This is my last reply with respect to your misfortune as to not derail the thread any further.
Based on your account, Dr. McColl's response sounded inappropriate only when the discussion of procuring an extra 100k in loans was trivialized. Saying that his behavior made him look "high on something" does not advance your plight because it leads me to think (not that you care what my opinion is) you are prone to misconstrue words. For example noting that he referred to your stutter as an "attribute" when it was noted in the dysphagia OSCE eval. I truly am sorry for all you went through, but merely saying someone "failed students intentionally" does not mean this is in fact the case or absolves you of your performance.
Based on the OSCE evaluations I agree with you that some points were deducted far too stringently (for example, palpating with radial pulse instead of using the cuff + stethoscope). And while it is understandable to forget details when carrying out the expected steps in OSCEs, you fail to mention glaring issues such as failing to recognize a potentially fatal hypertensive crisis (185 systolic!) despite using a better measuring technique (I'll get back to this later), and you emphasize receiving minimum discretionary scoring partly due to being provided the incorrect vacutainer tubes when the criteria for the subjective scoring included soft skills like "appeared confident" which are undermined by eval comments like "had difficulty applying tourniquet" and "extreme difficulty with the procedure." For the dysphagia OSCE, this sentence you wrote stood out in particular "
All these questions are rather irrelevant and have no bearing on the diagnosis and what’s worse is they are not mentioned in the PBL." It appears that your expectation was to re-enact the PBL in-person rather than as a stand-alone OSCE
relevant to the PBL. I assume that the OSCE was handled similar to would happen in real practice. If you say "let's do a Ba swallow" then you would not readily obtain an endoscopy image unless ordered. Furthermore, you say "
In the PBL it CLEARLY states that a barium swallow procedure should be performed first to determine the level of obstruction." Yet in your blog the linked PBL mentions the first physician orders a Ba swallow and then refers the pt to a gastroenterologist who subsequently performs "further investigation" by means of an "
endoscopic procedure". I cannot fathom a PBL session that did not discuss the diagnostic value of a simple x-ray image vs. a endoscopic biopsy or image. Still there should be a natural comparison of why both procedures were ultimately performed as well as their benefits and limitations. As to the eval question in the dysphagia OSCE, it asks "what investigation would you request to
establish a diagnosis?" There is more value in knowing why something happens (endoscopy w/biopsy) rather than where it happens (Ba swallow) especially when Barrett's esophagus is strongly suspected but the problem could have been mechanical as well (obstructed esophagus). Even if that was not explicitly stated in the PBL session, there are clues within the PBL packet that place the onus of clue recognition and learning on the learner. By this I mean the PBL asks questions like "Are symptoms suggestive of a medical obstruction or a mobility problem or is it not possible to say?" In the patient history mentions difficulty swallowing ("a piece of carrot seemed to get stuck for ages in his chest") which sounds like possible a physical problem (obstruction) but also weight lost and smoking should ring possible cancer bells that are explored with the mention of mild esophageal dysplasia that was obtained
endoscopically. What I'm saying is, the PBL, being bare bones as it is, was tool to guide your discernment rather constrain your reasoning.
Lastly you write, in response to the Venipuncture OSCE and Dr. Trumble's letter that "
there were no marks available for estimating it (blood pressure
) by auscultation, as this is a poor discriminator of performance." The exact words in the letter were "no marks [were] awarded for auscultation at the antecubital fossa = this is a given and is not worthy of reward." Furthermore, "other actions such as placing the stethoscope's diaphragm over the antecubital fossa or removing the cuff at the end are not good discriminators and do not warrant marks." The point of checking the radial artery was not to obtain an accurate BP measurement because it
simply is not accurate, in fact Dr. Trumble explains the evaluator noted "no marks were awarded for estimating systolic blood pressure by palpation" (because systolic BP is not measured there) but rather evaluators looked to see if there was a "correct level of cuff inflation" which was not achieved since the cuff was elevated to 160 mmHg (30 mmHg + 130 mmHg reported) and the OSCE patient actually had 185 mmHg.
