expected frequency of TCMT use. However, these attributes differed significantly across the three distinct classes of TCMT learners. Infrequent users (class 1) were concerned with learning expenses and learning difficulty; workaholics (class 2) focused on the mode of learning; and pragmatists (class 3) paid more attention to the expected TCMT efficacy and the expected frequency of TCMT use. We recommend targeted strategies to motivate TCMT learning suited to the requirements of each class of TCMT learners.

Rather than a single TCMT medical education program for primary health workers, CME programs should be targeted at different classes of TCMT learners.

Peer Review reports

Due to the complex and changing nature of medical knowledge, health workers undergo long periods of training, including university education and post-work practice. Previous studies have shown that four or more years of medical school education, and then several years of residency training, are both required to become a qualified physician in many countries, such as Germany, the United States, and China [ 1 , 2 , 3 ]. The advancement of medical practices, the updating of medical knowledge, and constant policy changes in the healthcare system, all of which mean health workers face tremendous learning challenges. Continuous learning and lifelong education ensure qualified health workers provide constantly improving medical services for patients [ 4 ]. Continuing medical education (CME) is any activity to maintain, develop, or increase their knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients [ 5 ]. Besides keeping healthcare professionals’ knowledge and skills current and promoting more efficient use of health resources, physicians who do not participate in CME have lower persuasiveness in making clinical decisions [ 6 , 7 , 8 ]. CME has been shown to enhance the knowledge, skills, attitudes, and clinical outcomes of health workers [ 9 , 10 ].

In China, CME is a mandatory requirement for continuous registration, requiring health workers to participate in CME activities each year and earn no less than 25 credits [ 11 ]. The content of CME includes new developments and advances in medicine, professional theories, treatment and management of common diseases, health policies and laws, new skills and practices and research capabilities. While CME has a long tradition in China, studies have shown that CME faces problems of outdated curriculum, lack of initiative in learning, only concerned with getting credits, short-term training resulting in unsystematic learning, and insufficient funding for grassroots CME [ 12 , 13 , 14 ].

In China, Traditional Chinese Medicine Technology (TCMT), which includes simple, convenient, cheap, and effective herbal prescriptions, acupuncture, massage, cupping and moxibustion [ 15 ], has broad-based patient support and is given equal emphasis with Western medicine in the Chinese government’s Healthy China 2030 Program and health policies [ 16 ]. Forming part of China’s CME, the promotion and use of TCMTs promotes the rational use of medical resources, improves the service capacity of TCM, and reduces the medical cost burden of residents [ 17 , 18 ].

TCMT is an essential component of CME. It plays an important role in enhancing the capacity of TCM health services. The government has been very supportive of the TCMT and has been steadily increasing its support in recent years. The 2022 TCM Development Plan calls for clinical, dental and public health to complete the required TCMT CME, and for 100% of community health units and more than 80% of village health units to be able to provide TCM services [ 19 ]. However, we noticed that the CMT CME effect is not ideal in primary health institutions in some areas. For instance, Health workers lack knowledge about TCMT. A study conducted by Wang et al. found that only 41.8% of health workers in Shanghai’s community health units know TCMT [ 20 ]. Meanwhile, primary health workers have little interest in learning TCMT and are willing to spend time learning TCMT. A study by Shi et al. showed that 37.1% of health workers in the village were unwilling to learn TCMT [ 21 ]. Moreover, Li et al. also conducted a study which indicated that there was a low number of health workers who used TCMT in clinical practice within township hospitals [ 22 ]. So, we believe that the TCMT CME should fully consider the learning preferences of health workers.

Previous studies have mostly examined TCMT’s current status, requirements and influencing factors, with few studies examining the motivation to learn TCMTs from the perspective of health workers. This paper addresses how to improve primary health workers’ motivation to learn TCMTs through CME. Specifically, we use a discrete choice experiment (DCE) to investigate Chinese primary health workers’ preferences for learning TCMTs and to explore the incentive mechanisms for promoting TCMT learning.

Developed by health economics, discrete choice experiments (DCEs) are one stated preference method used in applied economics to address key policy issues [ 23 ]. DCEs use a survey to quantitatively measure explicit preferences to determine a person’s or group’s trade-offs and choices for products and services under different hypothetical scenarios [ 23 , 24 ]. Respondents choose between different scenarios that contain hypothetical alternatives, which are composed of different attributes and different levels of each attribute [ 25 , 26 , 27 ]. The different learning scenarios are designed, from which health workers then choose, to measure their preferences for learning TCMTs.


