It is generally assumed that problem-based learning (PBL) is intrinsically motiuating for students to encourage them to indulge in self-directed learning. Howeuer, there are many factors that affect studednts’ learning througn the small group tutorial. Some of these include the students’ prior knowledge and group dynamics, the tutor’s attitude and facilitation skills and the nature and quality of cases. Since problems are used as the trigget to stimulate learning in PBL, they play a central role in affecting students’ learning. This paper addresses the issue of the role of problems in PBL as used in the Faculty of Medicine, Uniuersity of Malaya, in particular, how the nature of the problems presented to the students has a peruasiue influence on learning and how the actiuation of , and elaboration of , preuiously acquired knowledge has strong facilitatiue effects on the problem discussion by the group. In addition, the use of “twin” cases with similar learning objectiues for different sets of students is also discussed. Our preliminary studies showed that the nature and quality of the cases affected the progression of discussion and the extent of identification of the learning objectiues as compared to the “intended” learning objectiues for the case/ problem. We discouered that using more than one trigger within a case helped direct learning to a certain extent. The initial trigger encouraged the students to explore concepts in breadth and the subsequent trigger helped them to focus their learning and explore in greater depth. Adding certain euents into the case with the intention of triggering the identification of certain learning objectiues was influenced by the students’ prior knowledge and the “intended” learning objectiues were not always achieued.