Is home care clinical?

[unumsolum]

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I worked for a few hundred hours taking care of a person with physical and psychiatric disabilities in their home. Got paid, used my CNA cert, and not a family member. I've been considering this clinical but now I'm wondering if it really "counts"?

The vast majority of the job was spent caring directly for the client, not just doing chores/errands etc. Same tasks I did in a nursing home, but I didn't learn anything about what a medical facility looks like backstage so that makes me wonder.

 

[LizzyM]

Did you consider the person a patient? If you needed CNA certification to get the job, I'd consider it clinical if you wrote it up that way on the application.

 

[Catalystik]

Did you consider the person a patient? If you needed CNA certification to get the job, I'd consider it clinical if you wrote it up that way on the application.

I agree.

 

[eigen]

I think this is one where you want to be very thoughtful in how you describe it on your work and activities, because "home care" can mean a lot of different things. Being specific about your duties and showcasing the clinical side (need for certification / training) is important.

You don't want someone to misunderstand the hours, since it's (relatively) easy to have high hours doing home care if you're spending nights sleeping "on-call" or weekends but are mostly doing errands / helping around the house and not actively delivering clinical care. As such, you want to be certain that people aren't making assumptions about your particular home care work.

 

[unumsolum]

I think this is one where you want to be very thoughtful in how you describe it on your work and activities, because "home care" can mean a lot of different things. Being specific about your duties and showcasing the clinical side (need for certification / training) is important.

You don't want someone to misunderstand the hours, since it's (relatively) easy to have high hours doing home care if you're spending nights sleeping "on-call" or weekends but are mostly doing errands / helping around the house and not actively delivering clinical care. As such, you want to be certain that people aren't making assumptions about your particular home care work.

Yeah it was all 5 hour shifts without downtime, out of that 4 ish hours would be hygiene care, transfers, ROM exercises, etc. Client required quite a bit of care. The rest would be chores but not much total

 

[unumsolum]

Did you consider the person a patient? If you needed CNA certification to get the job, I'd consider it clinical if you wrote it up that way on the application.

*technically* a client but I do think it's completely fair to call them a patient

 

[Goro]

I think of them of patients as this type of activity brings you up front and personal with our morbidity and mortality.

You could always call them clients and let the Adcom decide what been the activity goes into.

 

[LizzyM]

Clients is a new thing.... that the client is in command and not a passive recipient of care. I don't like it (the term, not the sentiment). (I'm old.)

 

[Mr.Smile12]

I can be convinced it can be clinical assuming the necessary certifications and quality control. Home care is a less expensive (on the healthcare system) way of rehabilitation. The quality control aspect is extremely important so describe it if you are asked.

 

[unumsolum]

I can be convinced it can be clinical assuming the necessary certifications and quality control. Home care is a less expensive (on the healthcare system) way of rehabilitation. The quality control aspect is extremely important so describe it if you are asked.

Awesome, thanks! Could you elaborate what you mean by quality control?

 

[polymerization]

You have virtually no space on the application to go around in circles describing this experience with nuance. Your role is best described as CNA, just working 1:1 in an outpatient setting. Unless you were hired directly by the patient in this case (as opposed to a healthcare staffing company), I think it's safe to say this would be clinical and you should focus your attention in describing your role around recognizable facets of the nurse role (e.g., med rec/pass, assistance with ADLs, wound care, patient education).

Given your likely patient's status, it might also be a narrative opening for you to talk about your interest in memory care, geriatrics, community health... it all depends on the rest of your application and your vision for the rest of your life. Don't let it just be something you did for months of your life—you got to know this person very closely; above and beyond the tasks, what did it mean to you? Even if you don't elaborate in Work & Activities, this is something you can talk about in secondaries or interview.

 

[eigen]

You have virtually no space on the application to go around in circles describing this experience with nuance. Your role is best described as CNA, just working 1:1 in an outpatient setting. Unless you were hired directly by the patient in this case (as opposed to a healthcare staffing company), I think it's safe to say this would be clinical and you should focus your attention in describing your role around recognizable facets of the nurse role (e.g., med rec/pass, assistance with ADLs, wound care, patient education).

Sure you do? That's what the description in the Work & Activities section is for.

 

[polymerization]

Sure you do? That's what the description in the Work & Activities section is for.

Right. I mean that OP doesn't have the characters to spend a majority of their entry over-explaining a role that is decipherable even by laypeople.

