Background
Year | Pass rate (%) | ||
---|---|---|---|
Croatian candidates | Slovenian candidates | Global candidates (overall average pass rate for initial and recertification exam) | |
2006 | 68 | ||
2007 | 87 | ||
2008 | 58 | ||
2009 | 41 | 46 | 89 |
2010 | 58 | 83 | 90 |
2011 | 54 | 93 | 88 |
2012 | 31 | 43 | 85 |
2013 | 21 | 25 | 85 |
2014 | 60 | 86 | |
2015 | 23 | 63 | 84 |
2016 | 43 | 20 | 80 |
Mean | 39 | 59 | 86 |
Methods
Design
Setting
Sample
Measurement
Data collection
Data analysis
Comparison between the two countries
Predictors of exam success analysis
Results
Participant characteristics
Variable | Croatia | Slovenia | χ2 |
p
|
---|---|---|---|---|
n (%) | ||||
N | 36 (39.6) | 55 (60.45) | 3.97 | 0.05 |
Did you pass the exam? | n = 33 | n = 45 | ||
Yes | 19 (57.6) | 32 (71.1) | 1.00 | 0.32 |
No | 14 (42.4) | 13 (28.9) | ||
Demographic characteristics | ||||
Profession | ||||
Community nurse | 16 (41.0) | 14 (24.1) | 3.51 | 0.06 |
Midwife | 12 (30.8) | 15 (25.9) | 0.38 | 0.54 |
Neonatology nurse | 4 (10.3) | 18 (31.0) | 5.49 | 0.02* |
Doctor | 2 (5.1) | 1 (1.7) | 0.94 | 0.10 |
Other | 5 (12.8) | 10 (17.2) | 0.02 | 0.89 |
Highest qualification | ||||
University degree | 9 (25.0) | 14 (25.5) | 7.73 | 0.02* |
College degree | 27 (75.0) | 31 (56.4) | ||
High school degree | 0 (0.0) | 10 (18.2) | ||
Place of work | ||||
Community health centre | 15 (41.7) | 19 (34.5) | ||
Maternity hospital | 10 (27.8) | 21 (38.2) | 6.98 | 0.22 |
Neonatology ward | 5 (11.1) | 1 (1.9) | ||
Private practice | 2 (5.6) | 0 (0.0) | ||
Paediatric ward | 1 (2.8) | 2 (3.6) | ||
Other | 4 (11.1) | 11 (20.0) | ||
Time spent working with breastfeeding mothers (years) | ||||
> 20 | 16 (44.4) | 19 (34.5) | 6.82 | 0.08 |
11–20 | 14 (38.9) | 15 (27.3) | ||
5–10 | 6 (16.7) | 14 (25.5) | ||
< 5 | 0 (0.0) | 7 (12.7) | ||
Duration last child breastfed (months) | 7.58 | 0.11 | ||
> 12 | 20 (57.1) | 25 (47.2) | ||
> 6–12 | 6 (17.1) | 17 (32.1) | ||
3–6 | 3 (8.6) | 9 (17.0) | ||
< 3 | 2 (5.7) | 1 (1.9) | ||
Did not breastfeed | 4 (11.4) | 1 (1.9) | ||
Breastfeeding education | ||||
Was breastfeeding part of your formal education? | ||||
Yes | 15 (41.7) | 33 (60.0) | 2.90 | 0.09 |
No | 21 (58.3) | 22 (40.0) | ||
If yes, no. of hours | ||||
< 10 | 5 (13.9) | 24 (43.6) | 9.55 | < 0.01* |
10–20 | 2 (5.6) | 4 (7.3) | ||
> 20 | 8 (22.2) | 4 (7.3) | ||
If yes, did it include bed-side learning? | ||||
Yes | 11 (73.3) | 7 (21.9) | 11.20 | 0.01* |
No | 4 (26.7) | 25 (78.1) | ||
If yes, how many hours? | ||||
< 5 | 5 (45.5) | 0 (0.0) | 0.08 | |
5–10 | 0 (0.0) | 1 (16.7) | 5.58 | |
> 10 | 6 (54.5) | 5 (83.3) | ||
Which forms of informal breastfeeding education have you attended? | ||||