Purposive sampling and convenience sampling were used to gather the research sample. Based on the level of economic development and geographical characteristics of China, three provinces were selected for this study: Shandong Province (eastern region, high economic level), Henan Province (central region, medium economic level) and Guizhou Province (western region, low economic level). Then, 1–2 counties in each province were selected that were promoting the learning and use of TCMTs, i.e., Laizhou County in Shandong Province, Xiangfu County and Yuanyang County in Henan Province and Qingzhen County in Guizhou Province. Within the selected counties, county hospitals and township hospitals were selected for the study and each province ensured that the total number of hospitals selected was approximately the same. In Shandong, Henan and Guizhou provinces, 16, 17 and 12 hospitals respectively were selected for the study. We conducted the research in the selected primary healthcare units from July 1, 2021 to October 1, 2022. Using a combination of online and offline methods, the survey was completed anonymously. During the research, a face-to-face questionnaire survey was conducted with approximately 20–50% of the selected health workers on duty, totaling 1,063. The targeted respondents were healthcare workers who might use TCMTs in their treatment processes, including Conventional Medicine (CM) physicians, TCM physicians, and nurses.

Survey tools

In our DCE study, the constituent properties of hypothetical scenarios and their levels were determined through a literature review and expert advice. First, a literature review was conducted to sort out the attributes that influence health workers’ motivation to learn TCMTs. We then invited 7 experts from the field of health research and management to form an advisory group to assess the attributes initially identified and their levels. After expert adjustment, Table  1 displays the seven attributes (learning expenses, learning difficulty, mode of learning, type of technology, expected technology efficacy, expected frequency of use, and time required to learn) [ 21 , 28 , 29 ] and their levels. Four attributes (learning expenses, learning difficulty, mode of learning, and time required to learn) focused on the sacrifices and efforts that healthcare workers were willing to make to learn the TCMTs, related to economy, time, and effort. The other three attributes (type of technology, expected technology efficacy, and expected frequency of use) represent the characteristics exhibited by TCMTs in clinical practice. The expected technology efficacy refers to the therapeutic effect in TCMT clinical practice compared with existing technologies; the type of technology refers to internal treatments that require internal medication, such as herbal prescriptions, or external treatment that do not require medication, such as acupuncture, massage, moxibustion and cupping; and the expected frequency of use refers to the frequency of application of learning TCMTs in diagnosis and treatment.

Given the above attributes and levels, the respondents’ burden of answering a full factorial design comprised 1,296 ( \(={2}^{2}\times {3}^{4}\times 4\) ) hypothetical scenarios, which in turn would lead to 839,160 ( \(=(\text{1,296}\times \text{1,295})/2\) ) group selection tasks. The D-efficient design in SAS 9.2 addressed this problem by using an orthogonal design to generate 18 representative choice sets, which were randomly assigned to three versions of the questionnaire. Respondents were asked to choose which of the two hypothetical techniques they would prefer to learn, with Table  2 providing a representative example of the selection tasks. Additional data on age, sex, occupation, job title, and respondents’ self-assessed scores of motivation to learn medical technologies were collected.

Quality control

In order to better control the quality of responses, a consistency check question with a clearly superior option was added in every questionnaire to assess whether respondents took the survey seriously. Responses that failed the consistency test were precluded in our research. Before the deployment of the study, we conducted a pilot survey and adjusted the wording and layout to make the questionnaire clearer and easier to understand. During the on-site survey, trained investigators were assigned to provide questionnaire instructions and assistance in answering any questions from respondents during the survey.

Theory and statistical analyses

The theoretical basis of DCE random utility theory [ 30 ], which states that when a decision-maker facing with a choice, his/her preferences for a particular choice can be described by the utility value of the chosen object. Using a mixed logit model, the learning preferences of health workers, or the utility of learning a TCMT, was specified:

where U is the utility (U) participant i acquires from choosing TCMTs, j for choice set t, ɛ is participant-specific random error and incorporates both preferences estimates and variance-scale for the respective treatment characteristics.

The latent class analysis (LCA) model assumes that participants have different preferences and that participants can be probabilistically grouped according to different preference classes, each corresponding to a unique pattern of learning preferences. Also, the LCA model assumes that the distribution of coefficients is discrete rather than continuous. Suppose that all participants are classified into Q classes and the utility of individuals n in Q classes choosing TCMTs j under choice set t is

where \({\beta }_{q}\) is a class-specific parameter vector, and the other variables have the same meaning as in Eq. ( 1 ).

Akaike information criterion (AIC) and Bayesian information criterion (BIC) are used to select the best-fit model from a finite set of models for a given set of data, with smaller values indicating a better model fit [ 31 ]. The AIC derives from information theory and aims to select the model that generates the probability distribution with the lowest deviation from the actual one. The BIC is calculated through an asymptotic approximation from a large sample to perform a full comparison of Bayesian models [ 32 ]. We calculated AIC and BIC values that showed that the three classes model was optimal.

Relative importance is the ratio of the range of utilities within an attribute to the sum of the ranges of utilities of all attributes. The relative importance of each attribute is calculated by finding the maximum utility difference between attribute levels and is expressed as a percentage of the sum of all maximum differences [ 33 ]: \(\frac{{{\beta }}_{q} max}{{{\sum }_{n}^{m}{\beta }}_{m max}}\) , where \({{\beta }}_{q max}\) refers to the maximum value of the coefficient of attribute q and the denominator is the sum of the maximum values of the coefficients of all attributes.