In other words, I think this is another form of institutional gatekeeping.

Is there really a difference between injecting a patient at the nursing home vs the clinic vs the hospital? I've worked in clinic roles within the medical arts building of a community hospital (and next door to a nursing home) where we occasionally saw and treated patients across all three settings. It was honestly more of a challenge outside of the clinic or hospital, because you can only take with you what you can carry—and often the patients have chronic mobility and mental status issues that makes working with them even harder. Staff are often poor historians, so you just kind of have to try and do right by the patient within your role the best you can. I think, in some instances, to work in what some consider a less "formal" position can paradoxically require more skill, foresight, and leadership than otherwise.

Not at all pointed at you, but I'm generally exposing how some forms of work are less institutionally legible than others. Everyone knows what a CNA is and does, but if you're working outside of a setting medicine recognizes, you get demoted to lowly "home health aide," which might as well just be a personal assistant sans boundaries if they were to describe it in milquetoast fashion like they do here.

So, my advice to OP is to describe it like a CNA role because it is...I think their time and effort is better spent considering why it was important to them as opposed to trying to convince an imaginary audience of an implicit bias that they are unintentionally inspiring by beating around the bush.

 

[Mr.Smile12]

Awesome, thanks! Could you elaborate what you mean by quality control?

Briefly, your supervisor might do an unannounced check-in visit and make sure you are doing your job.

 

[eigen]

So, my advice to OP is to describe it like a CNA role because it is...I think their time and effort is better spent considering why it was important to them as opposed to trying to convince an imaginary audience of an implicit bias that they are unintentionally inspiring by beating around the bush.

No matter how challenging it is to describe a situation with nuance, I would never recommend an applicant describe a job as something other than what it was for both ethical and practical reasons. If someone decides to call their employer and the OP has described it as a CNA position / titled it as a CNA position and the employer does not list it as a CNA position, this will be interpreted as the OP not being truthful on their application.

As an example, I used to work at a school that didn't have a Biochemistry major, but had a Biochemistry track within the chemistry major. Many students got in the habit of colloquially referring to themselves as "biochemistry majors", to avoid having to explain the nuance of the situation. And then I had a student who listed their major as "Biochemistry" on their AMCAS application and ran into difficulties and delays because they did not, actually, major in biochemistry.

Most applicants have odd entries in their work and activities that require nuance to describe, or at least most of my students do. Part of being an effective physician is effective communication of nuance.

Right. I mean that OP doesn't have the characters to spend a majority of their entry over-explaining a role that is decipherable even by laypeople.

The OP can easily just describe the role and their responsibilities. It's not hard, and there are more than enough characters for that. Based on what they've shared, something like "Used my CNA certification to provide in-home care for a client, working in 5 hour shifts with a focus on providing hygiene care, transfers, and ROM exercises" is more than enough to adequately describe what they did as clinical care with nuance.

 

[unumsolum]

Briefly, your supervisor might do an unannounced check-in visit and make sure you are doing your job.

This did happen yeah

 

[polymerization]

No matter how challenging it is to describe a situation with nuance, I would never recommend an applicant describe a job as something other than what it was for both ethical and practical reasons. If someone decides to call their employer and the OP has described it as a CNA position / titled it as a CNA position and the employer does not list it as a CNA position, this will be interpreted as the OP not being truthful on their application.

As an example, I used to work at a school that didn't have a Biochemistry major, but had a Biochemistry track within the chemistry major. Many students got in the habit of colloquially referring to themselves as "biochemistry majors", to avoid having to explain the nuance of the situation. And then I had a student who listed their major as "Biochemistry" on their AMCAS application and ran into difficulties and delays because they did not, actually, major in biochemistry.

Most applicants have odd entries in their work and activities that require nuance to describe, or at least most of my students do. Part of being an effective physician is effective communication of nuance.



The OP can easily just describe the role and their responsibilities. It's not hard, and there are more than enough characters for that. Based on what they've shared, something like "Used my CNA certification to provide in-home care for a client, working in 5 hour shifts with a focus on providing hygiene care, transfers, and ROM exercises" is more than enough to adequately describe what they did as clinical care with nuance.

