<< I don't know, Regina--I usually think you are brilliant, so I am
willing to flesh out this idea with you.>>

Wow, thanks.


<< It's synchronous that you bring this up actually, b/c I was at a
ped's office today as my client's baby was getting a tongue-tie clipped
and a Resident was observing the procedure. I looked at her badge for
her name, which ended with the "MD" of course, and it occurred to me
that she had a lot to learn, yet was standing there with her credential
in hand. Yet, she was not let loose on families--she was completely
supervised. >>

That is EXACTLY my point! Thank you!  She may be an MD but she is still
supervised and learning, because of what I've decided in the last 24
hours is the large white elephant in our proverbial lacation room, being
ignored and causing the kind of chaos that all elephants do when ignored
instead of dealt with:

***Passing a test is not, in and of itself, adequate indicator of
readiness to be let loose, unsupervised, on families.***

In short, the entire premise of how we're training ourselves at the
moment is flawed. Don't get me wrong: I am a teacher, by nature and by
training. I do believe in tests; in fact, I am one of the few that
supports our current policy of re-testing every 10 years (because I
*should* be able to pass it, whether or not I should have to. If after
this long in the business I fail the test, please...force me out! And
because it forces everyone to keep studying, and not everyone will
unless made to. Sorry for the digression.)  BUT...tests only do what
they do, and I've pretty much decided that we're putting too much of a
burden, as a profession, on our board exam. What it tests, it tests
fairly well (one could make the argument that it isn't long enough but
that's another conversation).  But the evidence is in, and other
professions (such as the medical profession) already know what we still
haven't dealt with: ***it is possible to pass a test long before one is
competent to be let loose on the public, *unsupervised*.***

It is possible to pass OUR test and STILL not be competent to practice
unsupervised. There.  I said it.

Now, it is probably the case that IBLCE/etc thought/are thinking that
the board exam isn't, *in and of itself* being asked to indicate
readiness for practice. We *are* all supposed to be getting extensive
clinical hours in beforehand.  But again, the evidence is in: people are
not all getting the kind and numbers of hours they need in order to be
good LCs.  Part of this is a structural problem. Our field does not yet
have the infrastructure necessary to do this as well as needed.
Aspirants to the medical profession have medical schools, teaching
hospitals, and countless opportunities for structured, well-supervised,
and varied internship and residencies.  

Aspirants to our profession do not.  


<<We have no way of letting the public know that an IBCLC is newly
accredited and inexperienced. We have no way of supervising her practice
while she gains the skills we would like someone to have when practicing
on her own. And she has little opportunity to gain those skills on her
own.>>

Exactly. 


<<I raised this issue 12 years ago to ILCA and the reaction was far
worse than dismissive--it was appalling. I think there was such a desire
to have increased numbers of IBCLCs and increased numbers of nurses as
IBCLCs, that the opportunity for fraud as well as very poor preparation
was intentionally overlooked. I know that these comments may be seen as
inflammatory by some, but if those of use on this list can attest to
first-hand awareness of such situations, then certainly those in power
are equally aware. >>

I believe you.


<<I think that the IBLCE has placed its emphasis in the wrong place and
acted to restrict our practice b/c it cannot guarantee the quality of
our certification. >>

Wow. Interesting. That never occurred to me but it makes sense.


<<I think this is why I so resent the retesting--we already know that
incompetent people can pass this test rather effortlessly and practice
w/o any consequence. While this is certainly not the majority of IBCLCs,
I think it is enough to warrant overhaul of the entire system. >>

Granted.


<<I would love to see PPLCs experience the hospital/clinic setting (I
think it made me a much better LC to have done so) and hospital-based
LCs be required to experience PP...[large snip to save space]....So many
hospital IBCLCs in my area have no idea how the advice they give often
cascades into disaster once the mother goes home, nor do they understand
how the mother's experience of having seen an "LC" in hospital informs
her decision to seek additional help at home or not. I imagine that if
they did, just as I was awakened by my experience in the NICU, they
would adapt their practices accordingly. >>

I agree.  And this (requiring exposure to more than one type of
setting/institution in the gathering of clinical hours) is a do-able
change, IMO. 

<<I know there are many who advocate for additional formal education,
but I am such a believer in the apprenticeship model that this troubles
me. It only further medicalizes infant care and feeding. But, a model
based on the "residency" concept could work very well.>> 

I share your fear of over-medicalizing infant care/feeding. I am more
committed to the residency idea than I am to the
full-four-year-college-degree one, it's just that I think the amount of
learning involved is such that one really deserves to have earned a
bachelor's degree in the process. To have learned all this material and
not have a college degree to show for it seems like short-changing the
learner....

 

Regina M. Roig-Romero, BS IBCLC, very sorry for the long post!
Senior Lactation Consultant 
Miami-Dade County Health Dept WIC/Nutrition 
Breastfeeding Program 
7785 NW 48 ST, Suite 300 
Miami FL 33166 

(786) 336-1333 x162 
(786) 336-1345 fax 
(786) 336-1336 Breastfeeding Helpline 

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