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Prescription for Success: Take 10 to Pass the IBCLC Exam the First Try

A smiling brunette who passed the IBLCE Exam on her first try.

Of the hundreds of questions I’ve fielded in my years as a IBCLC exam prep instructor, this is probably the one I have heard most often: “What do I need to do in order to pass the IBCLC exam on the first try?”

None of us want to swallow the bitter pill of defeat, especially for a high-priced, high-stakes, career-important exam. So I’m going to offer you a prescription for success that will work wonders (and isn’t bitter at all):

1. Know the exam content, rules and regs

You wouldn’t try to take your driver’s exam without reading the manual. But every season, I encounter a lot of people who plan to register for (or have already registered for!) the IBCLC exam yet are completely unaware of the topics it will cover, the deadline for applying, the format of the test items, or the rules and regulations for actually taking the exam.

Before you register — before you can even decide, for sure, that you are going to register — you must read the Candidate Information Guide, as well as the Detailed Content Outline. It’s a major step toward passing the IBCLC exam on the first try.

2. Get a broad base of clinical experience

I know with certainty that some people can pass the IBCLC exam even with very limited clinical experience. But over the years I have found that many people who score low on the exam (or fail it entirely) have experience with mothers and babies in a very limited capacity. They may have worked with dyads during a certain period of time (e.g., the first few days after birth in the hospital), or with those who are mostly sick (e.g., preemies or NICU setting), or with those who are mostly well.

IBCLC exam items can cover anything from the prenatal period to toddlerhood, so it will behoove you to have clinical experience in a wide variety of settings, and with a wide patient population. People who pass on the first try tend to tell me they have a wide variety of clinical experience.

3. Take a comprehensive, 95-hour course

I have spent many hours just figuring out what to include in my Comprehensive Course — and I’m an experienced IBCLC and educator! I revise the course at least twice a year to ensure that it is based on the latest understanding of exam expectations. For strategies that will help you study effectively, be sure to attend a course that is specifically designed — and approved — as one that covers all of the topics and chronological areas of the IBCLC exam.

Many IBCLC exam candidates accumulate the required lactation-focused hours and communication through what I call the “hodge-podge” approach. They earn a few credits here and a few credits there, for seminars that are convenient or focused on specific topics they find interesting. There’s nothing wrong with learning information we find interesting, but that won’t necessarily prepare you for the exam. A comprehensive course is your best bet for preparing for what truly is a comprehensive exam.

It’s no wonder that the vast majority of people who call my office after having failed the exam have not taken a 95-hour comprehensive course. And those who have tried online courses often find that it’s much harder to learn in a distracted environment, with little or no structure, no participation, and little or no instructor feedback. Passing on the first try is absolutely possible, but probably more difficult.

4. Know your terminology

Landi’s study demonstrates the importance of vocabulary; she notes that vocabulary is “the single best predictor of comprehension ability … it has the highest correlation with comprehension ability.” And hers is just one of many studies that show vocabulary is the key to further learning.

While teaching many IBCLC exam candidates, I’ve seen this. And it’s probably true for you, too. Unless you understand the definition of a term, you cannot begin to understand the clinical “so-what” surrounding that word. For example, if an exam items asks about how a lipophilic drug affects the breastfeeding dyad, you’re sunk if you don’t know what the term lipophilic means.

I’ve talked with many IBCLC exam candidates after they took the test — some after they have failed — and those who struggle most with this seem to be the people who chose to take the exam in something other than their first language. But whether English is your first language or not, it’s a sure thing that medicalese isn’t! If you plan to pass on the first try, know your terminology, and you might want to read plenty more that I have to say about this!

5. Know your photos (and other images)

About half or more of IBCLC exam items are photo-based. (It varies a little each year.) It is imperative that you know how to recognize classic signs of normal growth and development, typical signs associated with pathology that is common among lactating mothers (e.g., mastitis), the hallmarks of an ideal latch, and much more. And, the exam can include some non-photo images, (e.g., graphs, diagrams, drawings), too. You need to be prepared to decode photos in order to pass on the first try.

Once you can recognize features of a photo, you still have to know what to do with that information. Here, keeping my “4 Rs” in mind can help: If what’s shown is normal, you can reinforce teaching and/or reassure the mother. If it’s not, you want to resolve the problem (if it is within your scope of practice) or refer the mother and/or baby for help from their primary health care provider.

6. Recognize how most IBCLC exam items are constructed

Any high-stakes exam can be daunting. A big step towards success is knowing how the test items are constructed. Most items you’ll see on the IBCLC exam follow a 3-part construction:

(a) description of the circumstances

This might include how old the baby is, how many weeks pregnant the woman is, how many weeks postpartum.