I think everyone should be truthful on their application as a manifestation of the integrity that the profession requires. That said, there is such a thing as strategic positioning and bringing to the forefront the tasks that most typify the role in the 700 characters provided. If I'm literally assisting in surgery for 99% of my day and bring a patient a cup of water because they're feeling faint, I'm not writing about the water in my essays. If I graduated with a degree in X and I call it a degree in Y—that's just a straightforward error. I don't think that describes this situation.

The OP got a CNA certification and was hired to be a CNA, and engaged in CNA work. I would argue that calling it anything else would be a disservice to OP's experience and credentials. There are a lot of people who don't bother to go through a training program and learn on the job—they call themselves CNAs (or RMAs, or PCTs—and may not actually hold the credential—so what does the C in CNA really mean in this case—is that lying too?).

Again, I'm by no means arguing that applicants should game or lie at all throughout this process. But on the other side of things, admissions games the process in the opposite direction (by threatening to "verify" references), even when most admissions deans will openly admit that it would be physically impossible to verify every activity for every student, and the application essentially works on an honor system. Even if they did want to verify activities, which ones would they verify and why?

Is there something about a CNA role that lists "medication reconciliation/pass, assistance with activities of daily living, wound care, and patient education" in the description that would raise red flags for you? Or, does it just seem like something you'd take issue with based on what OP has already shared about the role?

 

[eigen]

The OP got a CNA certification and was hired to be a CNA, and engaged in CNA work.

That's not how I read this job. The OP had a certification, and engaged in work that used their training.

They were not, by my read, hired to be a CNA, which is a specific job. They were hired to do home healthcare for a client.

There are a lot of people who don't bother to go through a training program and learn on the job—they call themselves CNAs (or RMAs, or PCTs—and may not actually hold the credential—so what does the C in CNA really mean in this case—is that lying too?

Yes. Nursing certification varies by state (some states have similar positions other than a CNA), but they are specific positions that require passing and maintaining a certification with a state board of nursing. If you do not have that certification, or are hired for a job other than a CNA, then calling it a "CNA" position is not correct.

Similarly, you may be hired as a PCT based on your CNA certification, but that doesn't make the job a CNA position: it's still a PCT job. Many entry level positions (for e.g., PCT) can be done by someone with one of many different entry level certifications. The certification is not the job. A physician working as an EMT doesn't put down that they're a physician: the job is EMT.

Is there something about a CNA role that lists "medication reconciliation/pass, assistance with activities of daily living, wound care, and patient education" in the description that would raise red flags for you? Or, does it just seem like something you'd take issue with based on what OP has already shared about the role?

The OP has been clear that they were not hired as a CNA. Listing it as a CNA position is not honest or correct. You seem to be advocating that the OP list the job as other than what they were hired as because it makes it "easier" and fits into a clean box. I disagree with that advice. Especially because it's ethically more straightforward and just as easy to list the job as "Home Health" or whatever the actual title is, and then give a description that says exactly what they did. No one will have difficulty interpreting that.

Again, I'm by no means arguing that applicants should game or lie at all throughout this process. But on the other side of things, admissions games the process in the opposite direction (by threatening to "verify" references), even when most admissions deans will openly admit that it would be physically impossible to verify every activity for every student, and the application essentially works on an honor system. Even if they did want to verify activities, which ones would they verify and why?

They don't verify all of them. But they do verify some of them. Being dishonest on your application is a risk that might come with a very significant downside. Not sure how it's "gaming the system" for admissions committees to... tell applicants to not lie in their application because they do occasionally verify things? "I don't have to be honest because the chances of me getting caught are low and being dishonest is easier" is not a good look for people who want to go into medicine, a career where ethics and not cutting corners when things are challenging is important.

Similarly, playing fast and loose with certifications and credentials in a field where they're very important is also not a good idea.

 

[unumsolum]

That's not how I read this job. The OP had a certification, and engaged in work that used their training.

They were not, by my read, hired to be a CNA, which is a specific job. They were hired to do home healthcare for a client.

Yes. Nursing certification varies by state (some states have similar positions other than a CNA), but they are specific positions that require passing and maintaining a certification with a state board of nursing. If you do not have that certification, or are hired for a job other than a CNA, then calling it a "CNA" position is not correct.

Similarly, you may be hired as a PCT based on your CNA certification, but that doesn't make the job a CNA position: it's still a PCT job. Many entry level positions (for e.g., PCT) can be done by someone with one of many different entry level certifications. The certification is not the job. A physician working as an EMT doesn't put down that they're a physician: the job is EMT.

