For LactNet

Reply to Lyn Moody
Subject:  Internationalism of Exam (long)
From  Erika Nehlsen, Regional Administrator for Europe, the Middle East and
North Africa

Dear Lyn,

As one of the first European IBCLCs (12 people sat the exam in 1987 in
Weinfelden, Switzerland in the German language) and the IBLCE Regional
Administrator serving European, Middle Eastern and African countries as well
as a BF Specialist Consultant to UNICEF I want to respond to your letter
(lactnet 31 July.)

In the beginning here in Europe we had the same feeling like you have. The
exam format was not familiar, the exam content too American.  The exam
format is still the same and multiple choice exams are now used here for
several disciplines, because this format is the fairest for candidates (as
well as for the mothers and babies we serve.)  The multiple choice of the
IBLCE exam was (and still is) challenging for us here in Europe as well.
But this format is the fairest way to evaluate a candidate's knowledge.
Only the candidate's knowledge is tested, there is no competition between
candidates.  Changing the exam format to partly multiple choice and perhaps
writing an essay additionally means that a reviewer has to read all these
essays.  Because of the high number of candidates it is impossible for one
person to read all the essays and that means that the evaluation of the
essays is always depending on the personal focus of the evaluating person
which can differ from that of the other evaluators and thus is not as fair
as a multiple choice test.  The exam committee that puts together the exam
every year consists of BF experts (every year, different ones) with various
backgrounds.  Some of them are practicing IBCLCs, some are non-IBCLCs. All
of them are experts in the field of lactation. There are always
international members, too.  Every year there is a European, an Australian,
and a Canadian, out of a Committee of seven.  Then the international Board
members also review the exam.

This year we had 126 candidates sitting the IBLCE exam, offered in four
languages, here in Europe and only one of all these candidates rated the
exam as being too American.  Since '87 there was steady European input into
the exam committee as well as European Delegates to the IBLCE Board.  And of
course we provided exam questions and slides (a nice way to help future
colleagues and earn CERPs at the same time.)

On the first view it seems to be a good idea to put the exam into two parts.
One with the basics and one covering a specific area of the candidate's
choice. In reality the IBLCE exam currently just covers the basics which
every IBCLC needs to know.  That is the specialty of us IBCLCs to draw
knowledge on BF from the various disciplines.  This is the only way for us
to evaluate various BF situations and be helpful to BF families according to
these special situations.
Ros Escott, the IBLCE Regional Administrator for Asia and the South Pacific,
and I worked on a culturally adapted exam for non-Western and Developing
Countries at the same degree of difficulty.  We bring to attention of the
IBLCE when there are questions which are not appropriate for our non-Western
constituency and the IBLCE Board as well as the Executive Director are
always open for our concerns. IBLCE always appreciates input from the
various experts in the field and for sure will appreciate your input on
culturally adapted questions for future exams to better meet the needs of
your colleagues in South Africa.  By the way, most of our current knowledge
on BF comes from non-Western countries!  A lot of research, especially on
benefits and practices of BF is done there.

You are curious what it takes people in non-English speaking countries to
sit the exam.  Here in Europe we have a growing number of translations to
enable candidates to sit the exam in their native language, despite the fact
that the most current literature is still in English.  Translations are
done, when there is enough interest shown in a particular language.  We have
had translations into German, Dutch, French, Spanish, Italian and Arabic.
For next year we hope to have translations into Polish, Greek or Czech,
depending on the interest people of these countries have to take the exam.
We offer our candidates a glossary, set up by the translator, with
translated terms as they are used in the exam.  For BF language there is
still no useful dictionary on the market.  In most non-Western countries the
candidates prefer to take the exam in English, because the BF literature is
in English.  Of course these candidates who sit the exam in a non-native
language get more time to complete the exam.  To be better prepared for the
IBLCE exam here in Europe we set up study groups.  This way not everybody
had to buy the expensive books.  It helped us a lot that each one of us
prepared one topic and shared that in our native language with the other
colleagues.  After a few years the European IBCLC pioneers started to offer
courses which helped our future colleagues to pass the exam.

I know that the cost of the exam and the necessary books to prepare for the
exam are high.  Despite this fact we have a growing number of candidates.
Most of them tend to take BF management courses first, not spend money on
the exam and fail.  Additional professional education is always expensive
when high quality is achieved (basic professional education as well as exams
are almost free of costs here.)  But without certified qualifications it is
difficult to build a reputation with the public and the medical community,
as well as confidence from the mothers we are working with.  Financially
disadvantaged candidates can apply to ALCC (Association for Lactation
Consultant Certification.)  Each year ALCC sponsors some candidates to
provide them books or the exam fee.  The IBLCE in Europe Office has some
books bought by ALCC to lend out to candidates with financial stress.  A
candidate can ask for them and then ALCC decides who gets the books.

James Akre UNICEF Technical Officer, Nutrition, pointed out in a WHO
bulletin that IBCLCs are a very useful resource for supporting successful
BF.  In time our work is recognised and now even the German National BF
Commission rates IBCLCs as BF experts.  So in time (almost 10 years in
Europe) it works out well not only for IBCLCs but for the whole society.  I
want to encourage you to keep up your work.  In the long run the IBCLC
Certificate will be an important credential to acknowledge lactation
consultant qualification.  It can only be international if those of us who
work outside North America make it so.  You should help!

=====================================================
International Board of Lactation Consultant Examiners
P O Box 2348
Falls Church  VA  22042-0348
Tele 703-560-7330
Fax 703-560-7332
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