View from the Hot Seat: Lessons Learned from the IBLCE Exam

Although I make my living as a lactation educator (Lactation Exam Review, Comprehensive Lactation Course, and more), I too have to take the IBLCE exam. Sitting for the exam is downright exhausting. It’s taken me days to regain my energy and put together my thoughts about the experience. (I admit it! That’s partly because I was busy with a national conference of breastfeeding coalitions—an experience much more enjoyable than taking the exam!)

It’s been five years since I last took the IBLCE exam. The test has changed quite a bit in that time. The format has changed. The number of items has changed. The testing period has changed. Here’s what I learned from taking the 2014 exam:

1) It’s not really a 4-hour test.
In its exam authorization letter, IBLCE writes that the exam “consists of 175 multiple-choice questions, 102 of which are associated with an image. The exam is given in 2 parts. You will have 4 hours to complete the exam, which includes two hours to complete Part 1 and two hours to complete Part 2.”

In practice, you don’t have “four hours” to complete the exam. You have “two hours” to complete each part of the exam. Even this is not equal; the parts have differing numbers of questions.

Here’s my tip: IBLCE exam-takers this year had 120 minutes to address 73 text-based questions of Part I, and 120 minutes to address 102 image-based questions of Part II. Be prepared!

2) Plan your break strategically.
The IBLCE allows exam-takers to take a break, but does not provide a specific time for it. Referring again to the exam authorization letter: “There are no scheduled breaks between Part 1 and Part 2 of the exam. Any minutes that you do not use to complete Part 1 will not be rolled over to Part 2.”

Here’s my tip: If you finish Part I of the exam before your time is up, before you click the “Finished” button, go take your break! You’ll want to take the “break time” while the clock is running on your first (nearly completed) section … not during the as-yet-unseen Part 2. This ensures that you have the full 2 hours you are allotted for tackling the second part of the exam. (And if you’re an older test-taker like me, consider applying for a scheduled break.)

3) Core principles of lactation care are timeless.
I recognized at least two photos included on the 2014 exam. I have seen them on other occasions during the past 25 or 30 years; I’ve even used them in my own courses. Although we in the health care field talk a lot about “new” research and “new” information, these photos remain relevant for today’s exam-takers and lactation-focused health care providers.

Here’s my tip: Focus on the core principles and concepts—and don’t be distracted by the outdated visual elements.

4) Flag for review judiciously.
When taking Part I, I flagged many, many questions to review again later. When I pushed the button to “Review flagged items,” I felt overwhelmed. I felt like I ought to change all of the answers just because I had doubted them—even though I know that’s not a good test-taking strategy!
I’m not saying that flagging an item for review is a bad idea, but I’m saying that it opens a door of temptation that I shouldn’t walk through too often.

Here’s my tip: Flag carefully.

5) Have confidence in the material you know.
There’s no telling how much time I wasted worrying about the exam content, or doing some last-minute studying. In fact, I would say last-minute studying did not help me at all.

Here’s my tip: A good night’s sleep and a healthy breakfast support exam success more than last-minute studying will!

So, that’s what you need to know, IBLCE exam-taker!

And, IBLCE, a few words of advice about the test structure:
- Allow MORE TIME for the more difficult, longer section of image-based test items! Since it includes about 40% more items than the text-based Part I, Part 2 deserves more time.’

- Check the clocks. This may have been an isolated incident, but I was hyper-vigilant about my time—especially when I sat down for Part 2—and I firmly believe that my clock counted down from “110 minutes” rather than the “120” it should have started with.

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Prepare Soon To Ensure You’re Ready Later

MBC_GraphicMany test takers seem to equate “recently taught” with “best remembered,” although I have never seen a scrap of research in the education literature to support that idea. Having taught hundreds of IBLCE exam candidates over the past several years,I can’t recall a single instance that supports that assumption. But among IBLCE test-takers I see a clear pattern.

