Introducing pain physiology to first-year medical students using a team-based learning approach

The basic physiology of pain is a high-yield topic for USMLE Step 1 examinees. Medical students exposed to organ systems-based, integrated pre-clerkship curricula most frequently interact with this topic during the Neurology course frequently offered in Year 2. We identified an opportunity to introduce the foundational physiology of pain perception in the Musculoskeletal System, Skin, and Hematology/Oncology (MSH) course, the first organ-system course for first-year medical students at New Jersey Medical School. To address the paucity of active-learning strategies focused on the fundamental physiological principles of pain, we developed a team-based learning (TBL) exercise that can be easily implemented in-person or online. One cohort of first-year medical students (n=171) were required to asynchronously complete the advance preparation via a pre-recorded podcast lecture on the basic physiology of pain, followed by individual and team readiness assurance testing (iRAT and tRAT, respectively). The team application module consisted of two short clinical cases which required students to work in small groups to discuss and answer eight multiple-choice or multiple-answer questions, followed by a class discussion. Students were surveyed about their level of confidence on achieving the four learning objectives (LO) of the session before (Pre-TBL; n=171) and after (Post-TBL; n=31) the TBL exercise using a five-point Likert-scale (1-no confidence; 5-full confidence). The Pre-TBL survey included an optional, open-ended question about student expectations. The Post-TBL survey included optional, open-ended questions about: 1) the aspects of the session they enjoyed; and 2) the changes they would implement. Qualitative Pre-TBL survey data shows that a majority of respondents expected to gain a better understanding of pain perception, and the ability to apply knowledge of pain physiology to clinical scenarios and patient care. Comparisons between the Pre- and Post-TBL responses for all Likert-scale questions indicate a shift towards higher degrees of confidence in achieving all four LOs after the activity; a one-tail t-test showed statistically significant differences for LO2 (Pre-TBL mean = 3.06 ± 0.84; Post-TBL mean = 3.38 ± 1.13; P = 0.036) and LO4 (Pre-TBL mean = 3.08 ± 0.89; Post-TBL mean = 3.44 ± 1.13; P = 0.024). Frequency distributions of student confidence levels of all LOs shows increased skewness on Post-TBL survey results, consistent with a shift towards higher confidence levels. Qualitative Post-TBL survey data indicates that students appreciated the challenging clinical scenarios, the ability to discuss the questions in small groups, and the explanations of question answers during class discussion. Taken together, our data supports the implementation of active learning teaching strategies such as TBL to introduce complex physiological concepts to first-year medical students. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.