90 h IBLCE exam preparatory course | 32 (88.9) | 46 (83.6) | 0.49 | 0.49 |
Breastfeeding conferences/symposiums | 26 (72.2) | 26 (47.3) | 5.47 | 0.02* |
UNICEF/WHO 20-h course for maternity staff | 18 (50.0) | 25 (45.5) | 0.18 | 0.67 |
Breastfeeding webinars | 18 (50.0) | 7 (12.7) | 15.00 | < 0.01* |
20-h course for primary health care teams | 9 (25.0) | 16 (29.1) | 0.18 | 0.67 |
Exam preparation | ||||
Motivation for sitting exam | ||||
To improve my knowledge in breastfeeding | 32 (88.9) | 40 (72.7) | 3.40 | 0.07 |
To obtain the prestigious IBCLC certificate | 11 (30.6) | 6 (10.9) | 5.47 | 0.02* |
So I can work as an IBCLC | 10 (27.8) | 14 (25.5) | 0.06 | 0.81 |
To test my knowledge in breastfeeding | 9 (25.0) | 15 (27.3) | 0.06 | 0.82 |
I was obliged to by my employer | 7 (19.4) | 6 (10.9) | 1.28 | 0.26 |
To prove that I can do it | 3 (8.3) | 9 (16.4) | 1.21 | 0.27 |
Study strategies used | ||||
Reread handouts | 31 (86.1) | 40 (72.7) | 2.25 | 0.13 |
Tested myself with practice questions | 30 (83.3) | 26 (47.3) | 11.23 | < 0.01* |
Underlined or highlighted while reading | 29 (80.6) | 33 (60.0) | 4.19 | 0.04* |
Made outlines | 14 (38.9) | 28 (50.9) | 1.25 | 0.26 |
Studied with others | 11 (30.6) | 11 (20.0) | 1.31 | 0.25 |
Re-copied my notes | 4 (11.1) | 8 (14.5) | 0.22 | 0.64 |
Crammed the night before the test | 4 (11.1) | 4 (7.3) | 0.40 | 0.53 |
Actively participated during breastfeeding course | 3 (8.3) | 15 (27.3) | 4.87 | 0.03* |
Other | 3 (8.3) | 1 (1.8) | 0.92 | 0.34 |
Materials used | ||||
Course handouts | 33 (91.7) | 46 (83.6) | 1.21 | 0.27 |
Translated questions from Comprehensive Lactation Consultant Exam Review | 24 (66.7) | 26 (47.3) | 3.27 | 0.07 |
Breastfeeding atlas | 19 (52.8) | 32 (58.2) | 0.26 | 0.61 |
Other | 4 (11.1) | 3 (5.4) | 0.34 | 0.55 |
There was enough literature in my mother tongue | 9 (25.0) | 31 (56.4) | 12.22 | < 0.01* |
I used study materials in English. | 15 (41.7) | 21 (38.2) | 0.01 | 0.94 |
Study pattern used | ||||
Study sessions spaced out over weeks/months | 24 (66.7) | 28 (50.9) | 0.70 | 0.40 |
Most study done in the days before the exam | 9 (25.0) | 16 (29.1) | ||
Did you spend time observing mother-support groups or otherwise find time to listen to normal, healthy mothers? | ||||
Yes | 9 (25.0) | 26 (47.3) | 6.58 | < 0.01* |
No | 27 (72.0) | 29 (52.3) | ||
Exam experience | ||||
Clarity of instructions provided by IBLCE regarding exam application process | n = 33 | n = 45 | ||
Completely clear | 16 (48.5) | 31 (68.9) | 4.45 | 0.11 |
Partially clear | 16 (48.5) | 14 (31.1) | ||
Unclear | 1 (3.0) | 0 (0.0) | ||
Clarity of instructions provided by IBLCE regarding exam procedure | n = 32 | n = 46 | ||
Completely clear | 19 (59.3) | 40 (86.9) | 8.73 | < 0.01* |