Uptake rate prediction analysis, a very flexible post-evaluation tool, is a simple way to describe how the uptake probability changes with the change of attribute and also provides a way to simulate interesting scenarios. The logit probability estimation equation of the individual choosing one scenario instead of another is:

where \({Xnj}_{1}\) and \({Xnj}_{2}\) were the attribute coefficient vectors of alternative \({j}_{1}\) and alternative \({j}_{2}\) , respectively.

All analyses were performed in Stata 16.0, using the default (uninformative) priors for the MIXL model and the lclogit2 procedure for the latent class models.

We conducted a face-to-face anonymous survey in Shandong, Henan and Guizhou provinces. A total of 1,063 questionnaires were collected from TCM physicians, CM physicians, and nurses, of which 1,001 (94.2%) were valid, which comprised the study sample.

The mean age of the respondents was 36.6 years (SD = 9.4), and the median of years in the profession was 10 years (IQR: 4 years—20 years); 34.9% of the respondents were male; 32.4% of respondents were CM physicians, 31.5% were TCM physicians and 36.2% were nurses. Half of the respondents had a junior job title (50.9%) and more than half had a bachelor’s degree or higher (58.9%).

Aggregate results

Table  3 displays the result of the mixed logit model, where all the attributes had a significant effect on the learning preferences. Respondents showed a preference for a higher expected efficacy (β: 1.088, OR: 2.969) and a similar expected efficacy (β: 0.313, OR: 1.367) over an uncertain expected efficacy technology. Preferences for simple learning difficulty (β: 0.693, OR: 2.000) and normal difficulty (β: 0.513, OR: 1.670) dominated a difficult TCMT. Respondents also preferred on-the-job learning to off-the-job learning (β: 0.575, OR: 1.776) and external treatments were preferred by respondents over internal treatments (β: 0.432, OR: 1.540). In addition, Table  3 reports that learning expenses (β: -0.0013, OR: 0.999), expected frequency to use the technology (β: 0.0114, OR: 1.011) and time required to learn (β: -0.0217, OR: 0.979) were all significant attributes that influenced respondents’ preferences to learn TCMTs. Overall, respondents preferred an external treatment technology that is less costly, less time-consuming, less difficult to learn, can be delivered through on-the-job learning and can be applied in daily work.

Results by class

Model estimate.

According to BIC in Table  4 , the latent class analysis identified three classes of respondents with different preferences. We assigned the class with the highest probability as the latent class. Table  5 reports that there were statistically significant differences between the three classes in terms of years in the profession, sex, occupation, and self-assessed learning motivation score. As displayed in Table  5 ; Fig.  1 , class 1 accounted for the biggest proportion of respondents (50.1%), showing a strong preference for TCMTs with simple learning difficulty (OR: 3.01) and external treatment (OR: 2.17), with respondents in class 1 having significantly lower learning motivation scores and the lowest percentage of TCM physicians. Class 2 accounted for the smallest proportion of respondents (20.1%), showing a strong preference for on-the-job learning (OR: 5.74), with respondents having the longest years in the profession. Class 3 consisted of 29.8% of respondents and showed a strong preference for higher efficacy (OR: 8.03) and higher usage frequency (OR: 1.5), with the highest proportion of TCM physicians.

figure 1

Latent class results of discrete choice experiments

Each of the classes had its preferred characteristics and demographic characteristics, which means that each of different classes requires different policies to motivate TCMTs learning.

Relative importance

Overall, the attribute with the highest relative importance was learning expenses (32.0%), followed by expected efficacy of TCMTs (22.3%), learning difficulty (14.2%), mode of learning (11.8%), type of TCMTs (8.9%), the time required to learn (6.2%) and expected frequency of use (4.7%). As shown in Fig.  2 , each class had a distinct pattern of the relative importance of attributes, which we classified as infrequent users (class 1) (n = 502, 50.1%), workaholics (class 2) (n = 201, 20.1%), and pragmatists (class 3) (n = 298, 29.8%). To be specific, among the infrequent users (class 1), learning expense had the highest relative importance (41.0%), followed by learning difficulty (21.7%), type of TCMTs (15.2%), the time required to learn (10.1%), mode of learning (6.6%), expected efficacy of TCMTs (3.6%) and expected frequency of use (1.7%). The relative importance of the mode of learning was the highest among workaholics (class 2) (59.3%), followed by expected efficacy of TCMTs (15.1%), learning difficulty (13.3%), learning expense (4.2%), type of TCMTs (4.1%), expected frequency of use (2.5%) and time required to learn (1.5%). Among the pragmatists (class 3), the expected efficacy of TCMTs had the highest relative importance (50.1%), followed by expected frequency of use (19.5%), learning expense (11.0%), mode of learning (7.0%), the time required to learn (6.4%), type of TCMTs (3.8%) and learning difficulty (2.1%).

