Acute-on-Chronic Carbamazepine Overdose: A Toxicology Simulation Case for Fourth-Year Medical Students

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.

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.

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.

Experiential learning is an effective pedagogical technique to teach carbamazepine overdose.