ibc STUDENT PRA CTICAL EXAMINATION
STUDENT NAME
PROGRAMME
ibc DIPLOMA 20__
EXAMINERS
EDITH L.J. KERNERMAN, IBCLC (Primary Examiner);
SUZANNE MCKINNON, IBCLC
EXAM DATES
SUPERVISOR
1.
2.
3.
(4.
(5.
MOVE ON?
)
)
PASS/FAIL
FINAL SCORE
DIPLOMA AWARDED: YES/NO
DATE ___________________
SIGNED__________________________________________
SIGNED__________________________________________
ibc STUDENT PRA CTICAL EXAMINATION
HISTORY TAKING
__________________________/32
All questions on form asked and noted
/5
Accuracy in reporting
/5
Demonstrates curiosity when appropriate
/5
Integrate mother’s verbal and non verbal information
/5
Timely history taking
/5
Complete SOAP
/5
Organized yet flexible approach
/2
OBSERVATION & PHYSICAL ASSESSMENT
__
/50
Accurately assess latch
/10
Accurately assess milk transfer
/10
Well Baby
Mouth
/5
Tongue
/5
Overall wellness
/5
Well Mother
Visual inspection of both breasts simultaneously
/5
Palpate both breasts and axilla
/5
Overall wellness
/5
LATCHING
Verbal guidance
Technique
Judgment/ Appropriateness of choice
Individualized approach
Hands-on guidance
Technique
Judgment/Appropriateness of choice
Individualized approach
_
/50
/10
/10
/5
/10
/10
/5
Comments:
ibc STUDENT PRA CTICAL EXAMINATION
PROTOCOL TO INCREASE BREASTMILK INTAKE
/20
Comprehension and Application
Comments:
/10
Judgment
/5
Individualized approach
/5
LACTATION AID, SUPPLEMENTATION: (only mark if applicable)
/8
Inserting
/2
Guiding mother to do it herself
/2
Timing
/2
Appropriateness (choice to supplement, of choice of supplement)
/2
EFFECTIVE MANAGEMENT OF: (only mark applicable areas)
/__
Not Yet Latching Baby
/15
Sore Nipples
/15
Lack of weight gain/ Late Onset of Slow Weight Gain / “Gassy”/Colic/Pulling at the breast
/15
GERD/FTT/Allergy/special circumstances
/15
Low milk supply due to biological reasons
/15
Prenatal consultation
/15
WORKING ASSESSMENT:
/25
Assesses “big picture“
/10
Creates most accurate and reasonable working assessment
/10
Able to identify missing information and incorporate uncertainty explicitly into decision
making
/5
PRESENTATION (summary, timing, accuracy)
_
/10
PLAN
_
/25
Comprehensive
/10
Individualized
/10
ibc STUDENT PRA CTICAL EXAMINATION
Feasible
COUNSELLING SKILLS
/5
__
/25
Comments:
Demonstrates active listening
/5
Is present and conscientious in care
/5
Addresses all stated concerns of the mother
/5
Demonstrates effective instruction and teaching—ensure that message conveyed is clear and
was understood by mother
/5
Empowers the mother
/5
PROFESSIONALISM & ETHICS____________________
/40
Abides by:
IBLCE SCOPE
IBLCE/ILCA Code Of Ethics
International Who Code
Baby Friendly Hospital Initiative
/5
Respects patient confidentiality, demonstrating knowledge of the legal, ethical, and medical
issues surrounding patient documentation, including confidentiality and data security
/5
Communicates with all clinic staff and colleagues in a courteous and respectful manner.
/5
Treats mother with dignity and respect (e.g. asks permission to touch her breast and touch
baby)
Does not make treatment suggestions to the mother without the prior approval of the
supervisor
/5
Demonstrates respect for cultural and socioeconomic diversity
/5
Conveys a sense of confidence, competence and compassion to mother
/5
Recognizes and accepts limitations in her/his own knowledge and clinical skills, and knows
when to refer.
/5
APPOINTMENT MANAGEMENT
__
/5
/30
Starts and ends scheduled appointment on time
/5
Appropriate prioritization of elements of appointment (e.g. aware of baby’s/mother’s cues)
/5
ibc STUDENT PRA CTICAL EXAMINATION
Create clean and safe place for mother and baby
/5
Arranged and observed the physician’s exam of the baby
/5
Obtained the required number of signatures on her chart?
/5
Closes appointment by confirming timing of subsequent appointment(s) and patient
understanding of the treatment protocol
/5
LACTATION/MEDICAL KNOWLEDGE_________________
Comments:
__/35
(please specify any areas of weakness in the comments section)
Demonstrates an understanding of how anatomy and pathophysiology relate to mother’s
complaints, assessment and diagnosis
Demonstrates knowledge of the contributing factors to current situation and the ways in
which they impacted the breastfeeding experience
/5
/5
Demonstrates knowledge about underlying medical conditions in both the mother & baby
/5
Demonstrate knowledge about medications and breastfeeding
/5
Identifies red flags and risk factors
/5
Demonstrates knowledge about commonly used “tools” and “techniques”
/5
Able to assess and apply current and relevant information in the care of the dyad.
/5
Students are expected to have knowledge in each of the following areas:




NIPPLE TRAUMA
CANDIDIASIS
VASOSPASM
REFERRED PAIN





BLOCKED DUCTS
ABSCESS
MASTITIS
CYSTS, FIBROADENOMAS
BREAST SURGERIES





LOW MILK TRANSFER
LACTATION AID
WEIGHT GAIN/GROWTH CHARTS
FAILURE TO THRIVE
LATE ONSET OF SLOW WEIGHT GAIN

INTRODUCTION OF SOLIDS





SUPPLEMENTARY FEEDING
COMPLEMENTARY FEEDING
ARTIFICIAL BABY MILKS






INABILITY TO LATCH
BREAST REFUSAL
NURSING STRIKE
WEANING
FLOW/NIPPLE PREFERENCE


SKIN CONDITIONS: MOTHER/BABY
HERPES, CHICKEN POX, ECZEMA

JAUNDICE


HYPOGLYCEMIA
HEMANGIOMA, CEPHALAHEMATOMA,
TORTICOLLIS
ALLERGIES





CUPS, F-F, BOTTLES, OTHER
FEEDING POSITIONS (including mother
lying down)
BREAST SHELLS/ EVERTER
REVERSE PRESSURE SOFTENING
SHIELDS
MILK STORAGE
PUMPS/ HAND EXPRESSION


RISKS OF NOT BREASTEEDING
BREASTMILK vs. BREASTFEEDING
ibc STUDENT PRA CTICAL EXAMINATION




MEDICATION/ILLNESS
CONTRAINDICATIONS
VITAMIN/MINERAL SUPPLEMENT
GALACTOGOGUES



SPECIAL BABIES, INCLUDING TRISOMY 21,
CLEFT PALATE
SPECIAL MOMMIES
PPB/PPD


PRENATAL MOTHERS
INDUCED LACTATION PROTOCOL