figure 2

Relative importance by class

Uptake rate

Based on the latent class analysis, we predicted the possible change in the uptake rate for TCMTs learning under different potential policy scenarios in Fig.  3 . We only varied the level of attributes that can be changed by external factors: learning expenses, mode of learning, expected technology efficacy, and time required to learn. For infrequent users (class 1), the uptake rate was increased by 78% compared with the baseline when learning the TCMT was free; increased by 25% when shortening the time of learning to 7 days; and combining both, the uptake rate increased by 86%. For workaholics (class 2), the uptake rate was increased by 70% compared with the baseline when they can learn the TCMT without suspending their jobs. None of the other measures and their combinations lead to a higher uptake rate. For pragmatists (class 3), the uptake rate was increased by 39% compared with the baseline when the learned TCMT can be used 40% more frequently in daily health work; increased by 22% when learning the TCMT was free; increased by 15% when they could learn TCMT without leaving their jobs; and increased by 13% when the time required to learn was reduced to 7 days. When all the above scenarios were met simultaneously, the uptake rate increased by 72%.

figure 3

Uptake rate for TCMTs learning under various potential policy scenarios

*Baseline learning TCMTs: learning expenses “1,200 yuan”; learning difficulty “normal”; mode of learning “off-the-job learning”; type of technology “internal treatment”; expected technology efficacy “similar to before”; expected frequency of use “20%”; time required to learn “7 days”

Research on how to motivate health workers to maximize CME performance is rare. To assess the motivation for CME, we used learning TCMTs as an example. The Chinese government promotes TCM as an equal treatment to western medicine with official health policy fostering TCMTs in rural and urban areas as a safe, effective, convenient, and affordable primary healthcare services [ 34 ]. TCMT CME is fundamental to advancing the Chinese government’s commitment to TCM, but TCMTs learning in China has been unsatisfactory [ 15 , 21 ]. Conducting an anonymous face-to-face survey of health workers in primary care institutions in three provinces, we found that taking all health workers together, health workers were motivated to learn TCMT when TCMT learning was less costly, less time-consuming, less difficult to learn, and could be learned on the job and used in their daily work. But, taking different classes of health workers, the motivations for TCMT differ across different types of learners.

Turning first to all health workers. the attribute of the highest relative importance was learning expenses (32.0%). In general, primary care workers consider their salaries to be relatively low [ 35 , 36 ], which makes them hesitant to pay to learn a new technology with which they are not familiar. Learning expenses were followed by the expected efficacy of TCMTs (22.3%), learning difficulty (14.2%), mode of learning (11.8%), type of TCMTs (8.9%), time required to learn (6.2%) and expected frequency of use (4.7%). Consistent with the evidence that innovative learning technology is more likely to be adopted by university teachers when it is perceived as superior to existing tools, easy to use, and readily available [ 37 ], our results show that primary health workers were more to undertake CME when the expected efficacy and expected frequency of use of TCMTs was higher than already learned technologies with the same effects. Most Chinese primary care physicians have a low level of education relative to Chinese physicians generally [ 38 ], which meant that easy-to-learn technology was more acceptable for these primary health workers. For health workers who are very busy in their daily practice, then on-the-job training or a less time-consuming technology is more popular among these primary care workers. The possible explanation for health workers’ preferences for TCM external treatment technology over TCM internal treatment is that they were more proficient in conventional medicine and had less knowledge of TCM, since TCM internal treatment requires greater theoretical knowledge than TCM external treatments.

Our key finding comes from our latent class analysis model that revealed significant differences in learning motivations according to three main TCMT learner classes: infrequent users (50.1%), workaholics (20.1%) and pragmatists (29.8%). The three groups differed in their socio-demographic characteristics, and required different motivational learning strategies. We recommend CME trainers target different CME approaches to address each of these types of TCMT learners. Infrequent users had significantly lower learning motivation scores and the lowest percentage of TCM physicians. The attributes they valued most were learning expenses and the difficulty of the TCMTs to learn.

The infrequent users group had significantly lower learning motivation scores and the lowest percentage of TCM physicians. The attributes they valued most were learning expenses and the difficulty of the TCMTs learning. This class mostly consisted of CM physicians and nurses who used mainly conventional medical technologies in their daily work; had a weak basic theory of TCM [ 39 ]; sought TCMTs that were easy to learn; and preferred TCMT that had low learning expenses. There exists pressure on CM physicians to respond to the national policy to learn TCM technologies [ 40 ], however, improving CM physicians’ knowledge of TCM has a positive effect on their ability to provide integrative medical services [ 41 ]. For the infrequent user group, we can reduce the learning expenses of TCM learning, select simple TCMTs, and at the same time enrich the teaching mode to increase their interest in learning. By applying targeted learning approaches to the infrequent user group, the motivation of learning TCMTs and the willingness to apply TCMTs in clinical practice in this group can both be increased [ 42 ].

The workaholics, who accounted for 20.1% of all respondents, had the longest work years and the attribute they valued most was the mode of learning. Workaholics’ long stay of work implies that they have mastered the necessary medical skills to perform their daily procedures well, so they prefer learning CME on the job, which is consistent with research that found many health workers preferred on-the-job learning due to the conflict between work and learning [ 43 ]. This group values small group educational meetings, multidisciplinary discussions (both formal and informal) and interactive workshops, in particular, all of which have been shown to be effective measures of CME [ 44 ], and allow for on-the-job learning.