Each year, we offer my Comprehensive Lactation Course in the fall and the spring. I’ve found that few people register for the autumn courses, and many register for the spring courses. Over and over again, IBLCE exam candidates call and inquire about this course so that they can get all 90 of the lactation-focused hours they need to sit for the exam, but many are reluctant to register for the fall courses. We field numerous calls, every week–sometimes every day–with exam candidates who tell us “I don’t want to take the course that early. I’ll forget what I learned by the time I go the exam in July.”

Au contraire! I can think of several reasons why taking the course early can be a big advantage:

Advantage #1: Interactive Learning is Retained
People who come to my course realize are engaged by an interactive teaching style within the first few minutes. Research in the education world shows that people retain more information when they are actively involved in learning, rather than passively listening to a lecture. People in my course retain what they learn.

Advantage #2: Hundreds of Pages of Syllabus for Review
Unlike most courses where participants get copies of bullet-point slides, my course offers a user-friendly syllabus that is chock-full of facts, ideas, and individual learning exercises and leads on additional resources that can be reviewed or reinforced later. Taking the course early gives people plenty of time to reinforce and review what they’ve learned.

Advantage #3: About 60 hours of Online Review
Because we offer a hybrid course, course participants are required to do hours of online “preparation” before the live, on-site session. That “preparation” can also serve as review. Every participant has the opportunity to review the online study materials as many times as they wish, until a few days AFTER the IBLCE exam. People do better when they do the preparatory learning, do the on-site learning, and then go back and review the preparatory materials afterwards. It all “gels” better. Register for a fall course for longer access to these valuable resources.

Advantage #4: Application of Learning Cements Learning
Applying your “class” or “book” knowledge in the real world is the best way to cement what you’ve learned in the classroom. If you have ever attended nursing school, applied for a driver’s license, or learned to knit, you know what I mean. When you learn your facts and then apply that information to the actual situation, you are more likely to retain what you’ve learned. Taking the course early helps to cement your knowledge.

Advantage #5: You’ll be set up to make the MARCH 2 deadline.
Most people think that since the IBLCE exam is in July, credits can be submitted until shortly before that. That’s just not the case. Since its debut in 1985, the IBLCE exam has been given once a year, during the last week in July. (There is a promise that it will be given twice a year in the future.) However, the first-time candidate must submit her credits long before that. In 2015, the submission deadline is March 2. Earning the credits in the fall makes it easy to met the submission deadline in the early spring.

Advantage #6: You’ll get a coupon for our Lactation Exam Review
If you attend our comprehensive course, you’ll get a coupon for a discount on our Lactation Exam Review course. Many course participants don’t redeem the coupon; the comprehensive course arms you with a wealth of knowledge and plenty of material to review to reinforce what you’ve learned, and we offer many other exam prep materials. But those who are particularly concerned about in-person review immediately before the exam are welcome to take both courses!

We’re here to help you succeed in meeting your IBLCE exam goals. We wouldn’t offer the fall courses if we didn’t have every confidence they could help you along your IBCLC journey. We hope to see you in the fall! (Note: Register today–or anytime before August 8th–and save big!)

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Mothers On the Go: Breastfeeding and Pumping in Airports Across America

Join Marie for “Born to be Breastfed” on Monday, July 28 and discussion of this important topic.

Every podcast episode makes me think. Preparing beforehand, reflecting afterwards, or both—every topic, every guest, every show is on my mind for some time. But this show, “Mothers On the Go: Breastfeeding and Pumping in Airports Across America,” is on my mind even now, hours after taping. I am still reeling from talking with Jeremy Blackman and his wife Nina about how airports lack a reasonable accommodation for a woman who needs to pump milk for her baby. I’m impressed by the vision of Gene Richardson, Director of Avitation at the Burlington International Airport, and Sascha Mayer, owner of the Mamava, who spearheaded efforts to build a modular Lactation Station within that facility. Several times during the show, Mr. Richardson said the decision to create such a room was a “no-brainer.” I think he probably underestimates his insightfulness, but there is a no-brainer in this story—airport personnel thinking that the “restroom” or “bathroom” is an appropriate place for a mother to express her milk.

