Preparing for the International Board Certified Lactation Consultant (IBCLC®) exam can be less intimidating when you understand how the exam is created and scored. The IBCLC exam is administered by the International Board of Lactation Consultant Examiners (IBLCE®) and is a high-stakes test recognized globally. Knowing how exam questions are written, how your exam will be graded, why some questions might not count, and what the pass rates look like can help you study more effectively and reduce anxiety on exam day. This post provides a detailed overview of the IBCLC exam process and explains why these behind-the-scenes details matter for your exam preparation.
How IBLCE Develops IBCLC Exam Questions
Data-Driven Blueprint: IBLCE uses a practice analysis (a type of job analysis survey of practicing lactation consultants) to ensure the exam content reflects real-world practice (IBCLC Commission, n.d.). Based on this large survey of the field, IBLCE creates a detailed Content Outline (exam blueprint) that defines the domains and topics the exam will cover. The IBCLC Detailed Content Outline has two dimensions – covering clinical skills and various chronological periods – to comprehensively map the scope of lactation practice (IBCLC Commission, n.d.).
Subject Matter Expert Item Writing: With the blueprint in hand, subject matter experts (SMEs) write the actual multiple-choice questions. Every exam question is written to match a specific content area from the outline (IBCLC Commission, n.d.), ensuring each question is relevant to IBCLC competencies. Questions are scenario-based and designed to test applied knowledge across the disciplines outlined by the blueprint.
Multi-Step Vetting Process: Each question goes through rigorous review and vetting before it ever appears on an exam. After an item is written, it is reviewed by other expert clinicians for accuracy, clarity, and relevance. (LER, 2022). IBLCE’s Exam Development Committee examines each item to confirm there is enough information provided to deduce the correct answer and that the question aligns with exam standards (LER, 2022). Because the IBCLC exam is international, all approved questions are translated into the multiple exam languages and back-translated to English to verify that no meaning is lost in translation (LER, 2022). This meticulous process means that by the time you see a question on exam day, it has been through an “arduous multi-step process” of creation and quality control (LER, 2022). In short, IBLCE does not include questions casually – each one is carefully crafted and reviewed to be fair and clear for a global candidate pool.
How the IBCLC Exam is Structured and Scored
Exam Format: The IBCLC exam consists of 175 multiple-choice questions delivered in two parts (IBCLC Commission, n.d.). Part II of the exam includes clinical images accompanying many questions, reflecting real-life lactation scenarios. Each question has one correct answer (IBCLC Commission, n.d.). The exam is administered on computer at secure testing centers (and via approved remote proctoring in some cases) under standardized conditions.
Standard Setting (Passing Score): The exam is scored based on the number of questions answered correctly, and IBLCE uses a statistical standard-setting process to determine how many correct answers are required to pass. Cut scores (pass/fail thresholds) are established using standard psychometric procedures, specifically a peer-based judgment of the performance level expected of a competent IBCLC (IBCLC Commission, n.d.). In practice, this means a panel of experts and testing psychometricians evaluate exam questions and set a minimum passing standard (often using well-known methods like Angoff or Rasch modeling, though IBLCE’s public materials simply describe it as “peer-based judgement”(IBCLC Commission, n.d.)). Because each exam version may vary slightly in difficulty, IBLCE employs equating – a statistical adjustment – so that the passing standard represents the same level of ability across different exam forms or languages (IBCLC Commission, n.d.). Once the exam is administered, scoring experts confirm the predetermined cut score is appropriate for that version before results are finalized.
What Score Do You Need to Pass? While the exact passing score can differ slightly each administration, it generally requires getting roughly 70–75% of the questions correct. For example, the September 2023 exam had a passing cut score of 128 out of 175 scored questions (about 73% correct)(IBCLC Commission, n.d.). These cut scores are approved by the IBCLC Commission after psychometric analysis to ensure they represent the minimum competency standard. The important thing to note is that your raw score (number of correct answers) is what determines passing, once compared against that exam’s cut score. The IBCLC exam is not graded on a curve, and there is no preset quota of how many will pass; in theory, everyone who meets or exceeds the cut score passes the exam.
Results and Score Reports: Official exam results are typically released about 10–12 weeks after the exam window (IBCLC Commission, n.d.). This time lag exists because scoring is not just an automated count of answers – it includes careful verification and review (discussed more below). When you receive your score report, it will show your total score and a breakdown by content area. The report lists how many points you earned in each domain out of the maximum possible in that area (IBCLC Commission, n.d.). These sub-scores are for your feedback only – they help you identify strengths or weaknesses in specific topics, but they do not affect the pass/fail decision (IBCLC Commission, n.d.). Only the overall score determines whether you passed. In other words, you do not need to “pass” each section; you just need to achieve the overall passing score. This feedback can guide your future study or continuing education plans, especially if you need to retake the exam or want to improve your knowledge in certain areas.