Partially clear | 11 (34.3) | 6 (13.1) | ||
Unclear | 2 (6.4) | 0 (0.0) | ||
Clarity of instructions provided by proctors during exam | n = 32 | n = 46 | ||
Completely clear | 24 (75.0) | 44 (95.6) | 7.38 | 0.03* |
Partially clear | 7 (21.9) | 2 (4.4) | ||
Unclear | 1 (3.1) | 0 (0.0) | ||
Clarity of photographs used during the exam | n = 33 | n = 46 | ||
Completely clear | 5 (15.2) | 11 (23.9) | ||
Partially clear | 19 (57.6) | 30 (65.2) | 3.83 | 0.15 |
Unclear | 9 (27.2) | 5 (10.9) | ||
Was there sufficient time to solve all exam questions? | n = 36 | n = 55 | ||
Yes | 27 (75.0) | 43 (78.2) | 2.56 | 0.11 |
No | 9 (25.0) | 12 (21.8) |
Comparison between participants who passed/failed the IBLCE exam
Passed | Failed | χ2 |
p
| ||
---|---|---|---|---|---|
n (%) | n (%) | ||||
N
| 53 | 39 | 0.18 | ||
Demographic characteristics | |||||
Profession | Community nurse | 19 (35.8) | 11 (28.2) | 0.60 | 0.44 |
Midwife | 14 (26.4) | 13 (33.3) | 0.52 | 0.47 | |
Neonatology nurse | 13 (24.5) | 9 (23.1) | 0.03 | 0.87 | |
Doctor | 3 (5.7) | 0 | 2.28 | 0.13 | |
Other | 4 (7.6) | 6 (15.3) | 0.73 | 0.40 | |
Highest qualification | University degree | 14 (27.0) | 9 (23.1) | 1.13 | 0.57 |
College degree | 31 (59.6) | 27 (69.2) | |||
High school degree | 7 (13.5) | 3 (7.7) | |||
Place of worka | Community health centre | 21 (40.4) | 13 (33.3) | 7.57 | 0.18 |
Maternity hospital | 18 (34.3) | 13 (33.3) | |||
Neonatology ward | 3 (5.8) | 3 (7.7) | |||
Paediatric ward | 0 | 3 (7.7) | |||
Private practice | 0 | 2 (5.1) | |||
Other | 10 (19.2) | 5 (12.8) | |||
Time spent working with breastfeeding mothers (years) | > 20 | 24 (46.2) | 11 (28.2) | 5.43 | 0.14 |
11–20 | 17 (32.7) | 12 (30.8) | |||
5–10 | 9 (17.3) | 11 (28.2) | |||
< 5 | 2 (3.8) | 5 (12.8) | |||
Duration last child breastfed (months) | > 12 | 27 (52.9) | 18 (48.6) | 0.51 | 0.97 |
> 6–12 | 13 (25.5) | 10 (27.0) | |||
3–6 | 6 (11.8) | 6 (16.2) | |||
< 3 | 2 (3.9) | 1 (2.7) | |||
Did not breastfeed | 3 (5.9) | 2 (5.4) | |||
Breastfeeding education | |||||
Was breastfeeding part of your formal education? | Yes | 29 (55.8) | 19 (48.7) | 0.45 | 0.51 |
No | 23 (44.2) | 20 (51.3) | |||
If yes, no. of hours | < 10 | 22 (78.6) | 7 (36.8) | < 0.01* | |
10–20 | 3 (10.7) | 3 (15.8) | 9.38 | ||
> 20 | 3 (10.7) | 9 (47.4) | |||
If yes, did it include bed-side learning? | Yes | 7 (17.9) | 12 (30.7) | 5.18 | 0.03* |
No | 21 (53.8) | 8 (20.5) | |||
If yes, how many hours? | < 5 | 2 (3.8) | 3 (7.7) | 0.45 | |
5–10 | 2 (3.8) | 1 (2.6) | 1.61 | ||
> 10 | 3 (5.7) | 8 (20.5) | |||
Which forms of informal breastfeeding education have you attended? | 90 h IBLCE exam preparatory course | 53 (100.0) | 26 (66.7) | 20.57 | < 0.01* |