The Purpose of the Place

Let’s think about it. It may sound innocuous and maybe even helpful for the airport staffer to direct a woman who needs to pump her milk to go to the “restroom.” But a restroom is actually not a place for rest.  The restrooms in airports, hotels, and other public places are anything but restful. They would be better termed “hurry-up rooms,” as one generally does what one must do before quickly dashing to catch a flight.

The words “bathroom” and “lavatory” may be used and are similarly unhelpful to the breastfeeding mother. Even in one’s home, where a “bath” may be present, the bathroom is more likely to be used for urination or defecation than for bathing. While the word “lavatory” is drawn from the Latin “to lavare” and means “to wash,” although one does wash one’s hands there, the main purpose is to leave and flush excrement.

Maybe airport personnel would understand the problem if we referred to these rooms for what they are: the” toilet room,” the “pee room,” the “poop room,” the “excrement room.” Grossed out? Disgusted? Does it seem repulsive to use such terms—slang for what really goes on there—for those places?

Such terms are evocative. Powerful, even. I bet you could practically see the room, maybe even smell it, when you read those terms.  Good, I’m glad. Thinking that way is a strong reminder that the room where adults excrete waste from food should not be a room where a woman secretes her baby’s food! That is the true no-brainer here.

A Place for the Purpose

Some people seem to think that just because the “women’s rest room” is the place for women in the airport (the place that men are not allowed to be) that it is the place that they should feel comfortable feeding their baby or expressing the milk from their breasts.

I’m trying to imagine how comfortable I would feel as a pumping mother: finding an outlet … standing at the counter … leaning over my breast pump … bare-chested … trying not to spill any of the precious milk my baby needs … hoping  the milk and my pump aren’t contaminated by splashing water,  soapy hands, or germs I’d rather not consider … trying to ignore the ‘wheeee-wheooo’ noise of the pump and focus on a good let-down of milk … praying for the bottles to fill quickly … balancing the flanges … trying not to spill milk on myself while another woman is rushing by—in a hurry, with luggage, holding a child’s hand, whatever …

Or how about as a breastfeeding mother: perching on a toilet … holding baby in my arms and trying not to let her come in contact with the surrounding walls or seat … constrained by the dimensions of the bathroom stall and the diaper bag hanging on the hook of the stall door … trying not to think about the germs that we are unable to avoid … wondering how others would feel if their lunch were prepared in the restroom (toilet room) …

It’s a no-brainer that’s not a place for the purpose of pumping. But it’s the reality of many women traveling through U.S. airports every day.

A Place With a Purpose

It seems to me that we make all sorts of accommodations for people who have needs—and rightly so. Our public buildings are ADA-compliant. Businesses set aside parking spots for the comfort of their pregnant patrons. We have express checkout lanes in the grocery store to accommodate those who are buying just a few things, and there are escorts available for children who are flying without a parent or guardian along. Airports have chapels to meet the needs of flyers who worship, free Wi-fi for those who want to access the Internet, and any number of other accommodations to meet the creature comforts of travelers.

It’s time for all airports to follow the lead of Gene Richardson and Sascha Mayer and offer lactation stations or mother’s rooms for those who need them.

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A Word from Your 4-Month-Old — as Translated by a Passing Nurse

Hot and sweaty, I began the trudge from the cardio machines to the women’s locker room at the YMCA. I passed two young mothers who were sitting together in lounge chairs. One had a baby with her whom I took to be about 4 months old. She was trying to feed him something; I couldn’t tell what. Each time she brought it to his mouth, he batted it away. Offer and bat, offer and bat, offer and bat. I wanted to blurt out, “Lady, he doesn’t want it!” But, I needed a shower, and honestly, I always have trouble figuring out where my nurse-advice should begin or end when I encounter strangers. I headed for the shower, and didn’t give the incident a second thought. Until, walking from the shower area to the locker area, I passed by the women conversing on a bench.

