While this thread fizzled about a week ago, there were a few posts to which
I wanted to respond, but I got sidetracked by life events. I continue to
think that we need to think about these issues and talk about them. This is
going to be a mish-mash of ideas, and for that I do apologize, but I've not got
the time to construct a masterpiece tonight! I'm sure you'll understand.
At least one person wrote that she was concerned that some of the posts
sounded like "RN bashing". I would disagree with that statement, in fact, I
think you could argue the opposite. Because it is so difficult to accumulate
practice hours, I think the expression of frustration with nurses could also be
described as "RN envy or R-envy". Of all the people who aspire to become
IBCLCs, the fact is, it is easiest for those working in L&D or postpartum units
to accumulate the required hours, and they get paid for it at the same time.
For practically everyone else, getting supervised practice hours means a lot
of volunteering, creative employment, finding gracious mentors, and luck.
Because the IBCLC is an INTERNATIONAL credential, the level of preparation,
the establishment of 2 or 4 year college level preparation courses, even
required reading and./or coursework and the level of difficulty of the exam
itself are incredibly complex issues. Some of these issues, hopefully, will be
addressed by the US Lactation Consultants Association, or whatever form that
organization takes, if it does at all (fyi ILCA is currently considering the
formation of some sort of American affiliate or association to more fully
represent the needs and desires of US based IBCLCs, while being able to focus
ILCA's attentions more fully on the issues of non-US IBCLCs). Pathways which
might work here or Canada or Australia might become additional options.
Mentorship pathways like Pathway F could be reinstated to offer qualified candidates
an opportunity to become IBCLCs without facing 5-10 years of accumulating
practice hours. Even with these options, though, more issues are raised...what
makes a qualified mentor? Who would help design a university program?
Would the program be roughly standardized as are other allied hcp programs? If
so, by whom?
I want to make it clear that I was not, and am not advocating that IBLCE
determine, set the standards for, or in any design any type of college level
program. As Linda Smith pointed out, that would be inappropriate. But I do
think it is appropriate for the IBLCE to be concerned and interested in these
issues, and to consult with ILCA, universities and other interested parties as
appropriate as the profession continues to develop.
Someone asked if I was advocating a 2 year program as opposed to practice
hours. The answer is no, at least not right now, and not for everyone. As
noted above, if we in the US have not yet been able to launch successful
college level programs, it can hardly be expected to see such programs be
established in developing countries of Africa or Asia. I think there has to be a
number of eligibility pathways, at least for now, to allow for all of those who
want to work toward certification to be able to.
The issue was raised that some people, it appears, are taking "short cuts"
to get their practice hours. It is true that accountability for practice
hours is based on the honor system. There are no time limitations on the
accumulation of hours, and it is economically impossible for each application to be
individually researched. How can one reasonably go back 15 years and try to
verify hours worked at a hospital now closed? Random checks are made on more
recent hours. My gut feeling is that there are those who falsify their
hours, and those who claim questionable hours, but for reasons of not enough
staff to investigate, or not enough blatant facts to "prosecute", the benefit of
the doubt has to be given.
Whatever the issue, the exam has always been an "entry-level" exam.
However, how do we define "entry level"? I have heard more experienced IBCLCs worry
aloud that new IBCLCs don't understand or use concepts such as test weights,
are not up to date on the literature, or do not know the proper use and ways
to fit a nipple shield. The issue then becomes, should an "entry level"
person necessarily know about test weights, difficult latch situations, or 'more
advanced' problems? How do we define these things? Partially by the role
delineation studies, which are only done every 3-4 years, and are on various
topics. Partly by consensus of more experienced IBCLCs. The profession is
so young and developing, it's hard to say. Different practice venues call for
different skills. Just about every issue is vague,and will remain so for a
while I think. Barbara Wilson Clay speaks eloquently about being in
situations years ago when she wasn't sure what to do. I don't think she'd hesitate
to tell you today if she encountered the same situation, she would not
hesitate to seek counsel from colleagues, search the literature, and invent a
technique or solution if she had to. We all must practice in this manner, whether
we passed the exam 20 years ago or in 2005.
Another way to address these issues might be the introduction lower level
credential. The lower-level credential is, I personally believe, important for
IBLCE to implement. I don't think it will weaken the IBCLC credential,
rather; it would be my hope that many people who take the IBCLC exam would choose
this credential instead because it would have fewer requirements for
eligibility, indicate a certain proficiency in basic breastfeeding helping skills,
yet not a qualification to do the specialized work of an IBCLC. It would set
a clearer line between "counselor" or "helper" and "professional" or
"expert". At that point, the IBCLC exam could be made more difficult. It could
be, with the proper marketing, education, and design, a credential that would
solve problems for IBCLCs, not make more. But it would be a risk. I agree
with Barbara Wilson Clay and others that educational, and practice standards
should be higher, the test more difficult, to achieve the alleged "gold
standard" but they have to be defined and established in a way that is
psychometrically valid, can withstand the legal challenges it would face, and
importantly, meet the requirements of the National Organization of Certifying Agencies,
without whose blessing, our credential would lack a GREAT deal of clout. It
is a very complex issue and will take years to work out.
One of the other major issues facing our profession is money. There is a
staff of 5-6 at IBLCE. Twice the staff, dynamic leadership, and state of the
art computerization would provide a start to addressing some of these issues.
I personally believe offering the option for computer-based testing would
also help. I've said it before, and I'll say it one more time. If you care
about these issues, you can do two things. Join ILCA, and don't whine about
exam, recertification and CERP fees, which keep IBLCE in business.
The level of training, reading, background, experience knowledge, needed to
become an IBCLC is interpreted differently by each person. It used to drive
me crazy. I've met people who completely outlined the entire Riordan and
Lawrence books, and other test-takers who never opened one book on the
recommended reading list. The thing is, you can pass with the lowest pass score or the
highest, but after the exam, it doesn't matter. Both candidates are IBCLCs.
Until we have a standardized educational program, at least as one pathway,
it is going to be very difficult to make this the quality profession you
envision it to be. We need to discuss this more, and more openly.
I hope more of you will join in this discussion.
Barbara Ash, MA, IBCLC
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