The OP has been clear that they were not hired as a CNA. Listing it as a CNA position is not honest or correct. You seem to be advocating that the OP list the job as other than what they were hired as because it makes it "easier" and fits into a clean box. I disagree with that advice. Especially because it's ethically more straightforward and just as easy to list the job as "Home Health" or whatever the actual title is, and then give a description that says exactly what they did. No one will have difficulty interpreting that.

They don't verify all of them. But they do verify some of them. Being dishonest on your application is a risk that might come with a very significant downside. Not sure how it's "gaming the system" for admissions committees to... tell applicants to not lie in their application because they do occasionally verify things? "I don't have to be honest because the chances of me getting caught are low and being dishonest is easier" is not a good look for people who want to go into medicine, a career where ethics and not cutting corners when things are challenging is important.

Similarly, playing fast and loose with certifications and credentials in a field where they're very important is also not a good idea.

I'm not sure I agree with this. Is it not a CNA job if I have a certification and use the exact skills from that certification on the job, regardless of whether or not PCTs are also hired? I was even paid a specific rate for CNAs higher than non-certified PCTs. If you were to call up my agency and ask if I worked as a CNA they would certainly say yes.

Either way, the specifics don't matter too much, sounds like this experience is indeed clinical.

 

[eigen]

If you were hired as a CNA and your employer would say you are a CNA in their employ, then yes, that’s correct. That wasn’t what I got from your earlier description. If, for example, you were a CNA but were hired as a PCT, then you would want to list the employment as a PCT.

 

[polymerization]

That's not how I read this job. The OP had a certification, and engaged in work that used their training.

They were not, by my read, hired to be a CNA, which is a specific job. They were hired to do home healthcare for a client.

Yes. Nursing certification varies by state (some states have similar positions other than a CNA), but they are specific positions that require passing and maintaining a certification with a state board of nursing. If you do not have that certification, or are hired for a job other than a CNA, then calling it a "CNA" position is not correct.

Similarly, you may be hired as a PCT based on your CNA certification, but that doesn't make the job a CNA position: it's still a PCT job. Many entry level positions (for e.g., PCT) can be done by someone with one of many different entry level certifications. The certification is not the job. A physician working as an EMT doesn't put down that they're a physician: the job is EMT.

The OP has been clear that they were not hired as a CNA. Listing it as a CNA position is not honest or correct. You seem to be advocating that the OP list the job as other than what they were hired as because it makes it "easier" and fits into a clean box. I disagree with that advice. Especially because it's ethically more straightforward and just as easy to list the job as "Home Health" or whatever the actual title is, and then give a description that says exactly what they did. No one will have difficulty interpreting that.

They don't verify all of them. But they do verify some of them. Being dishonest on your application is a risk that might come with a very significant downside. Not sure how it's "gaming the system" for admissions committees to... tell applicants to not lie in their application because they do occasionally verify things? "I don't have to be honest because the chances of me getting caught are low and being dishonest is easier" is not a good look for people who want to go into medicine, a career where ethics and not cutting corners when things are challenging is important.

Similarly, playing fast and loose with certifications and credentials in a field where they're very important is also not a good idea.

I think the way the thread has shaken out is a beautiful display of how institutional gatekeeping actually takes place; the weaponization of application details; and ultimately, the reality that much of what happens throughout this process is a matter often more aptly described by semantics than material differences in activities.

I acknowledge that sounds bold, but let's just consider for a second that nothing has factually changed throughout the thread. That their employer likely would have acknowledged their work as a CNA would seem logical and expected in many different contexts. For what it's worth, I've met many an administrator that doesn't know the difference between entry-level clinical roles. I've heard people confuse MAs and PAs. For that reason, I've noticed that many organizations have moved to call their roles really odd things. I've seen things like a "Care Partner" title to mean anything from dialysis technician, to phlebotomist, to sitter, to EMT.

Often, these roles are a way to fade professional boundaries and cross-train someone to work across scopes of practice. They'll take all kinds of certifications to do this poorly circumscribed role—because ultimately, any real medical work of consequence would require further licensure with protected titles (registered nurse, physician assistant, physician, and so on). These jobs are exploitative, underpaid, and target marginalized communities that do not have the network to "do pre-med" the privileged way—often through formal channels, with formal certifications, all facilitated by both the ways and means of social capital. In other words, this situation disproportionately affects those lacking better opportunities: they are often worked harder for longer, under more precarious circumstances. And posteriorly, they are punished for lacking a more acceptable title, even if the work is equivalent. It really comes across as a big "gotcha" that ultimately reflects on the admissions community as intellectually dishonest and in many ways turning the knife on a population of students that they outwardly encourage to apply, at great cost to them.