The third class was the pragmatists that contained the highest proportion of TCM physicians, who attached importance on the efficacy and expected frequency of TCMT use, and health workers of this class were more likely to be the actual users of TCMTs. They were extremely passionate about TCM, had a good theoretical foundation in TCM, and could better apply TCMTs learned through CME in practice, so pragmatists attach importance to TMCT frequency of use and efficacy, and expect that TCMTs should achieve more effective results for their patients [ 45 ]. For this group, it is necessary to screen learning programs to focus on the most effective TCMTs and to match TCMT learning to the urgent needs of the public [ 46 , 47 ].

This study has several limitations. Our DCE study focused on seven attributes, but future studies should consider other attributes, such as TCMT equipment conditions and personal development opportunities, which also affect health workers’ TCMT learning preferences. DCEs measure stated preferences, which may differ from their actual behaviors. Further research is needed to expand the measures of primary health care workers’ revealed preferences. This study focused on the learning preferences of primary health workers for TCMTs, which can increase learners’ motivation and improve the quality of learning from a personal subjective perspective, but the data in this study did not analyze the actual objective learning effects, and further research on this topic is needed. Our recommendations apply to primary health workers, and future studies should explore CME for hospital health workers.

TCMT CME is a key driver of the Chinese government’s commitment to promote TCM as an equal treatment with western medicine. Our study reveals the preferred CME approaches and recommends tailored TMCT CME programs. The key finding is that health workers can be divided into three distinct classes of TCMT learners. Infrequent users (class 1) (50.1%) preferred to learn simple and external treatment TCMTs; the workaholics (class 2) 20.1% preferred to learn TCMT on-the-job; and the pragmatists (class 3) 29.8% showed a strong preference for learning TCMTs with higher efficacy and more frequent use. We recommend that different measures can be taken to incentivize the three classes identified: for infrequent users (class 1), healthcare units can offer more free and short-learning in-hospital TCMT CME to increase their knowledge and interest in TCMT; for workaholics (class 2), it is crucial that TCMT CME does not disrupt their regular work; for pragmatists (class 3), healthcare units can offer more free, short-learning and frequently used TCMTs and teach them without disrupting normal work. While we used the example of learning TCMTs for our study, our research conclusions have implications for other CME programs.

Data availability

The data used and/or analyzed during the study are available from the corresponding author upon reasonable request.


Continuing Medical Education

Traditional Chinese medicine

Traditional Chinese Medicine Technologies

Discrete choice experiments

Conventional Medicine

The latent class analysis

Akaike information criterion

Bayesian information criterion

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The authors thank all the participants and hospitals for their time and effort. Responsibility for any remaining errors lies solely with the authors.

This project was funded by the National Natural Science Foundation of China (NO:7207040925).

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HY, ZRH, and XFS designed this study and drafted the original manuscript; SN, EM and YY participated in revising the paper; HY, WHZ and XFS collected research data; HLN and WJY participated in drafting and revising the manuscript, all authors have read and approved the final manuscript.

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Yan, H., Han, Z., Nie, H. et al. Continuing medical education in China: evidence from primary health workers’ preferences for continuing traditional Chinese medicine education. BMC Health Serv Res 23 , 1200 (2023).

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  • Continuing medical education
  • Discrete choice experiment
  • Health workers
  • Learning preferences
  • Traditional Chinese Medicine technologies

BMC Health Services Research

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case study in education sample

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Using a novel virtual-reality simulator to assess performance in lumbar puncture: a validation study

  • Sujun Xie 1 , 2 ,
  • Søren Grimstrup 3 ,
  • Leizl Joy Nayahangan 3 ,
  • Zheng Wang 2 ,
  • Xing Wan 1 &
  • Lars Konge 2 , 3  

BMC Medical Education volume  23 , Article number:  814 ( 2023 ) Cite this article

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A lumbar puncture procedure’s success depends on a competent physician minimizing the risk of failing to get a sample and avoiding complications such as post-dural headache. A new virtual-reality simulator might be helpful in deciding when a physician is competent to perform lumbar puncture. We aimed to investigate validity evidence for a simulator-based test in lumbar puncture and establish a pass/fail standard to allow a mastery learning training program.

Validity evidence was investigated using Messick’s framework by including participants who were novices, intermediates, or experienced in lumbar puncture. Each participant performed two lumbar puncture procedures on the simulator, and fifty-nine predefined simulator metrics were automatically recorded. Cronbach’s alpha was used to explore internal consistency reliability. Intergroup comparisons were made using independent sample t-tests with Tukey’s correction for multiple comparisons. The learning effect was explored using paired sample t-test analysis, and a pass/fail standard was established using the contrasting groups’ method.

