Perception and implementation gaps in active teaching and learning: a mixed-methods study of students and tutors in a medical degree program.

Background: Active Teaching and Learning methods (ATLs) are increasingly incorporated into undergraduate medical curricula. However, discrepancies often exist between educators' intentions and students' experiences. This study explored the perceptions of medical students and tutors regarding active learning within tutorial-based sessions at a Middle Eastern medical school. Methods: A cross-sectional mixed-methods study was conducted at a Middle Eastern medical school. Phase II medical students and tutorial facilitators completed parallel perception surveys assessing engagement, satisfaction, and use of active learning strategies. Quantitative data were analyzed descriptively. Four student focus groups were conducted, and qualitative data were analyzed using inductive thematic analysis. Results: Fifty-two students and twenty-nine tutors participated. While most tutors reported frequent use of active learning strategies and high satisfaction with tutorial delivery, students reported limited engagement and low satisfaction, with only 9.6% rating tutorials positively. Qualitative analysis identified three key themes: tutor-dominated sessions with limited interactivity, misalignment between tutorial activities and learning objectives, and structural barriers including large group size and inadequate resources. Tutors acknowledged limited training and preparation time as additional challenges. Conclusion: Substantial perception gaps exist between tutors and students regarding active learning implementation. Although tutors report frequent use of active strategies, students often experience tutorials as passive and minimally interactive. Addressing these gaps requires structured faculty development in facilitation skills, reduction of tutorial group size, clearer alignment between tutorial cases and stated learning objectives, and systematic monitoring of implementation fidelity.