I was glad to see that Kelly posted her frustrations with IBLCE regarding Pathway F, as I have heard from other aspiring IBCLCs looking for mentors for this pathway and with questions regarding other pathways.  The previous comments made that Pathway F is not a viable pathway is as relevant as saying that Pathway A and B are not viable pathways either.  In reality, as they stand now, neither A nor B are effective, viable means of establishing an applicant's expertise or eligibility to sit for the exam.
 
The guidelines for Pathways A and B were established in 1985, with the establishment of the credential.  At the time, using a psychometric model of level of postsecondary education, test scores and other factors, it was determined that the number of hours (2500 for a person holding a 4 year degree and 4000 for a person with a 2 year degree or equivalent) was appropriate.  Since then, those numbers have remained unchanged.   Upon careful reading of the supervised practice hours language, it is clear that the 2500 or 4000 supervised practice hours need only be supervised by someone who loosely overseas one's work.  That person need not be an expert in lactation; indeed, he/she could be an ardent anti-lactivist.  The hours collected for the 2500 - 4000 hours can be counted as far back on one's career as necessary.  While employed at IBLCE, it was not uncommon to see RNs counting hours accumulated more than 10-15 years in the past when accumulating the 4000 practice hours necessary to qualify for pathway B.  Hours were approved for individuals who worked for now deceased supervisors working at hospitals long closed and even demolished.   
 
How can these qualifications possibly be a more viable, effective means of establishing an applicant's expertise or eligibility to sit the exam than an individual who wishes to do an intensive minimum 500 internship with a currently practicing, recertified IBCLC?  In fact, in my experience, it was the applicants pursuing pathway F who showed the most initiative, intellectual curiosity, willingness to pursue post-graduate educational opportunities, make the financial and time commitments, and go out of their way to secure out-of-hospital experiences in preparing to sit the exam.  Those applicants choosing to pursue pathways A and B, and especially pathway B, largely collected their hours in one or two work settings, and their CERPs in one week-long course. In my view, there were particular marked weaknesses and limited experiences obvious outside the traditional scope of the postpartum nurse birth-day 5 comfort zone.  Obviously, this is a generalization, and does not apply to all candidates.  
 
Some pathway A applicants who were ineligible or unable to find mentors for Pathway F were able to combine A, G and H to expedite their accumulation of hours, but the process still was a multi year process.  Most Pathway A applicants held college degrees not directly related to healthcare, were not employed full time in health care, and were accumulating their hours via volunteer job and peer counseling positions on evenings and weekends. 
 
But here's the most interesting tidbit of all of this:  with a pass rate of nearly 100%, it doesn't matter which pathway you choose--500 practice hours, 900 hours, 2500 hours, 4000 hours, 6000 hours, nearly everyone passes.  The pass rate does vary widely -- from the just barely passing to passing with a very high score, but at the end of the day, a pass is a pass. Once you pass, everyone gets the same certificate; everyone is an equal.   I urge you to look at the annual report from the psychometrician summarizing the results of the exam; it is posted on the IBLCE website and does appear in the JHL as well.  What do these pass rates tell you about the way the exam is constructed and about the validity of the way the BC practice hours for each pathway are determined?  Should the exam be constructed in a way to 'weed out' more of the applicants?  Is it, in fact, too easy?  
 
I don't think that aspiring IBCLCs anxious to nudge IBLCE off the mark to get Pathway F back into practice are out of place.  For all its warts, there was working when it was pulled several years ago for  review.  To go out on a limb here, I would predict that the same problems that existed then will exist when and if Pathway F is reistated. They are problems that are essentially inescapable in the current fiscal environment:
 
1.  IBLCE will need to continue to rely on the honor system in regards candidates number of hours needed to master the clinical competencies.  The guidelines stated the candidates should take a minimum of 500 hours to complete the clinical competencies checklist, yet how odd that in nearly every application I reviewed the candidate needed exactly 500 hours to master the clinical competencies!  These applications are not verifiable.  IBLCE does not have the resources, financial or personel, to do so.
 
