"These candidates  can and do pass the exam based on being a post partum or
labor and delivery nurse for years, presumably some studying, and with a one
week course to fill in the gaps, bingo, they are close enough to pass.  Even
more disconcerting is that IBCLCs in private practice have also not
developed the skills necessary to solve more that the basic latch and sore
nipple problems. And let's not even discuss the ever growing concern of
mothers who enter the consultation with sore nipples and low milk supply and
come out with a pump and a decision to express milk and bottle feed the
baby.   Breastmilk feeding is not the same as breastfeeding, although you'd
be hard pressed to understand the difference in some areas of the country.

Practice hours and lactation specific areas, as well as medical background
education for non-medical candidates are other areas which desperately
require review.  How can it be that some candidates pass the exam with as
little as 500 practice hours, and others require 6000?  Are the standards
set 20 years ago based on post-secondary education still valid? The quality
of the practice hours could well be more important than the quantity.  Yet,
there is no mechanism to monitor these hours.  Financially for IBLCE,
realistically, administratively, it is impossible, unless candidates would
be willing to pay thousands of dollars for the exam process, and they are
not.  Few people realize that our credentialing organization exists nearly
exclusively on exam income (small additional income is derived from CERPs
fees, which, however, do not even cover the cost of administering the CERP
program).  It is unreasonable to expect to run a business (rent, utilities,
insurance, salaries, office supplies, exam development and administration
expenses, board meeting expenses, legal and psychometric fees, etc...) AND
add individual assessment requiring time, travel, hospital/work environment
set up time, etc. with a staff of 4 or 5? 

Prospective candidates went nuts a couple of years ago when the additional
requirements for the "background in" education requirements were announced
several years ago, so much so that applications to take the exam went up
considerably, then dropped equally considerably the following year.  Why?
These 'additional requirements' were perceived as unrealistic and unfair
burdens that previous candidates and nurses didn't have to meet.  And what
were we taking about here?  8 clock hours of education in areas meant to
help non-health care professionals and those with no prior exposure to
understand the basics, and be able to communicate on an elementary basis
with other HCPs without making fools of themselves.  Clock hours, not
university credits.  For anatomy and physiology hardly enough time to even
learn to identify the body's major systems let alone learn anything about
physiology. Yet complaints.  I remember a woman to ask if "large animal
anatomy" (she was a pre-vet major in another life) could be used to fill
this requirement.  What kind of professional, gold-standard behavior is
this?  Her argument:  humans are really large animals.  Answer:  No.

Concerns have been raised about falsification of hours and educational
experience in exam applicants.  I have no doubt that this happens.  Again,
resources force IBLCE to believe that applicants are telling the truth, that
supervisors signing off are honest, that education providers are
guaranteeing that students spend the entire courses with their butts in the
their chairs.  Spot checks are made, tips are followed up, suspicious
applications are investigated, and each application is completely read
checked to make sure the math is correct, but beyond that, realistically,
what can be done?  (Just FYI, the certification industry standard is that
not every application is checked; generally a random sample is taken.)  Do
you want the breastfeeding police to go out to verify each application?  And
do you want to pay for it?  That would involve an increase in exam and
recertification fees.  And even if each application is checked,  if the
supervises signs an affidavit that the hours are correct, short of
subpoenaing hospital records (unrealistic at best), one is  forced to accept
their statements, true or false.  The costs involved would be astronomical.
Current exam fees do not even allow the organization to rent sufficient
office space, pay employees average nonprofit wages, or exhibit at
conferences that would be ideal venues for recruiting.  Perhaps the large
number of hours necessary encourages fraud; role delineation studies are
meant to keep these requirements current and valid, so perhaps we will see
changes in the future.

45 hours of lactation specific education are required to sit the exam.
Think about this.  45 clock hours is required to prepare for a career.
There are no requirements as to the content of these 45 hours.
Theoretically, it could be 45 hours of basic positioning and latch, and the
applicant would have met the requirement.  How many clock hours do other
people spend in classrooms preparing for their careers?  At the present
time, these hours are not even required to be CERPs (although it is strongly
recommended), which would guarantee at least a certain level of quality and
relatively valid subject matter.  What happens is that most people
accumulate their hours, rush off to take the "lactation consultant course"
which through clever marketing and hospital administration pressure seems to
have become a "requirement" to sit the exam -it is NOT--, which gives you 45
CERPs, and voila you are eligible to sit the exam. 

Taking any 45 hour course or review type course in the time immediately
before sitting the exam if anything, should serve as a review of what you
have learned over the past years you have accumulated your practice hours
and read the books (at least some of them) on the recommended reading list.
It isn't currently a question on the exam application, but I would love to
see a poll of how many of the candidates read any of the books on the list
before the exam.  They don't even read the entire Candidate Information
Guide, based on questions I was accustomed to answering.

Ideally, individuals preparing to become IBCLCs should be thinking of it as
at least a 2-3 preparation experience.  I always advised "newly in love with
breastfeeding" IBCLC wannabe's to take a week-long course, do some reading
from the recommended reading list, go to some conferences, and THEN begin
accumulating hours.  If they were nurses, and had already begun (or indeed
finished) their hours, they still need to do these activities.  All of this,
and more, is in the Candidate Information Guide.  

45 Hour Requirement, Continuing education and the CERP system:  The CERP
system is another area that, I believe, needs major review and revamping.
Currently, CERPs are granted after an evaluation of the program, the
speakers CV, the program bibliography, and payment of a miniscule fee.
Other than this, there is no verification of the speaker's actual knowledge
on the subject, or skill at presenting the information.  Even more
disturbing, there is no sure way to verify actual attendance and LEARNING of
the attendees at the sessions.  Course providers often cannot even verify
attendance, let alone that participants learned anything.  I personally have
attended more than one conference and registered only to find the completed
CERP certificate for 15 or more CERPS already in the folder!  Why not just
see the sites of Chicago or New York in this case?  Do you?

Which brings us to another point.  Recertification is currently required
every 5 years by exam or CERPs, and at 10 years by exam only.  The
recertification by CERPs is, essentially, a gift.  Continuing education has
not been linked to continuing competency.  The only means of guaranteeing
continuing competency is through examination.  Our young field is
continually changing.  So are others.  Other allied health care professions
and international professional certifications require recertification by
exam every 2 or 3 years.  Practicing with out of date information is a Code
of Ethics violation.  Think about that one.  " (continued)


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