You conceded on technicality, but I beg you to consider whether there actually exists any substantive difference between the employer acknowledging that the role is called CNA vs. something else? Are you even truly convinced of your own concession to the OP, knowing what you know?

I really do think this is a fantastic opportunity to talk about what the purpose of the application really is and what you are actually evaluating... I don't know if this is really the platform or avenue to do it, but you have given me so much to think about. Thank you so much for sharing your views.

 

[eigen]

I think the way the thread has shaken out is a beautiful display of how institutional gatekeeping actually takes place; the weaponization of application details; and ultimately, the reality that much of what happens throughout this process is a matter often more aptly described by semantics than material differences in activities.

Accurately reporting your job titles isn't gatekeeping, nor is it limited to pre-meds or med school applications. It's equally of consequence in the rest of the working world. I have many job titles on my resume or CV that may or may not accurately reflect what I think the job should have been called. That doesn't mean I change the job title.

The OP has confirmed they were hired as a CNA, so they report it as a CNA. This is different than what you suggested, which was that they should report the job as a CNA *even if* they weren't hired as a CNA but it was close enough.

They'll take all kinds of certifications to do this poorly circumscribed role—because ultimately, any real medical work of consequence would require further licensure with protected titles (registered nurse, physician assistant, physician, and so on). These jobs are exploitative, underpaid, and target marginalized communities that do not have the network to "do pre-med" the privileged way

It is amazingly disappointing to me that as a future physician you view many of the people who will be your essential colleagues doing the vast majority of day-to-day patient care for your patients to be "not doing real medical work", and positions that only seem to exist to "exploit pre-med students".

You might be surprised that the vast majority of PCTs, phlebotomists, CNAs, and other similar positions aren't pre-meds at all, priveleged or not. And they do essential jobs that are critical to patient care, and are very much "real medical work of consequence".

You seem to have some pretty extreme blinders when it comes to this, as well as an axe to grind that is not relevant to the OP or this thread, so I'm going to leave the discussion here.

 

[polymerization]

The OP has confirmed they were hired as a CNA, so they report it as a CNA. This is different than what you suggested, which was that they should report the job as a CNA *even if* they weren't hired as a CNA but it was close enough.

I did not get the impression that OP has yet attested to being formally hired with an explicit CNA title (even now, only that their employer would describe them that way), and indeed would not have been a point of contention at all had OP been confident about listing it that way from the outset.

I'm sorry to have disappointed you, although that seems a rather extreme reaction. The pearl-clutching about how this is all "real work" while insisting it is ostensibly not so within the genre of medical school admissions is equally bewildering.

So it goes.

 

[eigen]

I'm sorry to have disappointed you, although that seems a rather extreme reaction. The pearl-clutching about how this is all "real work" while insisting it is ostensibly not so within the genre of medical school admissions is equally bewildering.

Literally no one has insisted that, other than you. I think you're reading things into the discussion that are not there. The only assertions that have been made are that (a) it needs to involve patient care to be considered clinical (which everyone has agreed it is), and (b) the description should clarify the job duties to make sure it's clearly differentiated from other home-health work that does not involve clinical care.

The description is there to be clear on what your responsibilities were when the job title is ambiguous, which is often.

 

[polymerization]

Literally no one has insisted that, other than you. I think you're reading things into the discussion that are not there. The only assertions that have been made are that (a) it needs to involve patient care to be considered clinical (which everyone has agreed it is), and (b) the description should clarify the job duties to make sure it's clearly differentiated from other home-health work that does not involve clinical care.

The description is there to be clear on what your responsibilities were when the job title is ambiguous, which is often.

You know, a lot of folks would see your insistence on formal titles over substantive ones as a form of disenfranchisement. Ironically, physicians are at the center of a hot bed of controversies around how they (and other healthcare professionals) refer to themselves and each other.

Try and tell a physician to write "Provider" as an entry on their CV, just because their hospital titles their apex that way.

I hear the American Society of Anesthesiologists has a bone to pick with CRNAs because they are beginning to call themselves "nurse anesthesiologists."

