I don't know if it helps for you all to know this, but the "slide" part of
the exam is no longer slides, but photos in a printed booklet.  This gets
around the notorious lighting variability, and also allows candidates to go
back and look at things again.  As someone who has participated in editing
the exam, I can assure candidates that great care is taken to try to find
photographs of situations one will really be dealing with in clinical
practice.  Care is also taken to chose clear, easy to see photos.  The photo
bank started out small when the test was new, and is growing thanks to
people's willingness to contribute their clinical slides to IBLCE for use on
the exam.  The visual quality is much better, the format is more workable,
and the IBLCE feels that the expanded photo section gives greater validity
to the test because it requires more real world knowledge.

Just a personal  comment.  I can't recall who said it, but I agree with the
person who remarked that a "consultant" is by definition an expert by virtue
of both education and experience.  Perhaps we need to consider different
terminology for those who are just entering the field by passing an entry
level exam.  I know that as I emerged from a volunteer background and began
practice as a newcomer in a new field, I was scared all the time.  I was
constantly seeing things I'd only (maybe) read about it books. It humbled me
to think people were paying me when it was clear to me my training was
incomplete.  I had to think real hard about every suggestion, and I made
hours worth of free phone follow-ups (and often free subsequent visits)
following my clients to assess their outcomes. This was so that if I was
making stupid suggestions which didn't work I could change strategies.  No
one calls or pays a consultant to straighten out a problem for which free
and effective help is readily available thru NMAA or LLL or a book.  We see
the really complicated cases (train wrecks) and usually there are three or
four things going wrong simultaneously.  I say, again, we need to have a
university pathway to train LCs as other health care professionals are
trained.  This does not negate the value of "putting more troops on the
ground" in terms of peer counselors, more volunteers in the mother-to-mother
groups, or giving "lactation initiator" credentials to entry level people
who function as RNs or RDs etc.  But for the person who is going into a
clinical practice situation, there still needs to be more in the way of both
didatic and clinical practice education.

I'd be interested in people's comments on the idea of a two-tier system of
credentialing.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html