Acute-on-Chronic Carbamazepine Overdose: A Toxicology Simulation Case for Fourth-Year Medical Students.
- 1Medical Student, Virginia Commonwealth University School of Medicine.
- 2Associate Professor, Department of Emergency Medicine, and Attending Physician, Division of Clinical Toxicology, Virginia Commonwealth University Health.
Abstract
Introduction
Carbamazepine is an antiepileptic medication used to treat seizures, trigeminal neuralgia, and bipolar disorder. Although carbamazepine overdose occurs frequently, it receives limited attention in undergraduate medical curricula. Multimodal, experiential learning provides a safe, structured learning environment. We developed a simulation of carbamazepine overdose to address this educational gap.Methods
Fourth-year medical students enrolled in a toxicology course completed a pretest and a Likert-scale questionnaire assessing confidence in managing carbamazepine overdose. Students received a 30-minute lecture and participated in a 15-minute simulation involving a 26-year-old patient with an intentional carbamazepine overdose followed by a 15-minute debrief. Critical actions included obtaining a focused history, neurological assessment, and carbamazepine level; administering multidose activated charcoal; and requesting toxicology and psychiatric consultation. Required equipment included a high-fidelity manikin, IV supplies, and standard pharmaceuticals. We evaluated students with a critical actions checklist and posttest. Students then completed additional Likert-scale questionnaires assessing workshop reactions, confidence, and intent to change practice.Results
Forty-nine students participated across 10 sessions. Mean pretest and posttest scores were 67% (SD = 19) and 98% (SD = 5), respectively, with significant improvement (Wilcoxon W = 0.0, P < .001). All groups completed the critical actions checklist. Median confidence scores for identifying clinical manifestations, ordering and interpreting diagnostic studies, and initiating treatment increased from 3's and 4's to 5 across all domains (Mann-Whitney U P < .001). Students rated the workshop favorably and most reported intent to change practice.Discussion
Experiential learning is an effective pedagogical technique to teach carbamazepine overdose.
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BibTeX
@article{leung2026acuteonchronic,
title = {{Acute-on-Chronic Carbamazepine Overdose: A Toxicology Simulation Case for Fourth-Year Medical Students.}},
author = {Lauren Leung and Krithika Senthil and John Kothmann and Johnny Bui and Derick Nguyen and Caelan Nzamba and Michelle Troendle},
journal = {MedEdPORTAL : the journal of teaching and learning resources},
year = {2026},
month = oct,
doi = {10.15766/mep_2374-8265.11640},
url = {https://europepmc.org/article/MED/42910297},
note = {CC BY},
}
RIS
TY - JOUR
TI - Acute-on-Chronic Carbamazepine Overdose: A Toxicology Simulation Case for Fourth-Year Medical Students.
AU - Lauren Leung
AU - Krithika Senthil
AU - John Kothmann
AU - Johnny Bui
AU - Derick Nguyen
AU - Caelan Nzamba
AU - Michelle Troendle
PY - 2026
DA - 2026/10/14
JO - MedEdPORTAL : the journal of teaching and learning resources
DO - 10.15766/mep_2374-8265.11640
UR - https://europepmc.org/article/MED/42910297
AB - Introduction Carbamazepine is an antiepileptic medication used to treat seizures, trigeminal neuralgia, and bipolar disorder. Although carbamazepine overdose occurs frequently, it receives limited attention in undergraduate medical curricula. Multimodal, experiential learning provides a safe, structured learning environment. We developed a simulation of carbamazepine overdose to address this educational gap.Methods Fourth-year medical students enrolled in a toxicology course completed a pretest and a Likert-scale questionnaire assessing confidence in managing carbamazepine overdose. Students received a 30-minute lecture and participated in a 15-minute simulation involving a 26-year-old patient with an intentional carbamazepine overdose followed by a 15-minute debrief. Critical actions included obtaining a focused history, neurological assessment, and carbamazepine level; administering multidose activated charcoal; and requesting toxicology and psychiatric consultation. Required equipment included a high-fidelity manikin, IV supplies, and standard pharmaceuticals. We evaluated students with a critical actions checklist and posttest. Students then completed additional Likert-scale questionnaires assessing workshop reactions, confidence, and intent to change practice.Results Forty-nine students participated across 10 sessions. Mean pretest and posttest scores were 67% (SD = 19) and 98% (SD = 5), respectively, with significant improvement (Wilcoxon W = 0.0, P < .001). All groups completed the critical actions checklist. Median confidence scores for identifying clinical manifestations, ordering and interpreting diagnostic studies, and initiating treatment increased from 3's and 4's to 5 across all domains (Mann-Whitney U P < .001). Students rated the workshop favorably and most reported intent to change practice.Discussion Experiential learning is an effective pedagogical technique to teach carbamazepine overdose.
SN - 2374-8265
ER -