73 novices, 18 intermediates, and 19 physicians performed the test resulting in a total of 220 procedures. 25 metrics (42.4%) had good discriminatory ability, and the reliability of these metrics was good, Cronbach’s α = 0.81. The experienced physicians were significantly better than the novices (18.3 vs. 13.3, p < 0.001), and the pass/fail standard was established at 16 points. This standard resulted in 22 (30.1%) novices passing (i.e., false positives) and 5 (26.3%) physicians failing (i.e., false negatives).

This study provides validity evidence for a simulator-based test of lumbar puncture competence. The test can help ensure basic competence at the end of a simulation-based training program for trainees, i.e., a mastery learning training program.

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Lumbar puncture is a crucial procedure for diagnosing various diseases and for therapeutic purposes [ 1 ]. The success of a lumbar puncture could minimize the risk of failing to get a sample and avoid complications such as post-dural headache [ 2 ]. However, the lumbar puncture procedure can be challenging to learn, and it remains uncertain how optimal training should be arranged to ensure that trainees meet the requirements of clinical practice [ 3 ]. According to Kern’s six-step approach to curriculum development, we must be able to answer essential questions such as “How to practice?” (i.e., which educational strategy to use) and “How much to practice?” (i.e., setting goals and objectives for the training) [ 4 ].

Traditionally, medical procedures have been taught using the apprenticeship model, where novices practice directly on patients supervised by a more experienced colleague. However, ethical considerations and increased concerns for patient safety have made simulation-based training on physical phantoms and virtual reality (VR) simulators more common [ 5 ]. These modalities allow trainees to practice repeatedly in a standardized and safe environment until basic competency is acquired and they are ready for supervised practice on patients. Recent studies found good trainee satisfaction with an educational 3D video delivered in virtual reality and positive effects of hands-on training on a virtual reality lumbar puncture simulator [ 6 , 7 ].

Nevertheless, how much practice is necessary? Standard courses use a fixed amount of time or a fixed number of performances. However, this approach fails to ensure competence as all trainees learn at different paces, and individual performance cannot be predicted [ 8 ]. Hence, it is strongly recommended to use Mastery Learning (ML), where each trainee continues to practice until they passes an end-of-training test. Every ML program’s success depends on the test, making it very important that it measures what it is supposed to measure, i.e., that it has solid evidence of validity [ 9 ]. Validity evidence should be gathered scientifically using a contemporary framework of validity, e.g., Messick’s framework containing five sources of evidence: Content, response process, internal structure, relationship to other variables, and consequences [ 10 ].

An assessment tool with solid evidence for validity according to Messick’s framework has already been published for lumbar puncture, the LumPAT [ 11 ]. This tool has been used to assess the performance on a physical phantom and to assess clinical procedures either by direct observation or based on video recordings of the procedure. However, experienced faculty is necessary for rating purposes, and all human assessments are prone to bias [ 12 ]. Assessments based on objective metrics provided by virtual-reality simulators have been used for other procedures to provide automatic, unbiased test results [ 13 ]. However, to our knowledge, this has not been done for lumbar puncture.

This study aimed to develop an objective and standardized test based on a newly developed lumbar puncture simulator to gather validity evidence for the test and establish a credible pass/fail standard that can ensure basic competency in lumbar puncture before continuing to clinical practice.

The development of the test and the exploration of validity was done at the Clinical Skills Center (2021–2022) at the Guangzhou University of Chinese Medicine, Guangzhou, China.

Development of the simulator test

The Virtual Reality Lumbar Puncture simulator (Virtual Puncture Surgery Platform, CXV-CS-PVO80, Shanghai, China) consists of master controllers, pedals, and a personal display (Fig.  1 ). The lumbar puncture simulator delivers 59 metrics divided into 10 sub-procedures equipped with haptic and automated evaluation feedback. These are automatically recorded, ensuring unbiased outcome measures. All lumbar puncture procedures in the simulator were tested by an expert (who had performed more than 500 lumbar punctures), who chose a typical case of a 52-year-old male who presented with a headache for six days and was admitted to the neurology department.

figure 1

Trainee interacting with the simulator ( a ) Screen-shots from the simulator ( b ) VR simulator setup ( c )

Participants in the validation study

Participants were novices, intermediates, and experienced physicians. They were recruited through campus network notification and WeChat groups. Novices were medical students in years 3–4 from the Guangzhou University of Chinese Medicine without previous lumbar puncture training. Intermediates were residents from various affiliated hospitals of Guangzhou University of Chinese Medicine who had taken a lumbar puncture course using a phantom and had performed 1–3 lumbar punctures on patients. Experienced physicians were doctors who had performed more than 50 lumbar punctures including the neuraxial procedures such as subarachnoid blocks, epidurals, and lumbar drain placements. They came from different neurosurgery departments, departments of internal medicine (including neurology, emergency care unit), and anesthesiology at the First, Second, and Third Affiliated Hospital of Guangzhou University of Chinese Medicine and had taken part in the lumbar puncture simulation-based curriculum.

