Jane and all who are in on this thread...
When I think of appropriate training, I go back to my schooling to become a
Physical Therapist. I would not have been able to take my licensing exam had
I not graduated from an accredited PT program - 2 full years in the case of
my school - which included many clinical affiliations in various settings. In
our senior year, we were full-time at hopsitals working under the supervision
of licensed PTs for at least 20 weeks. In my case I was in four  completely
different settings ( acute care including ICU in poor neighborhhood, amputees
only, general acute care and a rehab center These were my choices.) This
could translate into working with a private LC in her office, a WIC setting,
a large hospital post=partum, and/ or NICU setting with LC., etc. Although I
took the exam, and did well, I do not feel  comfortable going  "alone" as an
LC yet. This may be different for RNs who work in hospital settings, but I
would think that some kind of probationary period, as PTs newly graduated
also have. would ensure adequte PRACTICAL training. As a PT student/ every
note I wrote in those 5 months was reviewed by a PT, every patient I worked
with was discussed with the PT.  Even as a new graduate, we are at least
loosely supervised during a probationary period as we await the taking of, or
confirmation of passage of the exam. This would be a lot of work for the
profession, but I think would ultimately be of great benefit to all.  I have
asked other experienced LCs to be my mentors, and some have said yes, but due
to geographic  and scheduling difficulties nothing has worked out yet. From
my point of view, I think it is appropriate to charge if CERPS are provided,
but am not sure it is fair to charge otherwise. The situation should be
structured so that the lactation-learner is providing some service in lieu of
payment, such as working ,under supervision with clients and doing all the
appropiate paperwork with necesary review and co-signing , follow-up,
research, inservice, and even scut work( confirming appointments by phone,
ordering supplies, etc.) The cost of the "student internships" for many is
prohibitive in my area, and I believe there should be some way to provide
this both-ways beneficial link without always demanding payment. This could
be benficial to LCs in practice, fledgling LCs, and the profession as a
whole.
    of course I understand that these are two different professions, and
areas can become oversaturated with LCs which is not a big problem with PT,
and payment is different client to LC, vs client to PT, since most insurance
covers PT. Still, we can use this as a starting point to set expectations and
guidelines. If the IBLCE exam determines "entry'level competency" then anyone
who passes it should be ready to practice professionally as an LC - people
who tabulate hours by giving out misinformation about BF should not be able
to either take the test, or at least not be able to pass it! A good way to
prevent this is by offering structured, supervised learning experiences, and
having a practical component to the exam itself. I would be happy to help
anyone design this practical, if this sparks the interest of anyone in
"power". Sincerely, Judy Fram, Brooklyn, NY