Post-Exam Review and Discarding of Questions
One of the reasons results take a while to be released is that IBLCE conducts a thorough post-examination analysis to ensure the scoring is fair and accurate. After every exam administration, testing experts perform an item-by-item statistical review of all questions (IBCLC Commission, n.d.). Any question that performed unexpectedly – for instance, one that an unusually high number of well-prepared candidates got wrong, or any item showing abnormal response patterns – is flagged for further scrutiny by subject matter experts (IBCLC Commission, n.d.). This means that even after the exam is over, each problematic question is evaluated to decide if it was flawed or unfair.
Why might a question be discarded? There are a few scenarios in which IBLCE may “throw out” an exam question from scoring to protect candidates:
Ambiguous or Flawed Question: If expert reviewers determine that a question was poorly worded, ambiguous, or has no clear correct answer, that question can be removed from everyone’s score tally. This ensures no candidate is penalized by an unfair item (IBCLC Commission, n.d.). For example, if a question was supposed to have one best answer but in hindsight could be interpreted to have multiple reasonable answers, IBLCE would likely invalidate that item.
Translation Issues: The IBCLC exam is truly global – it has been offered in up to 17 different languages (IBCLC Commission, n.d.). Sometimes, a question might be correctly written in English but a nuance could be lost or altered in one of the translated versions. If the post-exam analysis finds that a question only performed poorly in a certain language (e.g. candidates who took the exam in Portuguese all misinterpreted one item), this flags a potential translation problem. In such cases, IBLCE will discard that question for the affected language group (LER, 2022). The candidates testing in that language would not have that item counted against them, even if it remains counted for other languages where it functioned as intended.
Content or Regional Differences: Because lactation practices can vary internationally, an exam question might be interpreted differently due to regional practices. If analysis shows that responses were aberrant in one region or cultural context (and not due to translation), IBLCE’s experts consider whether a widely accepted local practice conflicted with the expected answer (LER, 2022). This is another facet of fairness – ensuring that one cultural viewpoint doesn’t unfairly disadvantage candidates elsewhere. If needed, the item might be thrown out or adjusted in scoring to account for this.
Through this post-exam psychometric review, IBLCE “provides the most fair and accurate results to IBCLC test-takers” (IBCLC Commission, n.d.). In practical terms, if a truly flawed question slipped through the pre-exam vetting, it will not affect your score (LER, 2022). IBLCE’s scoring protocol is designed to protect candidates: if a question doesn’t meet the exam’s statistical and quality standards, it is removed from scoring (for all candidates or for specific languages/regions as appropriate). This rigorous approach is one of the reasons the IBCLC credential is respected – the exam results are as valid and reliable as possible, and candidates can trust that they weren’t failed due to a bad question. As a candidate, if you encounter a question that seems “off” or unsolvable, it’s wise to stay calm and answer it as best you can; there’s a good chance that if it truly is flawed, it will be nullified in the scoring process (LER, 2022).
Recent IBCLC Exam Pass Rates and Trends
IBLCE publishes exam statistics that include the overall pass rates for each exam administration. These figures can give you an idea of how challenging the exam is and how well-prepared candidates tend to be. In recent years, the global pass rate for the IBCLC exam typically falls in the range of roughly 70% to 85%. Pass rates can vary from year to year and between the spring and fall exam administrations, depending on the composition of candidates and other factors.
For the March/April 2023 IBCLC exam, about 74.4% of candidates passed the exam (IBCLC Commission, n.d.). The passing cut score for that exam was statistically set at 129 questions correct out of 175, which equated to about 73.7% of the exam content answered correctly (IBCLC Commission, n.d.). In other words, nearly three-quarters of the test-takers demonstrated competency by meeting that standard.
For the September 2023 exam, the pass rate was very similar: approximately 72.9% of candidates passed globally (IBCLC Commission, n.d.). The cut score in that case was 128 out of 175 (around 73% correct)(IBCLC Commission, n.d.). Over 3,800 candidates from 86 countries took the exam in Sept 2023, reflecting how worldwide the IBCLC credential has become (IBCLC Commission, n.d.).
To put these numbers in perspective, a pass rate in the low-to-mid 70s means that the majority of well-prepared candidates do succeed on their first attempt, but a significant minority do not, underlining the importance of thorough preparation. Historically, there have been exams with higher pass rates – for instance, the April 2021 IBCLC exam (offered in English only amid the pandemic that year) saw about 82.7% of candidates passing (IBCLC Commission, n.d.)– and some with lower, but generally the pass rate hovers around 70–85% year to year. The passing score (number of questions you need right) is not a fixed percentage but is based on the difficulty of that particular exam form; IBLCE’s use of standard setting and equating is what causes slight fluctuations in the required score and pass rate.
