Abstract: The faculty of medicine of the University of Transkei (UNITRA) was established to produce physicians with adequate knowledge, skills, and attitudes to enable them to provide quality healthcare in the rural and under-privileged areas of the then 'homeland' of Transkei. For UNITRA to realise this vision, it adopted an innovative programme that would combine a community-based education (CBE) setting with problem-based learning (PBL) in small group tutorials. This innovative curriculum was commenced in 1992, seven years after the faculty's inception. A major problem that confronting the UNITRA medical faculty was the scarcity of African applicants possessing the pre-requisite higher grade (HG) matriculation passes in mathematics and physical science. Most secondary schools in the African population offered those subjects at standard grade (SG); and the few African students who obtained HG in those subjects chose to enrol in the established medical schools, rather than in the former 'homeland' institution. To address the racial inequality in health care delivery, it was imperative that the intake of African medical students should increase. It was thus decided that a student obtaining good SG passes in mathematics and physical science would be considered for admission into the physician training programme. This policy was effected in 1992, at the same time that the innovative PBL/CBE curriculum was implemented. From 1990 to 1996, the UNITRA medical school graduated physicians trained under the traditional curriculum. From 1997 to date, UNITRA has been graduating physicians trained under the innovative PBL/CBE curriculum. Besides the mode of delivery, and the great emphasis placed on the process of learning, and on metacognitive functions in the PBL/CBE curriculum, students in the two programmes have had similar attributes (educational and social background, faculty, assessment, etc). By the time they completed their training under either curriculum, there was no distinction, on the basis of final year academic achievement, as to which UNITRA medical graduates had entered the programme with HG or SG passes in mathematics and physical science. More interestingly, under the PBL/CBE curriculum, there was a significantly lower attrition rate and a shorter course completion time. In addition, more PBL/CBE graduates have gone into Registrar training programmes than did their 'traditional' predecessors. The changes observed in the cognitive educational outcomes in the two programmes are a reflection on the attributes of the different curricula. We have previously reported on the positive impact that the PBL/CBE curriculum has had on the learning styles and strategies of our students. In the present study, we have gathered evidence to suggest that the PBL/CBE curriculum has a positive impact on the acquisition of knowledge and clinical skills by students in a physician training programme within relatively disadvantaged educational settings.