“Well, what did your pediatrician say?” asked the one woman. The other replied, “He said to start solids at 4 months.” There was a pause. “Oh. Well, yeah, mine said that too. Maybe you can try a different food with her.” Okay, that did it! I felt compelled to go into nurse mode.

Clad in a towel and flip-flops with hair sopping wet, I decided to deliver my abbreviated rant to these two mothers. “Every pediatrician I’ve ever met belongs to the American Academy of Pediatrics, the AAP. But the AAP, the Academy of Breastfeeding Medicine, the United States Breastfeeding Committee, the World Health Organization, the American Academy of Family Physicians, the American College of Nurse Midwives, the American Dietetics Association, the Centers for Disease Control and Prevention, and every other major organization that I know of says that soft, solid or semi-solid foods should not be started until the baby is 6 months old.” The women looked at me, with eyes as big as saucers. I quickly added. “You can verify what I said by checking on the web-and you should check, don’t take my word or anyone’s word for it-but I’m very confident that what I’ve just said is accurate.”

Did I poke my nose in where it doesn’t belong? Maybe. But I’ve about had it here. The baby had clearly spoken. But the mother didn’t hear the baby’s message. She heard only the pediatrician’s message. Unfortunately, this scenario is not uncommon. I hear this over and over from mothers. I hear this from nurses, lactation consultants, childbirth educators and others in cities where I teach. It’s not a local thing. All across the country, wherever I go, this is what I hear. What do mothers hear?

Mothers hear the message from the doctor. But they aren’t hearing the message from their babies. This mother’s baby spoke loud and clear. She did not hear her baby’s message. I just tried to amplify that message in a way that she might hear it.

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Relieve Yourself of Worry about Research!

I wish I had a nickel for every IBLCE exam candidate who has said to me: “The research questions scare me. What should I do?”

I wish I had a nickel for everyone who has hated my answer!

It’s simple: Know your stuff. I can give you all of the test-taking tips in the world, but they won’t do you bit of good if you don’t actually know your stuff. And, after preparing literally thousands of people for the IBLCE exam, I can tell you, with certainty, most IBLCE candidates don’t know their stuff where it comes to research. I distinctly remember an interaction from my Lactation Exam Review course in Denver. A woman sitting on my left about half-way from the front said, “Marie, this research stuff all looks like Greek to me! And so I can’t understand it because I don’t speak Greek! I don’t read Greek!” Oh, I felt like this conversation had been scripted! She had given me the cue, and I was ready to deliver my next line!

I said to her, “If you were going to Greece and wanted to speak the language of the locals, what would you do? You would learn the vocabulary. True, you might have great difficulty actually putting a sentence together, but you wouldn’t stand a chance of doing so unless you knew your vocabulary! You must know simple words or phrases. Bathroom?  Along with a shrug and raised eyebrows, would be a one-word but much-needed question if you need to relieve yourself! But if you didn’t know the Greek word for bathroom, you’d continue to find yourself mighty uncomfortable.  Knowing the vocabulary is the first step in speaking Greek, or in learning the research.”

Feel free to go back to college or buy a big heavy textbook if you wish. But instead, please consider our flashcards. I doubt that $12 for the pack will send you to the poorhouse–but knowing the vocabulary for just one question might make the difference between your passing or failing the IBLCE exam. Shuffle them, re-use them, wear them out. Just learn the vocabulary, have the conversation and relieve yourself of this worry!

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IBLCE Exam Success Depends On … You!

Note: Registration now open for Marie’s FREE Five Keys to IBLCE Exam Success webinar, on July 10 (two times available — 9 am ET or 3 pm ET — space is limited).

