Good teacher, good tutor.

Dear editor

We have read with great interest the paper by Kassab et al1, who have essentially shown that good teachers will be good tutors in a problem-based learning (PBL) environment. We have been facing great difficulties to select tutors because there has been no tradition in PBL in our region in the preuniversity teaching. Furthermore, the majority of our teachers have been formed in a discipline-based medical curriculum.2 Therefore, it is reassuring to learn from the work by Kassab et al1 that subject-matter mastery is the powerful independent predictor of tutoring skills.

This fact parallels, at least in part, our students’ positive opinion about the impact of subject-matter expert tutors to guide the learning process, thus helping them to construct their medical learning.3 In fact, it has been demonstrated that self-directed study is the most important part of the tutorial session, which leads to retention of knowledge in long-term memory.4 Therefore, good teachers, by activating prior knowledge and making clear gaps in knowledge through interactive lessons and by encouraging learning based on their experience on the subject during lectures, will certainly have enough competence to motivate students to seek information in self-directed study to solve problems in tutorial sessions.

Lectures are not commonly delivered in PBL medical teaching approach. Kassab et al1 also support our view that lectures may help to promote learning in a PBL environment. In our course, we have provided students with selected lectures at the pre-clerkship stage. Importantly, such lectures have been delivered following the reporting phase of a tutorial session in the problem-solving process, usually four classes per module, and summarize the concepts related to the problems at hand. In this situation, apart from the discussion and integration of new acquired learning in the problem-solving process, students still have to undergo a written assessment through multiple-choice tests following the reporting phase, which by itself drives learning.5 Therefore, at the time of a lecture, students have a great deal of intrinsic motivation to attend such classes and to learn.

Another important point that deserves further consideration is the association of teacher’s capacity of creating a relaxed atmosphere during a lecture and tutoring skills.1 This teacher will certainly be able to stimulate a favorable environment during a tutorial session for learning. In addition, by more interaction and better communication with students, he or she will lead to a favorable learning process.6 The same can be said regarding the ability of a lecturer to use audiovisual aids, another independent predictor of tutoring skills. As Kassab et al1 suggest, teachers who use audiovisual guides in lectures can help students to structure knowledge by constructing concept maps. This is very important because not all schools rely on this step in the tutorial session. We have been using this tool over the last 12 years, and the data by Kassab et al1 lend support to this approach. In conclusion, the paper by Kassab et al1 shows that good teachers will be good tutors. We agree with that.

We have read with great interest the Letter to the Editor by Couto et al in this issue about our previously published manuscript.1 We were reassured by the interesting thoughts they raised about our manuscript, which strongly endorsed our findings and corroborated their previously published research in the same area.2 In that context, we would like to emphasize that the role of the problem-based learning (PBL) tutor is considered as one of the 12 key roles of any university teacher.3 In PBL programs, lectures play a different role than in traditional curricula being considered as a learning resource for prompting students’ learning. In addition, the role of teacher versus tutor (small-group facilitator) should be viewed as a continuum, with shared skills common to each other, and not be viewed as bipolar. For example, the ability to integrate knowledge is a common feature needed for planning the lecture, and also by PBL tutors through directing a tutorial group to link the different concepts related to the problem of the week by encouraging concept mapping.4

Tutoring in PBL programs is a complex process that needs special skills and techniques. Therefore, recruiting skilled PBL class tutors is one of the challenges in any PBL program. Although subject-matter mastery is one of the predictors for tutoring skills, process expertise is a sine qua non for a PBL tutor. However, a good tutor should balance the “process expertise” with the “content expertise” to conduct a successful PBL tutorial, an intuitive decision in response to the learner needs or learner participation in the classroom. Switching roles between lecturing and tutoring and the implicit conceptions and/or attitudes of some teachers toward the PBL philosophy and how it is implemented remain a challenging task for innovative medical schools.

The findings in our study can also open avenues for future practice and research. First, defining who is a good teacher in PBL programs is still fuzzy and requires the development of instruments with good psychometric properties in order to enhance the research in this area. Second, a paradigm shift in faculty development programs in PBL is essential. Faculty need to be trained in their role as lecturers as well as small-group tutors with great emphasis on the aspects of lecturing skills that predict the PBL tutoring skills. For example, how to maintain a relaxed atmosphere in the classroom, whether in small or large groups, needs to be part of the faculty training in PBL programs. Finally, teaching subject matter in PBL programs must be integrated with approaches, such as metacognitive activities, to enhance the degree to which students will transfer their new learning to other settings.5