The medical community wholesale has come out against PAs trying to distinguish themselves from MAs by rebranding themselves as "physician associates."

And yet, there are rich kids with doctor parents who have years of coffee-fetching under the "formal" title of Clinical Manager at Uncle Bob's clinic who get Rhodes scholarships for substantively lying, only laundered through institutions only available to (you guessed it) much of the population applying to a super high-barrier-to-entry process like medicine.

I know it is not comfortable to talk about and that there are no easy answers, but oversimplifying the argument or attacking one I did not make doesn't help anyone. Ultimately, I'm here to learn—and believe me, I'm learning a lot.

 

[LizzyM]

I might add that among the adcom members I know, many could not distinguish a PCT from a CNA. All they care about is whether the applicant reports having had a "clinical experience" with patients at the bedside. That can be in a home setting, ambulance, outpatient setting, or inpatient setting.

If a job required a CNA certificate, it sounds like it was a clinical job and the adcom won't split hairs over the job title. In some ways, we're there to check a box and this checks the box.

 

[eigen]

You know, a lot of folks would see your insistence on formal titles over substantive ones as a form of disenfranchisement. Ironically, physicians are at the center of a hot bed of controversies around how they (and other healthcare professionals) refer to themselves and each other.

It's interesting that you bring this up in this particular fashion: you've made several comments that lead me to think you're assuming I'm a physician or sit on admissions committees. I'm just a humble Phake Doctor who doesn't have a fancy title to use and gets paid very, very little because of it. I volunteer my time for my students and here to help them be as successful as they can during the admissions process, and part of that is helping them identify and avoid potholes.

Ironically, you seem to be implying that I'm placing too much importance on titles when the substance of my argument has been that your insistence on choosing the "right" title is misplaced. Call it whatever the actual title of the job is: as LizzyM notes, no one is screening based on your job title.

The important part is the description where you say what you are doing (i.e., providing clinical care for patients).

The (very small) risk of "inflating" a title or giving one that a supervisor might not support on a reference call is outsized to the benefit (which is negligible). Small risk to non-existent reward is still a bad idea.

 

[polymerization]

It's interesting that you bring this up in this particular fashion: you've made several comments that lead me to think you're assuming I'm a physician or sit on admissions committees. I'm just a humble Phake Doctor who doesn't have a fancy title to use and gets paid very, very little because of it. I volunteer my time for my students and here to help them be as successful as they can during the admissions process, and part of that is helping them identify and avoid potholes.

Ironically, you seem to be implying that I'm placing too much importance on titles when the substance of my argument has been that your insistence on choosing the "right" title is misplaced. Call it whatever the actual title of the job is: as LizzyM notes, no one is screening based on your job title.

The important part is the description where you say what you are doing (i.e., providing clinical care for patients).

The (very small) risk of "inflating" a title or giving one that a supervisor might not support on a reference call is outsized to the benefit (which is negligible). Small risk to non-existent reward is still a bad idea.

To start, I hope I have been clear that I'm not targeting you personally in particular or engaging with you in bad faith. I don't think you're an evil person or a stand-in for the structures I'm attacking. You do, however, insist on compliance with what I view as historically discriminatory directives, and I wanted to have an intelligent and intelligible conversation about that.

I'm aware you can't change the rules. But are the rules valid, at least on an intellectual level we can talk about, if you can't defend them? It certainly helps me as a student to discuss these things frankly, and helps many other members of this community that reach out to me privately, fearful of the judgment or reprisal of professionals. Can you say you are really helping if you're not interested in what your students are actually thinking? To have grievance and expect due process and deliberation is the foundation of our entire country. We argue about the existence of gods, let's not draw the line of unimpeachability at medical school admissions...especially with the turning tides that have made it clear their commitments are not as ironclad in solidarity as they would have us believe even a cycle or two ago.

You even diminish foundational premises to have an easier time quieting dissent. For example, is it really intellectually honest to say what you write in your application, down to the nitty-gritty bureaucratic details, doesn't matter? How many threads here do we see about not submitting early if you're going to have misspellings or grammar errors on your application? Certainly not because "it doesn't matter," but because carelessness manifests in a bureaucratic context as something as simple as a misplaced comma. Of course job titles, descriptions—and everything else—matters.

