The Unexpected Truth Revealed by a South African Study
Imagine you're a medical student facing a complex case of infectious disease. Your learning process isn't guided by a lecture but through collaborative problem-solving with peers under the guidance of a tutor. This is Problem-Based Learning (PBL), an educational approach that has revolutionized medical education worldwide. But here's a question that has puzzled educators for decades: Does it matter if your tutor is a subject-matter expert or primarily a skilled facilitator?
Before we explore the UNITRA study, it's essential to understand what PBL entails. Unlike traditional curricula where students first learn basic sciences and later apply them to clinical problems, PBL integrates knowledge from the beginning. Students work in small groups to analyze clinical cases, identify learning needs, and collaboratively fill knowledge gaps.
In PBL, tutors don't "teach" in the traditional sense but facilitate the learning process 3 :
At UNITRA Medical School, researchers designed a retrospective study to examine whether tutor subject-matter expertise influenced student performance in content-based examinations. The study analyzed data from six years (1994-1999) of third-year medical students' results in microbiology, pathology, and pharmacology 1 .
The researchers classified tutors as "expert" if they had postgraduate specialization in the given discipline. For example, a microbiologist was considered an expert tutor for microbiology blocks, while a pathologist or pharmacologist tutoring microbiology would be classified as "non-expert" for that subject 2 .
6 Years
1994-1999
Student achievement was measured using end-of-block modified essay questions (MEQ), which require students to apply knowledge to clinical scenarios—a perfect assessment for PBL outcomes 1 .
| Aspect | Details |
|---|---|
| Time Frame | 1994-1999 (6 years) |
| Student Cohort | MB ChB III students |
| Subjects Assessed | Microbiology, Pathology, Pharmacology |
| Assessment Method | End-of-block modified essay questions (MEQ) |
| Expert Definition | Postgraduate specialization in the discipline |
The findings surprised many in medical education. When researchers pooled and compared scores between groups tutored by experts versus non-experts, they discovered:
The microbiology difference—while statistically significant—amounted to just 3 percentage points, a marginal difference in educational terms that might not reflect meaningful clinical significance.
| Subject | Expert-Tutored Groups | Non-expert-Tutored Groups | P-value | Significance |
|---|---|---|---|---|
| Pharmacology | 51.1 ± 0.6 | 52.6 ± 0.7 | 0.109 | Not significant |
| Pathology | 49.8 ± 0.6 | 49.9 ± 0.8 | 0.919 | Not significant |
| Microbiology | 54.1 ± 1.0 | 51.2 ± 0.8 | 0.032 | Statistically significant |
The UNITRA findings weren't isolated. Researchers worldwide have been investigating this question with surprisingly varied results:
| Study | Findings | Expert Definition |
|---|---|---|
| Schmidt et al. | Students with expert tutors achieved better | Specific knowledge from training/experience |
| Matthes et al. | No difference in outcomes | Senior staff with postgraduate education vs. juniors |
| Steele et al. | No difference in performance | Faculty vs. peer facilitators |
| Hay & Katsikitis | Experts scored higher in end-of-course tests | Professional competence in subject |
If subject expertise isn't the primary factor, what does make an effective PBL tutor? Research suggests that effective tutoring requires a blend of skills:
Ability to guide discussions without dominating, ask open-ended questions, and encourage participation from all students
While not necessarily expert-level, sufficient understanding to recognize errors and prompt critical thinking 3
Providing constructive feedback that promotes growth and self-directed learning
Creating a safe environment for discussion and managing conflicting personalities
Interestingly, Schmidt's research found that both knowledge-related behaviors and process-facilitation skills affected student achievement, and these two skill sets were often correlated . This suggests that the best tutors might be those who develop both areas simultaneously.
The UNITRA findings and related research have significant implications for how medical schools structure their PBL programs:
The UNITRA medical school study contributes valuable evidence to the ongoing debate about tutor expertise in PBL. Their finding that subject-matter expertise has minimal impact on student achievement suggests that effective facilitation skills may be equally—if not more—important than deep content knowledge.
This doesn't mean content knowledge is irrelevant. Rather, it suggests that medical schools might focus on developing tutors who possess both sufficient content knowledge and excellent facilitation skills, rather than prioritizing one over the other.
The next time you walk into a PBL session—whether as student or tutor—remember that creating an environment conducive to collaborative inquiry, critical thinking, and active participation might matter more than having all the right answers. After all, medicine isn't about memorizing facts but about learning how to think, solve problems, and work together to improve patient care—skills that extend far beyond any single specialty or discipline.
As medical education continues to evolve, studies like UNITRA's remind us that effective teaching is both an art and a science—one that requires balancing multiple factors to create optimal learning environments for future healthcare providers.