(b) description of what’s going on

This may be a narrative (e.g., “the mother says that doctor told her to…”) or a photo that shows what’s going on. If you can’t recognize what’s going on, it will be difficult to get the right answer.

(c) question about what you’re going to do about it

The “what you do about it” approach is the essence of an application item.

If you are thinking — as many of the people I encounter seem to be — that this certification exam will primarily ask items of recall, you’re in for a surprise. Memorizing facts, figures, or important ideas is not enough. You must be able to choose an appropriate solution to a problem, which means that your studying needs to go beyond simple memorization and recall.

The IBCLC exam, like many others that are designed to document the candidate’s ability to do a job safely, has mostly application-based exam items. For example, it isn’t enough to be able to list hunger cues. It isn’t enough to recognize hunger cues when you see a photo. You must know what to DO about hunger cues in a variety of different situations, and across a wide variety of ages. Anything that is within your role (e.g., the words you say to counsel the mother, the way in which you document your teaching), could be “fair game” for an exam item.

7. Use effective study strategies to pass on the first try

Most of us grew up just reading and re-reading our sources, highlighting text and highlighting more text, and repeating that sequence. Interestingly, research in the education field has shown that those two strategies are woefully ineffective. Active learning strategies have been shown to be effective, especially distributed practice and using practice tests.

Distributed practice is the technique of studying during in several short sessions. A study from Purdue University asserts that “beyond a shadow of a doubt … meaningful learning is promoted when distributed practice is conducted.”

Flashcards, a form of distributed practice, were shown to produce significantly higher exam scores overall among undergraduates who used them compared with peers who did not. According to one study, the best way to use the flashcards is to study in relatively large stacks across multiple days.

But flashcards aren’t the only means of distributed practice. I provide a hefty course manual that is chockfull of things to “do” (active learning) rather than just “read” (passive). Engage in matching exercises, solve short problems, and more. Or make up your own activities, such as creating a mind map for a topic. Study with a partner and teaching each other little chunks of material each day.

8. Learn test-taking strategies

Knowing the information is not enough. When you actually sit down to take the test, you must be able to eliminate the wrong options and pick the right option. Sounds simple, right? Sure, if you are very knowledgeable and confident about a particular test item, it is simple.

However, if you are halfway-knowledgeable and less confident, you will need to figure out how to make the best choice from the options given.

9. Score at least 80% on a practice exam (or more than one)

I can’t emphasize this enough: Time and again, studies have shown that taking a practice exam was one of the best ways to actually learn the material.

We see this at Breastfeeding Outlook, too. Our practice exams attempt to mimic the real IBCLC exam in the number of questions, format, and difficulty level. Like the IBCLC exam, our practice tests call for application and not just recall. We have found that people who have not taken our practice exams are more likely to fail the IBCLC exam.

We suspect that taking the practice exams helps them with two things. First, it helps them to develop the stamina necessary for getting through 175 questions. Secondly, it provides a reality-check for what the real exam will be like. Studies show that doing practice exams activates information retrieval responses in the brain. Clearly, our observations square with the existing research.

10. Identify and deal with test anxiety before the exam

Anxiety is an emotion. An emotion is energy in motion. If your energy in motion is working against your success, you increase your chances for failure. Dr. Alan Watkins (Coherence: The Secret Science of Brilliant Leadership, 2013) explains the process of performance. He says that our performance is affected by our behavior, our behavior is affected by how we think, how we think is affected by how we feel, how we feel is affected by our emotions, and our emotions are affected by the stimuli that reach our brains. That stimuli might be the sugar we just ate, or the environment we are in. Of course it includes the pressure we are under, such as the stress of an IBCLC exam! The result can be what he calls frontal lobe shutdown; under pressure, we can lose our ability to perform.

One of my favorite strategies for reducing anxiety is hypnosis. Barrie St. John’s audio self-hypnosis program Exam Success, is perfect for when you are preparing to take the IBCLC exam. Self-hypnosis is not an instant cure. Most people need to listen to the program each day for three weeks before experiencing results. If you want to try this, don’t leave it to the last minute. But it’s a simple thing to do (I use it just before falling asleep). Believe me, its anti-anxiety effects can be profound.

Take this, call me in the morning, and pass on the first try!

Over the years, I have helped about 5,000 IBCLCs to achieve their professional goals. I am confident that my Prescription for Success will help you succeed too! Click here for more IBCLC exam study and prep tips.

How have you prepared to pass on the first try? Tell me in the comments below! If you know someone who is preparing to take the IBCLC exam, please this post to help them succeed on the first try!

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