While everyone is singing a chorus in perfect synchrony about how home care is clinical now, we had 27 posts, 5 professionals, and arguably an unfinished debate around it and the implications of it. There are things to talk about, because the boundaries around all aspects of this process, including what can be adjudicated as "clinical," is for the most part socially constructed and representative of the societal value (or the famous pre-med buzzword "impact") attached to it. I think talking about it is more active than kicking the can down the line and saying "well, it's fine, just go gently into that good night so you can personally get in, you'll never fix it all by yourself." Imagine who we would be as a people if everyone thought that way.

And, for what it's worth, the OP still may not have been hired formally as a CNA, even if they would be identified that way by their employer. So, is it really about the capital T truth? Or just what you can get away with on verification? More uncomfortable questions...

 

[eigen]

You do, however, insist on compliance with what I view as historically discriminatory directives, and I wanted to have an intelligent and intelligible conversation about that.

You have not articulated a solid argument for why you think being accurate in reporting what you have done is historically discriminatory, or why reporting an accurate title with an accurate description of the work and responsibilities is problematic. You do keep hinting that applicants should be dishonest "if it makes things easier", then falling back on systemic challenges as a reason for that dishonesty.

There are absolutely systemic challenges in every aspect of higher education, including medical school applications. However, I think many applicants blow things significantly out of proportion in talking to peers. It is usually quite obvious when someone has an inflated position due to family connections, especially if they can't talk well about the work they did. On the other hand, it's also pretty clear when a student has needed to work to support themselves and their families, and that has altered their job choices and opportunities available to them. For the record, I work with about 90% students who are Pell eligible. None are able to gain clinical experience that is not paid (and well paid) because they need to work to pay for school, pay for their room and board, and help support their families at the same time.

One of the major challenges they face doesn't come from the system, or admissions committees, but from their fellow applicants who are thoughtless in how they balloon the expectations that "medical schools" have, usually based around online discussions that mostly involve T20 schools. I spend most of my days helping them re-think what they need to do in a reasonable, realistic context. The problem isn't students working at a 7-11 or doing roofing or landscaping work and putting that in their work and activities: there are a lot of competencies that you learn and display that are relevant to medicine in that work. The problem isn't choosing a job as a well paid PCT or phlebotomist over a more desired scribing position: again, there are lots of relevant competencies that come from providing base-level patient care and showing that you're willing to work in healthcare even when your primary job involves moving, bathing, and cleaning.

Rather than encouraging your fellow applicants to be ashamed of the work they've done and try to hide it under a "better sounding" title, I would strongly encourage you to be the change you would like to see in recognizing and supporting that work as important to their development and learning such that they can proudly what they did rather than feeling like they need to obscure it.

While everyone is singing a chorus in perfect synchrony about how home care is clinical now, we had 27 posts, 5 professionals, and arguably an unfinished debate around it and the implications of it.

I feel like you and I are reading different threads, because all of the professionals said pretty much the same thing: if you're providing care, it's clinical. And that you should make it clear in your description what you did and what your responsibilities were.

For example, is it really intellectually honest to say what you write in your application, down to the nitty-gritty bureaucratic details, doesn't matter? How many threads here do we see about not submitting early if you're going to have misspellings or grammar errors on your application? Certainly not because "it doesn't matter," but because carelessness manifests in a bureaucratic context as something as simple as a misplaced comma. Of course job titles, descriptions—and everything else—matters.

You seem to be confusing careless mistakes with other parts of your application. Showing you have attention to detail matters. But broadly, the advice you're seeing is professionals trying to push back on the student-manifested view that if they don't submit in the first week of the season, they're cooked for the cycle. Which, like the other issues I point out above, just isn't true. But my students all hear it from other students online, and panic. So far half of my advising time this summer has been devoted solely to talking students off a ledge because they're going to submit a primary in mid-June rather than June 1.

Nothing in this application process asks for or necessitates applicants be perfect. In fact, many of the most successful applications I've seen are from students that have gone down winding and challenging roads, and have mediocre MCATs and GPAs. But they are honest, they are reflective, and they have developed the competencies they need to succeed in medicine and can explain how they have done so and why they are going to be an excellent physician.

 

[polymerization]

You have not articulated a solid argument for why you think being accurate in reporting what you have done is historically discriminatory, or why reporting an accurate title with an accurate description of the work and responsibilities is problematic. You do keep hinting that applicants should be dishonest "if it makes things easier", then falling back on systemic challenges as a reason for that dishonesty.