Administration of the test

A 5-minute video illustrating a virtual reality simulation of a lumbar puncture was shown to each participant before the test. Then each participant performed a lumbar puncture procedure on the simulator. A simulator operator was available for assistance for any technical issues but not procedural advice. After the first test, the participants received feedback from automatic metrics provided by the simulator, then the participants repeated the same lumbar puncture procedure a second time.

Statistical analysis

Internal consistency reliability was calculated using Cronbach’s Alpha to explore the consistency of the scores across the different items in the test. An item analysis was performed to calculate Item Difficulty and Item Discrimination Index, according to the recommendations of Thomas Haladyna [ 14 ]. The final test consisted of the items with an appropriate level of difficulty and good discriminatory ability. The relationship to other variables was calculated by comparing the scores of the three groups using independent sample t-tests with Tukey’s correction for multiple comparisons. The learning effect was calculated by paired sample T-test. Finally, the contrasting groups’ methods were used on novices and experienced physicians to establish a pass/fail standard [ 15 ]. The consequences of this standard were reported by the numbers of false positives (novices that passed the test) and false negatives (physicians that failed the test) and by using Fisher’s exact test to compare these results. All statistical analyses were done using IBM SPSS Statistics version 28. P-values less than 0.05 were considered statistically significant.

A total of 110 participants were included in the study, and all performed two simulated lumbar punctures procedure. Table  1 shows the group allocation, experience level, and participants’ demographics.

The item statistics analysis showed that 27 out of 59 items had a difficulty index between 0.25 and 0.91, i.e., an appropriate level of difficulty (not extremely easy or hard). All but two of these items also had a good discriminatory ability above 0.10, resulting in 25 out of 27 items being included in the final test. Six of these metrics (24%) were diagnostic, five items (20%) concerned the preparation of the procedures, two (8%) were regarding the identification of landmarks, 10 (40%) tested skills in disinfection, and the last two (8%) tested local anesthesia skills. (Table  2 ).

Response process

Validity evidence regarding this source was ensured by standardizing the testing process: All tests were facilitated by the same three experienced simulator operators who did not offer any procedural advice during the tests. Potential bias was eliminated by using the automatic simulator judgment.

Internal structure

The internal consistency for the 25 included simulator metrics was 0.81, CI 95% [0.76–0.86]. A Pearson’s correlation of r = 0.66 [0.54,0.76], p < 0.001 demonstrates a highly significant and relatively strong correlation between the 1st and 2nd test (Fig.  2 ).

figure 2

Scatter Plot of Total Score by Groups

Relationship to other variables

The relationship to other variables was explored by comparing the scores of the three groups using independent sample t-tests with Tukey’s correction for multiple comparisons for test 1 and test 2 separately (Table  3 ). The experienced physicians performed significantly better than the novices in both procedures.


A pass/fail standard was established at 16 points, CI 95% 14.4–17.5 points, Fig.  3 . This standard resulted in 22 (30.1%) novices passing (i.e., false positives) and 5 (26.3%) physicians failing (i.e., false negatives).

figure 3

Establishment of the pass/fail standard using the contrasting groups’ method

Learning effect

Comparing the results from the first and the second procedure with paired sample t-tests showed that the novices and the experienced physicians improved significantly in the total score. However, the intermediates did not improve significantly (Fig.  4 ; Table  4 ).

figure 4

Total sum of 25 items in the first and second procedure between different groups

In this study, we developed a new virtual reality simulation-based test of competence in the lumbar puncture procedure. One-hundred and ten medical students and physicians took the test in a standardized setting, and solid evidence of validity was established for all five sources in the contemporary validity framework of Messick [ 16 ]. This research is the first validity study using Messick’s five sources to explore a test based on a VR simulator for lumbar puncture with haptic feedback.

The internal consistency of the 25 items was good, with Cronbach’s alpha = 0.81. High-stake tests, e.g., end-of-course or end-of-year summative exams in medical school, need a reliability of more than 0.8, making our test suited for mastery learning training programs. The Lumbar Puncture Assessment Tool (LumPAT) had an internal consistency of 0.92 but relied on expert ratings, which could introduce issues concerning subjectivity and bias. A study on infant lumbar puncture used residents as raters and found an acceptable internal consistency of 0.77 [ 17 ]. Ma et al. explored an error-focused checklist in lumbar puncture and found a low internal consistency of 0.35. Despite this relatively low reliability, they still recommend using the error-focused checklist to identify procedural incompetence [ 18 ]. It could be worth exploring whether a combination of our objective test of competence could be combined with an error-focused checklist to better identify the superior and safe performance of competent trainees.

Experienced participants performed significantly better than novices in both procedures. However, physicians performed about the same as the intermediates, which may indicate that the simulator cannot discriminate the small nuances in the lumbar puncture procedure, a problem also reported with a VR simulator for robot-assisted radical prostatectomy [ 19 ]. However, our simulation-based test possessed discriminatory ability as opposed to a test using a virtual reality simulator of uretero-nephroscopy, which could not even discriminate between novices and experts [ 20 ].

