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This article describes a detailed analysis of knowledge building in a problem-based learning group. Knowledge building involves increasing the collective knowledge of a group through social discourse. For knowledge building to occur in the classroom, the teacher needs to create opportunities for constructive discourse in order to support student learning and collective knowledge building. In problem-based learning, students learn through collaborative problem solving and reflecting on their experiences. The setting for this study is a group of second-year medical students working with an expert facilitator. The analysis was designed to understand how the facilitator provided opportunities for knowledge-building discourse and how the learners accomplished collective knowledge building. We examined episodes of knowledge-building discourse, the questions and statements that the students and facilitator generated throughout the tutorial, the change in their understanding of the problem that they were solving, and the collective knowledge that was constructed. The results indicate that the group worked to progressively improve their ideas through engaging in knowledge-building discourse. The facilitator helped support knowledge building through asking open-ended metacognitive questions and catalyzing group progress. Students took responsibility for advancing the group's understanding as they asked many high-level questions and built on each others thinking to construct collaborative explanations. The results of this study provide suggestions for orchestrating knowledge-building discourse.