You won't learn if you just watch the action. You have to be able to learn unless you dive right in and work with clients -- early and often. Not surprisingly, you'll find these opportunities in smaller firms with an 'all hands on deck' philosophy. That starts with ghSMART, which posted one of the highest averages in all of the categories. In fact, this 9.914 marks a slight decline from the previous year, when ghSMART also topped the list. Clearview Healthcare Partners again ranked #2, with the Keystone Group slipping to #4 despite a higher score. The big move: Bain vaulted from #5 to #3 with a near .2 of a point improvement. Bain switched spots with McKinsey as well.