Angela,
Believe me, lots of people share your frustration, both certified, and those
working towards certification. As a LLLL, you have many advantages over
those people who want to become IBCLCs but have to accumulate their hours in
volunteer positions that take even longer than 5 years (or 3 if you complete
supplementary pathways G and H). You see a range of babies and infants at
various ages, but you also lack the opportunity to deal with newborns in NICUs
unless you find a way into a hospital to do this. The fact of the matter is,
there is no way to verify that anybody completes the 2500 or 4000 or 900
hours. It is entirely the honor system. There simply is not enough money and
staff to verify hours. There are occasional "spot checks" and the numbers are
re-added to make sure there are no gross errors in addition, but that's all
that can be done.
Even more disturbing is that "supervised" practice hours, in effect can be
supervised by anybody one reports to. For example an RN completing pathway B
can accumulate all 4000 hours at work under the charge nurses on her floor as
far back in her career (even as much as 10 or 15 years if necessary) and
there is NO requirement that the "supervisor" knows one fact about breastfeeding,
or for that matter even cares. You are absolutely right. By looking at
test scores, it is very clear who has had experience in certain age ranges and
who hasn't. It is clear who has spent the time learning basic research
techniques (almost nobody, which is incredibly unprofessional, in my humble
opinion). But at the same time, anybody can read Riordan and get away with a low
pass and be an IBCLC. That's how it works.
Many people feel that the number of practice hours required desperately
needs to be revalidated, We know for a fact that one does not need 2500 hours to
pass the exam. The Pathway F program was a success. The pass rate was
outstanding. Those students of lactation were working one-on-one with mentors who
truly cared about training lactation professionals, not only because they
care about the profession, but also because it was their reputation on the
line. Yet this is not the answer either. There were, during the program's
existence, no means of qualifying mentors, and again, no way of validating hours,
and no way of validating that the clinical skills checklist had actually been
completed. I can't tell you how many applications I received that accounted
for EXACTLY 500 hours. You tell me how one times out her training to learn,
practice, and master all the skills on the checklist in exactly 500
hours.Tell me how they learn what they need to know when there are no required
readings, no standardized format, no other requirements. Included on the checklist
was working with cleft palate and lip infants. How realistic is that? I've
been working with babies for 10 years and only had one case. What should
the requirements be for students who do not have this opportunity within the
time of their internship? Who decides that?
It is my personal belief that our profession will never gain acceptance and
respect of the medical profession until there are serious, accredited college
programs with required, verifiable internships as part of the program. The
programs must include not only lactation, but the basics of anatomy and
physiology, medical terminology, and other elements currently outlined in the
pathetically inadequate 4 clock hour requirement that everyone panicked and
complained about several years ago. No other allied health care profession enters
employment and expects professional respect without a standardized college
or Associate degree. Even the programs in existence, according to reports I
have received from current and past students, do not meet these standards.
You CAN and SHOULD do something about this. There is a new Executive
Director and a new Board Chair of IBLCE. Write, call, or email them with your
concerns. Whether you've passed, waiting for results, or plan to sit, it makes
no difference. There's no way your comments could ever be connected with your
test results. Like government, school districts, and other organizations,
those in management will do what they want if you don't express your concerns.
They operate in a vacuum if they do not hear from their constituency.
Believe it or not, this exam process is regarded as a model for the
INTERNATIONAL exam process. However, this is based, I believe, largely on the
organization's ability to offer the exam in 10 or more languages annually. Perhaps
the Board, like ILCA, needs to step back and consider the future of the
profession, where the bulk of the professionals are coming from, and stop trying
to be all things to all countries. Perhaps, even within the certification
community, the system is considered to be strong, that doesn't mean it doesn't
need fixing. It's time to look at that. Much progress has been made in 20
years. That certainly cannot be denied by anyone. After having seen what has
been accomplished, it is, frankly, unbelievably amazing and forward thinking.
But it is time to think about the next 20 years, the next generation.
Remaining stagnant means a sure, slow decline. Taking risks, treating the
organization as a business, and improving the way IBLCE and ILCA do business will
ensure a strong future for our profession.
As you have stated, the quality of lactation consultants varies so widely
that it is nearly pathetic. I myself have experienced the embarrassment of
'cleaning up' messes created and left by my colleagues. On the other hand, I
have had the honor of learning from experienced IBCLCs who know far more than I
ever will. But the thing is, a "pass" on the exam is a "pass" whether is it
is a pass by 1 point or the highest score for that year. It is a pass
whether the test taker cares about lactation and helping mothers and infants, or
simply wants to try to get a small pay raise at work. There are so many
shortcomings in the system, and so much work to do that it is overwhelming.
I know there is much controversy over the introduction of a second
credential that would recognize and standardize knowledge and guarantee a standard of
care, through training and recertification, just as the IBCLC does, at the
CLC level. Whether or not you support it, I think it behooves all of us to
consider it, or something like it, and how it might apply to people that Angela
mentions--RDs, SLPs, OTs, and others. Those who are interested in
breastfeeding, who can provide specific, vital information and expertise to the IBCLC
for example in the delicate and complicated business of balancing a premie's
supplementation in the NICU, who can help an infant with dysphagia, or who can
assist in multiple physical therapies for an infant with multiple
disabilities. These professionals do not have the opportunity nor the interest in many
cases to acquire 2500 practice hours, yet, they have valuable contributions
to make. It would be so much easier to identify them if we knew who they
were. Breastfeeding counselors would not take jobs from CLCs if they were
marketed properly, along with the IBCLC credential to hospital administrators, the
public, and others. Yet there is no money, no interest, and no help for
ILCA to do this. How can our profession except a mere handful of individuals,
volunteers and those paid less than a living wage in Washington DC to do all
this?
There are things that can be done now. A role delineation study, focused on
how many hours of supervised practice are REALLY necessary, is one.
Establishing what defines "supervision" would help. Reinstituting an internship
pathway would be a good stop gap until formalized programs can be developed, but
this should be done properly, not with one person on the staff making up the
program with little to no direction. ILCA should be intimately involved,
not in the exam process, but in the educational development process. In fact,
it is not IBLCE's role to be involved in the education development process,
but for years, ILCA has not taken up this role. Now that they are, every
IBCLC and aspiring IBCLC should join ILCA for and support this effort. IBLCE
needs to be involved too, for it sets the competencies and would need to be
involved in contributing to curriculum development, much as it was for the
development of the checklist for Pathway F. Input, not the final word. There has to
be a separation between the two organizations. It never ceases to amaze me
that IBCLCs complain about not being treated as professionals, yet they do
nothing to enhance their professional status. They do not join their
professional association, they do not work on committees dealing with issues that must
be dealt with. They complain about having to do continuing education.
They complain about recertification. We leave it largely to the group of
"founding mothers" of the profession, who, you should be aware, are nearing
retirement age, if not already there. But to whom will they pass the responsibility?
No one is stepping up. Put your money where your mouth is, ladies.
I heard all the time at IBLCE that the test was too expensive, joining ILCA
was too expensive, and people had to maintain other professional licenses,
memberships, and requirements. Well, to me it is simply a matter of
priorities. If you choose to buy a pair of new jeans or go out to dinner once a year
rather than join ILCA, don't complain about what ILCA provides you. The more
members ILCA has, and if a US affiliate is formed, the more effective the
organization will be. Being an IBCLC is either important to you or not. You
decide.
Barbara Ash, MA, IBCLC
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