We used a recommended standard-setting method to establish a pass/fail limit of 16 points. Unfortunately, there was a considerable variation in performances, and 26.3% of the experienced physicians failed the test. As they were unfamiliar with the virtual reality simulator, a longer warm-up (i.e., a familiarization phase) could solve these issues. Gustafsson et al. used a VR simulator to explore the learning curves of orthopedic surgeons. They found that experienced surgeons needed to perform seven simulated hip fracture procedures before they performed in a way that resembled their actual competence [ 21 ]. Warm-up on a simulator is a good idea in research on SB training and could positively impact the real clinical world. Chen et al. found that performing a brief warm-up exercise before a laparoscopic procedure significantly improved the intraoperative performance of residents [ 22 ]. Future studies using the VR lumbar puncture simulator should investigate the learning curves of both trainees and the familiarization curves of experienced physicians.

Virtual reality simulation or simple phantoms?

VR is an emerging technology that creates a virtual environment for users to get an aesthetic feel for the desired surroundings [ 23 ]. In this study, novices got a higher score on the second test (2.1 points improvement, p <0.001), indicating that the VR simulator’s automatic feedback is valuable when training. VR simulators offer several kinds of automatic feedback, which encourage the trainee to practice again to achieve or meet the required level [ 24 ]. However, the simulators often come at a high cost. They should only be integrated into a well-thought-out training program, e.g., mastery learning programs using evidence-based pass/fail standards [ 25 ]. Physical phantoms are less expensive but require direct observation by expert instructors, which is both time-consuming and expensive [ 26 ]. Our study makes it possible to implement a mastery learning program where novices practice on the simulator while receiving automatic evaluations and structured feedback after each performance. Simulation-based training can accelerate the trainees’ learning curves [ 27 ]. However, future studies must explore the transfer of skills to procedures on actual patients after trainees have trained to our predefined mastery level.


Our study has several limitations. First was the heterogeneous background of experienced physicians from several different specialties. They were recruited because they were key teaching staff of lumbar puncture, but several did not perform the actual procedure regularly. The attainment and maintenance of a 90% success rate may require 45–60 attempts at spinal and epidural anesthesia [ 28 ]. The neurosurgical doctors have a high lumbar puncture activity, but unfortunately, it was not easy to recruit many of these.

Secondly, the final test is unbalanced. Many items probed disinfection technical issues (40% of items). In contrast, few items relating to the actual puncture were included in the final test which may explain why some of the included novices managed to pass the test with very little lumbar puncture experience. The current version of the simulator has limitations concerning the tactile sensation during the needle insertion. Vamadevan et al. report that haptic virtual reality simulators reduce the time to reach proficiency compared to the non-haptic simulator. However, the acquired skills are not transferable to the conventional non-haptic setting [ 29 ]. In the future, the haptic feedback of the VR simulator should be improved and allow more specific items regarding the actual procedure to be included in the test. Alternatively, the learning process on the simulator should be supplemented by needle punctures on physical models. This could make the test better at measuring the actual puncturing skills which would probably reduce the number of false positives, i.e. novices that manage to pass the test without adequate skills.

Our study provides validity evidence for a virtual reality simulator-based test of lumbar puncture competence. We established a pass/fail level, which can be used to make a mastery learning training program without the need for expert faculty.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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The authors would like to thank the China Scholarship Council for the support that allowed the first author Sujun Xie to be a visiting scholar at CAMES.

Guangdong Higher Education Teaching Reform Project (2020). National Examination of Traditional Chinese Medicine Scientific Research Project (TB2021002).

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Guangzhou University of Chinese Medicine, Jichang Road 12, Guangzhou, 510405, China

Sujun Xie & Xing Wan

Guangdong Academy for Medical Simulation (GAMS), No.10 Hongming Road, East District, Huangpu District, Guangzhou, 510530, China

Sujun Xie, Zheng Wang & Lars Konge

Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Ryesgade 53B, opg. 98A, Copenhagen, 2100, Denmark

Søren Grimstrup, Leizl Joy Nayahangan & Lars Konge

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SX and LK conceived the study and its design. SX collected data and coordinated and drafted the manuscript. LK supervised the entire validation process and contributed to the revision of the manuscript. SG carried out the statistical analysis and commented on the manuscript. LJN contributed to the design and revision of the manuscript. ZW and XW participated in the review and interpretation of the results and reviewed and commented on the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Sujun Xie or Xing Wan .

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This educational study with the project number 2601-22-427-003Z033 did not involve patients nor patient data and was granted exemption by the Guangzhou University of Chinese Medicine Experimental Animal Ethics Committee. Informed consent to participate in the study was obtained. Participation was voluntary. We certify that this study was performed in accordance with the ethical rules and principles that were outlined in the 1964 Declaration of Helsinki.

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The authors declare no competing interests.

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Xie, S., Grimstrup, S., Nayahangan, L.J. et al. Using a novel virtual-reality simulator to assess performance in lumbar puncture: a validation study. BMC Med Educ 23 , 814 (2023).

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