There are absolutely systemic challenges in every aspect of higher education, including medical school applications. However, I think many applicants blow things significantly out of proportion in talking to peers. It is usually quite obvious when someone has an inflated position due to family connections, especially if they can't talk well about the work they did. On the other hand, it's also pretty clear when a student has needed to work to support themselves and their families, and that has altered their job choices and opportunities available to them. For the record, I work with about 90% students who are Pell eligible. None are able to gain clinical experience that is not paid (and well paid) because they need to work to pay for school, pay for their room and board, and help support their families at the same time.

One of the major challenges they face doesn't come from the system, or admissions committees, but from their fellow applicants who are thoughtless in how they balloon the expectations that "medical schools" have, usually based around online discussions that mostly involve T20 schools. I spend most of my days helping them re-think what they need to do in a reasonable, realistic context. The problem isn't students working at a 7-11 or doing roofing or landscaping work and putting that in their work and activities: there are a lot of competencies that you learn and display that are relevant to medicine in that work. The problem isn't choosing a job as a well paid PCT or phlebotomist over a more desired scribing position: again, there are lots of relevant competencies that come from providing base-level patient care and showing that you're willing to work in healthcare even when your primary job involves moving, bathing, and cleaning.

Rather than encouraging your fellow applicants to be ashamed of the work they've done and try to hide it under a "better sounding" title, I would strongly encourage you to be the change you would like to see in recognizing and supporting that work as important to their development and learning such that they can proudly what they did rather than feeling like they need to obscure it.


I feel like you and I are reading different threads, because all of the professionals said pretty much the same thing: if you're providing care, it's clinical. And that you should make it clear in your description what you did and what your responsibilities were.


You seem to be confusing careless mistakes with other parts of your application. Showing you have attention to detail matters. But broadly, the advice you're seeing is professionals trying to push back on the student-manifested view that if they don't submit in the first week of the season, they're cooked for the cycle. Which, like the other issues I point out above, just isn't true. But my students all hear it from other students online, and panic. So far half of my advising time this summer has been devoted solely to talking students off a ledge because they're going to submit a primary in mid-June rather than June 1.

Nothing in this application process asks for or necessitates applicants be perfect. In fact, many of the most successful applications I've seen are from students that have gone down winding and challenging roads, and have mediocre MCATs and GPAs. But they are honest, they are reflective, and they have developed the competencies they need to succeed in medicine and can explain how they have done so and why they are going to be an excellent physician.

I genuinely believe we agree more than we disagree—especially on the importance of honesty and the dignity of everyday medical care.

Where I think we diverge is in what qualifies as “accuracy” in a system where job titles are inconsistent, responsibilities are fluid, and institutional categories often obscure more than they clarify. You’ve framed this as a question of simple truthfulness. But from my perspective, it’s also a matter of how nontraditional students must translate their lived experiences into a language that the system can recognize to receive acknowledgment for that effort.

The irony is that we’ve seen this dynamic play out here. You were certain the OP wasn’t a CNA—until they were. That ambiguity isn’t a failure of honesty; it’s a symptom of the system. A student using their CNA certification to provide CNA-level care shouldn’t be disqualified by the fact that HR happened to call them a “Wellness Associate III.” Calling it what it substantively was isn’t inflating anything—it’s responding to a genre of evaluation that often fails to distinguish between already legitimate roles, even among common ones like CNA and PCT, let alone in less formalized care settings. I mean, exhibit A: OP wasn't trying to hide anything or get one over on you, it was the hedging and explaining that made you more cautious.

I respect your defense of integrity—I share it. But I also believe in a deeper conception of truth that recognizes that the rulebook you are holding onto so tightly was also one that at one point formally legislated the exclusion of a great deal of individuals. When they wrote Flexner, they also said they were doing it "for the patients," for ethical certitude—even as they closed HBCU medical schools and narrowed an entire profession along racial and class lines. Objectively, events like this have consequences that are not easily undone.

That isn't just a history to acknowledge only in retrospect, it's a history we have to be always vigilant of repeating. Look around. Some would argue it already is, only in new terms, with new rules to follow and new standards to abide by.

If I’ve complicated what seemed like straightforward advice, then I apologize—but only in part. I’ve learned that there’s never really a “right” time to raise these questions, and rarely a welcome one. But someone has to say something...because this matters. And I hope someone out there is listening.