How do students who feel “not free to participate” perceived their tutorial sessions in problem based learning?

Background: Verbal interactions are paramount to develop cognitive and social skills of students taught using problem based learning in small group tutorials. Responses to a questionnaire showed that 27% of second year medical students did not feel free to participate in their groups Aim: To explore if these students may have different perceptions respect to their peers, regarding the functioning of their tutorials. Material and Methods: The answer to the item “feel free to participate” was the criterion to allocate students in two groups, study (n = 25) and control (n = 66). The means of the perceptions were compared between groups in the 15 items’ questionnaire. Results: Students in the study group had different perceptions in eight of the items. These students enjoyed and considered interesting the topics addressed in the tutorials less frequently. Also they did not study all learning issues, did not always understand the case and foresaw less opportunities to participate in their groups. Conclusions: Quiet students perceived tutorials different than their more active peers. Those differences concerned motivation and a mixture of cognitive (individual) and social (rest of the group) strategies that were not conducive to build a suitable learning environment for those students in their respective tutorial groups.