Facilitating the integrated small-group tutorial in a medical programme--the University of Transkei (Unitra) experience.

Context: The Unitra (now Walter Sisulu University) medical programme is problem- and community-based, offered in a small-group tutorial setting under a tutor. The first 3 years of the programme are integrated horizontally and vertically. The hypothetico-deductive format, with progressive disclosure, is utilised in the tutorial process. Regular training of tutors is carried out to assist faculty in adapting to the new methods of training. Performance of tutors is regularly assessed by students.

Objectives: To describe the students' perceptions of the faculty performance as tutors over the past 10 years of the problem-based learning/community-based education programme and to construct a profile of a Unitra tutor.

Design: A prospective longitudinal study.

Setting: The first 3 years of the medical programme is divided into 10 blocks lasting 10 weeks each. At the end of each block, students evaluate their tutors using a pre-designed form with items pertaining to both process and content facilitation. For each item, the tutor is assigned a score on a scale that ranges from 'unacceptable' to 'superlative'. Students' evaluations over the years were reviewed and the findings were analysed for trends and similarities.

Main Outcomes: Process facilitation and content facilitation.

Results: Evaluations from 460 individual tutorial groups, and of 83 tutors, were analysed. PROCESS FACILITATION: Tutors were regular in attendance, were punctual and showed enthusiasm for the tutorial process. They were proficient in keeping the group on track, in giving feedback to the group, and in helping the group to function. They were less proficient in managing group time and in giving feedback to individuals within the group. They did not give students adequate direction in the clinical reasoning process. CONTENT FACILITATION: Tutors were proficient in asking probing questions, in encouraging students to pursue learning issues, in integrating basic and clinical sciences and in identifying learning errors, and they often shared their experiences with students. They tended to teach within the tutorial session, and did not lay strong emphasis on psycho-social issues raised by the cases.

Conclusion: The students are generally happy with the Unitra tutors. Content is better facilitated than process. Integrating psychosocial issues into the tutorial process, minimizing teaching in the tutorial room, giving feedback to individuals, and giving appropriate guidance to students in the hypothetico-deductive clinical reasoning process are the major challenges facing the Unitra tutor.