It’s also noteworthy that pass rates can differ by candidate category. IBLCE breaks down statistics by pathway (the route through which candidates became eligible) and by whether candidates are testing for the first time or repeating. First-time candidates tend to have higher success rates than repeat test-takers. For example, in one exam analysis, first-time candidates had around an 80% pass rate while those repeating the exam had a considerably lower pass rate (IBCLC Commission, n.d.). Likewise, among the eligibility pathways, those coming through structured mentorship programs (Pathway 3) have at times scored higher on average (e.g., an 85% pass rate in one recent exam) compared to those from clinical practice or academic pathways (IBCLC Commission, n.d.). These differences highlight that adequate preparation and clinical experience are key – and that if you are re-testing after a previous failure, you may need additional study or mentorship support (as reflected in IBLCE’s retake policies).
Overall, the IBCLC exam is rigorous but passable. Typically around three-quarters of test-takers pass, and IBLCE provides a fair process to all candidates worldwide. If you prepare according to the exam blueprint and truly understand the material, you have a strong chance of joining the ranks of the 38,000+ certified IBCLCs around the globe (IBCLC Commission, n.d.).
Why Understanding the Exam Process Matters
Knowing how the IBCLC exam is constructed and scored is more than just trivia – it has practical implications for how you prepare and approach the test:
Focused Studying: Understanding that the exam is blueprint-driven means you should base your studies on that content outline. Focus on mastering the specific disciplines and skills listed, because IBLCE is intentional about testing those areas (IBCLC Commission, n.d.). This helps you avoid wasting time on topics that are outside the exam’s scope.
Confidence in the Exam’s Fairness: Realizing the lengths to which IBLCE goes to vet questions and review them for fairness should give you confidence. You can walk into the exam knowing that each question has been reviewed by experts and that if something truly anomalous occurs, it won’t unfairly ruin your chances (LER, 2022). This knowledge can reduce anxiety – you can focus on doing your best, rather than worrying “what if a question is wrong?”
Strategic Exam-Taking: Since there is no penalty for wrong answers and every question counts, you should plan to answer all 175 questions. If you know that roughly 70-75% is the typical passing threshold, you can gauge your practice test performance against that ballpark. Also, being aware that the exam is four hours long with a planned break can help you practice timing and stamina.
Interpreting Your Results: If you don’t pass, understanding the score report can guide your next steps. Because the score report breaks down performance by category (IBCLC Commission, n.d.), you can identify which domains were weaker for you and target those in your further study. IBLCE also has policies (like waiting periods and additional education requirements) for retaking the exam, underscoring that you should address knowledge gaps before the next attempt. Knowing that repeat candidates historically have lower pass rates (IBCLC Commission, n.d.) can motivate you to utilize the time between attempts to significantly boost your preparation.
Summary
In summary, the IBCLC exam is developed with scientific rigor and a commitment to fairness. The questions you face are the result of careful work by lactation experts and psychometricians to reflect real-world practice and to distinguish who meets the standard for certification. Scoring is based on sound methodologies to ensure the pass/fail decision is valid, and problematic questions are eliminated so they don’t unfairly impact anyone’s score. For exam candidates, insight into this process can be empowering – it demystifies the test and lets you concentrate on studying the content itself, confident that the exam will accurately assess your knowledge. By understanding how the IBLCE writes exam questions, scores the exam, and upholds its quality, you can approach your IBCLC exam with a well-informed and positive mindset, ready to demonstrate your competency in lactation practice.
References
International Board of Lactation Consultant Examiners. (2023a). IBLCE examination test analysis: September 2023 examination. https://iblce.org/wp-content/uploads/2023/12/September-2023-Examination-Analysis.pdf
International Board of Lactation Consultant Examiners. (2023b). IBLCE examination test analysis: March 2023 examination. https://iblce.org/wp-content/uploads/2023/07/March-2023-Examination-Analysis.pdf
International Board of Lactation Consultant Examiners. (2021). IBLCE examination test analysis: April 2021 examination. https://iblce.org/wp-content/uploads/2021/08/April-2021-Examination-Analysis.pdf
International Board of Lactation Consultant Examiners. (2022). IBLCE candidate information guide. https://iblce.org/wp-content/uploads/2022/03/Candidate-Information-Guide.pdf
International Board of Lactation Consultant Examiners. (2024). Facts & figures about the IBCLC examination. https://iblce.org/wp-content/uploads/2024/04/IBCLC-Exam-Facts-Figures.pdf
Love-Zaranka, A. (2019). Questioning the question: What to do when an exam question seems flawed. Lactation Education Resources Blog. https://lacted.org/questions-on-exam-questions