Breastfeeding conferences/symposiums | 42 (79.2) | 11 (28.2) | 23.97 | < 0.01* | |
UNICEF/WHO 20-h course for maternity staff | 28 (52.8) | 15 (38.5) | 1.86 | 0.17 | |
Breastfeeding webinars | 22 (41.5) | 4 (10.3) | 10.82 | < 0.01* | |
20-h course for primary health care teams | 19 (35.8) | 6 (15.4) | 4.76 | 0.03* | |
Exam preparation | |||||
Motivation for sitting exam | To improve my knowledge in breastfeeding | 48 (90.6) | 25 (64.1) | 9.60 | < 0.01* |
So I can work as an IBCLC | 19 (35.8) | 6 (15.4) | 4.76 | 0.03* | |
To test my knowledge in breastfeeding | 17 (32.0) | 7 (17.9) | 2.24 | 0.13 | |
To obtain the prestigious IBCLC certificate | 13 (24.5) | 5 (12.8) | 1.96 | 0.16 | |
To prove that I can do it | 9 (17.0) | 3 (7.7) | 1.71 | 0.19 | |
I was obliged to by my employer | 6 (11.3) | 7 (17.9) | 0.81 | 0.38 | |
Study strategies used | Reread handouts | 47 (88.7) | 25 (64.1) | 7.89 | < 0.01* |
Underlined or highlighted while reading | 41 (77.4) | 22 (56.4) | 4.56 | 0.03* | |
Tested myself with practice questions | 39 (73.6) | 18 (46.2) | 7.71 | < 0.01* | |
Made outlines | 25 (47.2) | 18 (46.2) | 0.01 | 0.92 | |
Studied with others | 19 (35.8) | 4 (10.3) | 7.85 | < 0.01* | |
Actively participated during breastfeeding course | 16 (30.2) | 2 (5.1) | 8.99 | 0.01* | |
Re-copied my notes | 8 (15.1) | 5 (12.8) | 0.09 | 0.75 | |
Crammed the night before the test | 7 (13.2) | 1 (2.6) | 3.02 | 0.07 | |
Materials useda | Course handouts | 53 (100.0) | 27 (69.2) | 18.75 | < 0.01* |
Breastfeeding atlas | 37 (69.8) | 15 (38.5) | 8.99 | < 0.01* | |
Translated questions from Comprehensive Lactation Consultant Exam Review | 35 (66.0) | 15 (38.5) | 6.89 | < 0.01* | |
There was enough literature in my mother tongue. | 13 (48.1) | 27 (50.9) | 0.06 | 0.81 | |
I used study materials in English. | 16 (59.3) | 24 (48.0) | 0.89 | 0.34 | |
Study pattern used | Study sessions spaced out over weeks/months | 37 (72.5) | 16 (59.3) | 1.43 | 0.23 |
Most study done in the days before the exam | 14 (27.5) | 11 (40.9) | |||
Did you spend time observing mother-support groups or otherwise find time to listen to normal, healthy mothers? | Yes | 30 (56.6) | 15 (55.3) | 0.01 | 0.92 |
No | 23 (43.4) | 12 (44.7) | |||
Exam experience | |||||
Clarity of instructions provided by IBLCE regarding exam application process | n = 53 | n = 26 | |||
Completely clear | 44 (83.0) | 16 (61.5) | 4.41 | 0.11 | |
Partially clear | 8 (15.1) | 9 (34.6) | |||
Unclear | 1 (1.9) | 1 (3.8) | |||
Clarity of instructions provided by IBLCE regarding exam procedure | n = 53 | n = 27 | |||
Completely clear | 38 (71.7) | 10 (37.0) | 10.26 | < 0.01* | |
Partially clear | 14 (26.4) | 17 (63.0) | |||
Unclear | 1 (1.9) | 0 | |||