2.  IBLCE will need to continue to rely on the honor system in regards to supervisors properly supervising candidates, in whatever form the new or changed guidelines take.  For me, it is particularly disturbing to think that overworked IBCLC hospital staff will not be able to closely (hand over hand) supervise interns.  If this hand-over-hand requirement is relaxed, how will Pathway F be different from the supervision required by pathway A and B?
 
3.  The qualifications of mentors remains a minimum of being recertified once.  Will there be any additional training required?  If so, who will do it?  Just because one can do, doesn't necessarily mean one can teach. You can count on one hand the number of IBCLCs who recertify by exam at 5 years.  Yet, recertification by continuing education does not guarantee continuing competence. But we accept that as proof that these individuals are capable of training the next generation.  Intellectually, what we know from the science of certification, and what we do in the practice of certification do not jive.  There is something wrong with this picture.  I don't think IBLCE should try to have it both ways.  If the IBCLC wants to be a mentor, that mentor should be guaranteed to be recertified in a way that proves continuing competence, and the only way to do that is through examination.  (I know that this will set a lot of people's hair on fire, but so be it.  I"m entitled to my opinion.)
 
In developing the first set of guidelines for mentors, I recommended mentors consider journal groups, reading assignments, quizzes, study groups, conference attendance, study guides, and other tools for helping their students learn.  In the several hundred applications I processed under Pathway F, fewer than half a dozen included any indication that any of these supplemental educational techniques were included.  Would they have enhanced the learning experience?  Would the student have achieved a better score, been a better lactation consultant?  Would it have mattered at all?  Should these things continue to be optional or has IBLCE's research over the past several years shown it to be beneficial and therefore a necessary component of the Pathway?  As/if IBLCE has reviewed this information, perhaps we will see a change in the requirements for mentors and applicants under pathway F.  I seriously doubt it, however.  I predict it will return essentially unchanged.  If anything, because of IBLCE's inability to provide any kind of credible effort to police the requirement of one-to-one the IBCLC mentoring the student in the same room at the same time, I expect that aspect will be relaxed to some sort of "when she is ready, the mentor can turn her loose, as long as the mentor is close by in case she has any problems."  Again, I would ask how this is different from the turning loose of the candidates in the Pathways A and B.  Yes, it's a little more guided and personalized, but once the trainee is out there on her own, in theory, she could be doing any old thing she wants to.
 
As with the SOP debacle last fall, there was a lot of noise, whinging, whining, complaining, grandstanding and handwringing, until IBLCE withdrew their ill-considered pronouncement, and then ... nothing.  I would like to see LACTNET used as a forum to discuss such important issues as the future of our profession as well as the clinical issues we deal with every  day.  You may not be interested or concerned with these issues on a daily basis, but they do affect all of us.  Since the SOP information was withdrawn from their website, but NOT withdrawn as a policy, IBLCE has done nothing to update IBCLCs on the status of the issue.  Now, after months and months of promising to update hundreds of aspiring IBCLCs and their mentors interested in Pathway F, we see the same performance.  The steady decline over the last 2 years, showing cracks in the framework in the Pathways, the Code of Ethics, the bylaws, and the understanding of IBLCE's role as the certifying organization vis a vis the professional association, is growing increasingly disconcerting.  A little less inertia and a little more leadership would go a long way to restoring many IBCLCs confidence in their certification organization, and perhaps in their choice of a profession as well.
 
Barbara Ash
Falls Church, VA
 
 
 
________________________________________________________________________
AOL now offers free email to everyone.  Find out more about what's free from AOL at AOL.com.

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
Mail all commands to [log in to unmask]
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or [log in to unmask])
To unsubscribe: unsubscribe lactnet or ([log in to unmask])
To reach list owners: [log in to unmask]