INTRODUCTION Problem-based learning harmonized with education in and for the community is the cornerstone of the curriculum for the undergraduate medical degree at Walter Sisulu University, Mthatha, South Africa. In tutorials, students construct knowledge and learn to work collaboratively while interacting with one another in their search for solutions to a pedagogically modeled health issue based on a patient. Problems cover students' needs defined by the learning cycle of the second year medical curriculum, organized into four learning blocks. OBJECTIVES Determine student perspectives on which factors affect tutorial group functioning and detect the reported presence of these factors in the four learning blocks comprising the second year of medical studies at Walter Sisulu University. METHODS Twenty second-year medical students were chosen by stratified random sampling and assigned to two focus groups. One group discussed factors that foster smooth functioning of the tutorial group; the other focused on factors hindering effective group work. Later, in a joint session, 17 items previously identified by both groups were selected and included in a survey given to all 97 students at the end of second year. The survey assessed presence of each item in 0, 1, 2, 3 or 4 of the learning blocks. RESULTS Survey response was 93.8%. Mean reported presence of factors that influenced tutorials in the four learning blocks was 2.71 (SD 0.31) for the social dimension, 3.02 for motivational (SD 0.02), 3.00 for cognitive (SD 0.42), and 2.22 for self-directed learning (SD 0.79). CONCLUSIONS Tutorial group performance at Walter Sisulu University is positively influenced more by motivational and cognitive factors than by social and self-directed learning factors. Social dimensions should be prioritized when training tutors and self-directed learning stressed for students. The poor productivity of extra-tutorial group discussions suggests the need for a critical evaluation of this activity.

The present paper organized information that supports problem based learning as an educational strategy of choice whenever integration and curricular contextualization are required to develop a doctor that should be a communicator, able to work in teams and educate the individual and the community to live a healthy life as well as highlight and manage with capacity and professionalism those aggressiveness to health. The Primary Health Care teaching scenarios where Cuban doctors are formed, enable the design and creation of a more revolutionary learning model where the identification of the prevailing health problems may become an essential curriculum tool, whose didactic transformation to teaching problems may enable to achieve competences and professional performance;in this way, problem based learning occurs within and for Primary Health Care.

El presente trabajo organizó información que sustenta cómo el aprender solucionando problemas constituye una estrategia educacional de elección cuando se persiguen la integración y contextualización curriculares, para formar un médico que deberá ser un comunicador, capaz de trabajar en equipos y de educar al individuo y a la comunidad a vivir con sanidad, al tiempo que detectar y manejar con capacidad y profesionalidad las agresiones a la salud. Los escenarios de la Atención Primaria de Salud donde se forma el médico cubano, pueden permitir el diseño y creación de un modelo de aprendizaje aún más revolucionario, porque la identificación de los problemas de salud prevalentes se torna esencial recurso curricular a nivel del macro currículo, y esta precisión, permite su transformación didáctica en problemas docentes en función de lograr las competencias y desempeño profesional, de este modo el aprender solucionando problemas ocurre en y para la Atención Primaria de Salud.

In the 20th century, the basic biomedical sciences (particularly anatomy, histology, embryology, physiology and biochemistry) were taught predominantly in the first semesters of Cuban medical education, with differing curricular connections between these and the clinical sciences. Establishment of the University Polyclinic Program in 2004 laid the foundation for integration of basic biomedical sciences into a transdisciplinary unit designated morphophysiology. This paper argues for improvements in this curricular unit and in its coordination with family medicine in the first semesters of medical training, complemented by integration of basic biomedical sciences into family medicine clinical courses throughout the remainder of the six-year curriculum.

The present paper was aimed at presenting some considerations on the present situation and the possibilities of the improved curriculum for the medical career in Cuba as to the development of scientific thinking linked to clinical reasoning and the role that the basic biomedical sciences should play in the formation of physicians within the present professional model. There were used theoretical methods to establish the referential context and to shape the considerations connected to the stated objective. The integration of the BBS and the clinical sciences at early stages and throughout the complete process of medical formation offers several advantages to lay the foundations for more effective transfer of professional performances and better development of the clinical reasoning. The inclusion of Morphophysiology discipline in the medical studies in Cuba is a step forward in the road to curricular updating and modernization, though further improvement is still needed. Nevertheless, the transit to adequate integration of the basic biomedical and the clinical sciences in the curricular improvement requires that this integration be part of the medical formation policy in Cuba, with the corresponding promotion of the academic environment in the teaching-assistance institutions. The presence of BBS in the upgraded base curriculum should respond to the principle of relevance in terms of the learning requirements of clinics derived from the professional model to be set. The adjustments for the formation of foreign students may be made through suitable utilization of a flexible curriculum.

El objetivo del presente trabajo es exponer algunas consideraciones acerca de la situación actual y posibilidades de perfeccionamiento curricular para la carrera de Medicina en Cuba, en lo concerniente al desarrollo del pensamiento científico vinculado al razonamiento clínico y el papel que le corresponde jugar a las ciencias básicas biomédicas (CBB) en el contexto de la formación de los médicos que se proyectan en el modelo del profesional vigente. Se aplicaron métodos teóricos para el establecimiento del marco referencial y para la conformación de las consideraciones relativas al objetivo declarado. La integración de las CBB con las clínicas desde etapas tempranas y a lo largo de toda la carrera en el proceso de formación médica, ofrece ventajas para sentar las bases de una transferencia integradora de modos de actuación profesional más efectiva y un mejor desarrollo del razonamiento clínico. La existencia de la disciplina Morfofisiología en la carrera de Medicina en Cuba, es un paso adelante, aunque perfectible, en el camino de la actualización y modernización curricular. No obstante, el tránsito hacia una adecuada integración de las CBB con las ciencias clínicas en el perfeccionamiento curricular requiere que pase a formar parte de la política formativa de médicos en Cuba, con el fomento del ambiente académico en las instituciones docente-asistenciales. La representación de las CBB en el currículo base perfeccionado debiera responder al principio de pertinencia, respecto de las necesidades de aprendizaje de la clínica, derivadas del modelo del profesional que se establezca. Los ajustes para estudiantes extranjeros pueden lograrse mediante una apropiada utilización del currículo flexible.

The leading role demanded from the executants and actors, of the organization of the active educational and teaching process in the disciplines of health sciences is guarantee of past and future professional excellence. The professor has the responsibility of having the student to take a method that allows for discovering the regularities of his/her particular science, where there is always place to incorporate new things. The formulation of objectives with a productive assimilation level, the search of an algorithm to approach the contents, the design of a system of abilities and the use of active methods have been the didactic strategies followed in the enhancement of the study program of Embriology in Medicine. In order to favour the role of the student, the time for seminars was increased, while the time of conferences was reduced. In addition, the problem-solving method is approached in the different forms of organization of the teaching process.

El protagonismo que demanda -de conductores y actores- la organización del proceso docente-educativo activo en las disciplinas de las carreras de ciencias de la salud, es garantía de excelencias profesionales presente y futura. El profesor tiene la responsabilidad de que el alumno se apropie de un método que le permita descubrir las regularidades de su ciencia particular, donde siempre quede espacio para incorporar lo nuevo. La formulación de objetivos con un nivel de asimilación productivo, la búsqueda de un algoritmo para abordar los contenidos, el diseño de un sistema de habilidades y el empleo de métodos activos han sido las estrategias didácticas seguidas en el perfeccionamiento del plan de estudio de la disciplina embriología para la carrera de medicina. Para favorecer la función del estudiante se incrementaron las horas de seminarios a expensas de la reducción de conferencia y se incursiona en el método problémico en las diferentes formas de organización de la enseñanza.