As I recall, the first time the exam was given we were told that the picture portion was a temporary part of the certification.  The original idea was to have a clinical portion where the examinee would be given a situation (or situations) to consult and a panel of experts would evaluate the person's competency in doing the consult.  This sounds good, but logistically a nightmare.  (At least they went to the pictures in a book which is far superior to the way they were shown on a screen at the first exam and some of the time you couldn't tell what the picture was showing.)  In the first years when there might have only been one IBCLC in a large area, the idea of internships was unreachable for many.  As our profession grows, the availability of persons to supervise such experiences and the locations where one could get such experiences also grows.  I would hope that we are close to reaching the point where it will be practical to require some supervised practice before qualifying for the exam. 
 
I also feel there needs to be a better way of documenting the hours to qualify currently than just having someone sign that the candidate has the hours.  For example, an RN working in OB would have to show how they cameup with their hour total.  When I re-took the exam one of the years they were experimenting with experience vs retesting I was in that position.  I kept close track for a couple of weeks just how many hours out of my work week were actually spent with breastfeeding help.  I then asked myself if these were typical weeks and when I felt that they were I took the percentage of BF hours times the total hours to come up with my hours for the year.  I'm now kicking myself as it seems all I had to do was get someone to sign off and could have avoided all that record keeping!

We are still a growing, learning profession.  We need to be aware of our shortcomings and how to improve the process, but we can't expect to be at the same place that other professions are when they have been around many many more years than we have!

Winnie Mading

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