Clarity of instructions provided by proctors during exam | n = 52 | n = 27 | |||
Completely clear | 47 (90.4) | 22 (81.5) | 2.51 | 0.29 | |
Partially clear | 4 (7.7) | 5 (18.5) | |||
Unclear | 1 (1.9) | 0 | |||
Clarity of photographs used during the exam | n = 52 | n = 27 | |||
Completely clear | 15 (28.3) | 2 (7.4) | |||
Partially clear | 32 (60.4) | 17 (63.0) | 7.12 | 0.03* | |
Unclear | 6 (11.3) | 8 (29.6) | |||
Was there sufficient time to solve all exam questions | n = 52 | n = 27 | |||
Yes | 48 (90.6) | 23 (85.2) | 0.52 | 0.47 | |
No | 5 (9.4) | 4 (14.8) |
Predictors of exam success
Criteria | Variables | Odds Ratio | 95% CI for Odds ratio | R2* |
---|---|---|---|---|
Model 1† | ||||
Passed the test (0-No, 1-Yes) | How many hours of clinical practice you had(1-less than five to 3-more than ten) | 260.59 | 0.83,81,691.2 | 0.68 |
Number of hours of bedside learning (1-less than 5 to 3-more than 10) | 0.45 | 0.06,3.09 | ||
Forms of informal breastfeeding education have you attended: Breastfeeding conferences/symposiums(0-No, 1-Yes) | 2.51 | 0.24 26.36 | ||
Forms of informal breastfeeding education have you attended: 20-h course for primary health care teams (0-No, 1-Yes) | 2.55 | 0.97,6.71 | ||
Forms of informal breastfeeding education have you attended: Breastfeeding webinars(0-No, 1-Yes) | 1.66 | 0.51,5.38 | ||
Motivation for sitting exam: To improve my knowledge in breastfeeding (0-No, 1-Yes) | 1.42 | 0.58,3.44 | ||
Motivation for sitting exam: So I can work as an IBCLC (0-No, 1-Yes) | 1.11 | 0.56,2.21 | ||
Study strategies used: Reread handouts (0-No, 1-Yes) | 0.10 | 0.01,2.21 | ||
Study strategies used: Tested myself with practice questions (0-No, 1-Yes) | 0.22 | 0.01,3.61 | ||
Study strategies used:Studied with others (0-No, 1-Yes) | 1.12 | 0.54,2.34 | ||
Study strategies used Underlined or highlighted while reading(0-No, 1-Yes) | 0.81 | 0.33,1.99 | ||
Materials used: Course handouts(0-No, 1-Yes) | 0.56 | 0.09,3.57 | ||
Materials used: Translated questions from Comprehensive Lactation Consultant Exam Review (0-No, 1-Yes) | 1.44 | 0.54,3.86 | ||
How clear were instructions provided by IBCLC regarding exam procedure (1-unclear to 3-completely clear) | 1.18 | 0.07,19.55 | ||
How clear were the photographs used in the test?(1-unclear to 3-completely clear) | 2.68 | 0.22,32.51 | ||
Constant | 0.06 | |||
Model 2‡ | ||||
Passed the test (0-No, 1-Yes) | How many hours of clinical practice you had(1-less than five to 3-more than ten) | 0.48 | 0.28,0.82 | 0.42 |
Non-formal breastfeeding education: Congresses/Simposiums(0-No, 1-Yes) | 7.49 | 2.26,24.84 | ||
How clear were the photographs used in the test?(1-unclear to 3-completely clear) | 3.49 | 1.17,10.41 | ||
Constant | 0.08 |