As you prepare for the IBLCE exam by reading through practice questions and mock exams, do you find yourself thinking “It depends on if …” as you try to figure out your answer? (I hear this a lot from participants of my Lactation Exam Review course I admit that I sometimes fall into the habit myself.)

Well, that’s not a good thing. Read on for an explanation of why you (like most people) might initially do this — and why it isn’t a good idea.

Usually, “depends-on-if” thinking is a symptom of greater lactation or postpartum care experience. I know; in nearly 30 years of providing clinical care, I’ve seen a wide variety of circumstances, challenges, and outcomes.  In those situations, I’ve done what any good clinical expert would do: I’ve looked at the whole clinical picture. I bet you’ve done the same! But while the “depends-on-if” approach is good in the clinical area, it is not good for answering exam questions.

Here’s why: If the answer to the question hinged on the “depends-on” info you’re wondering about, that info would have been in the stem of the question. For test-taking purposes, you need to pay attention to what the exam item says–and ignore the possibility of anything it doesn’t.

Certainly, I’m not going to sit here and tell you that every single question on the IBLCE exam is air-tight. But apparently the answer doesn’t depend on the “depends-on-if” factor that leapt to your mind — or else that would have been specified. Although we train ourselves to think through each situation with our clients, we need to be careful that we don’t overthink the question when our “client” is the IBLCE exam!

So, you ask: What about when they give you a ton of information? How should you deal with that? Well, it depends on if …

Just teasing. But come on back to the blog for another post on that topic later.

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Looks Like … Sounds Like … IBLCE Exam Success!

Another question from the (FREE!) Five Keys to Lactation Exam Success webinar:

What kind of question can get me in trouble when I actually do more or less know the answer?

In truth, there are several kinds of questions that might be troublesome. (Deep breath, folks! We’ll get through it.) I think, that the biggest one is what I call the look-alike, or the sound-alike, questions. Here’s an example from my Test-Taking Strategies module:

Which of the following would be prescribed for a mother who was diagnosed with postpartum depression?
a. Celebrex
b. Cerebyx
c. Celexa

Ok, take note: You’re not going to see brand names on the real IBLCE exam. You’ll see only generic names. But this example clearly hints at the look-alike/sound-alike nature of some  text questions. (Register for an upcoming Five Keys to Exam Success for other examples.)

Having generated thousands of test items over the years, I’ve noticed that the look-alike or sound-alike questions separate the “almost-know” test-takers from the test-takers who are dead-sure of their answer. So don’t get caught in one of these. Know your stuff.

We talk about these and other test-taking issues during the Five Keys webinar, offered frequently. It’s a live discussion of hot topics in lactation exam-taking, delivered via the Internet. In addition to the folks here in the U.S., we’ve had attendees from Brazil, Australia, Ireland, and elsewhere, so come on in! You’ll have an opportunity–I’d even say an invitation–to ask questions on the spot.

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Think It Through on the IBLCE Exam

Have you heard this story? A kid comes out of a room after having taken an exam. His friend asks, “Did you have trouble with those exam questions?” The kid’s response: “No, not really. The questions didn’t bother me. It was the answers I had trouble with!”

It reminds me of the IBLCE exam.

Let’s face it. There will be questions on the IBLCE exam that you’ll have trouble with. There will be questions on content that you never studied, or to which you’ve had no exposure. There will be questions for which neither you nor I know the answer. It happens. Don’t panic!

Sometimes, we know more than we think we know. I’ll show you how this works. I’m going to give you a question for which I’m sure you don’t know the answer! Then, you’re going to figure out the correct answer–or at least make an educated guess. Here’s the question:

Marie’s sister began working in Rochester NY in 1962. She is now happily retired, but volunteers at a local charity 3 days a week. Which of the following was Marie’s sister’s occupation during her years of paid employment?
a. Chemical engineer
b. Professional firefighter
c. School teacher
d. Scuba diving instructor

Now, let’s reflect for a moment before we go on. You know right away that “firefighter” isn’t a likely answer. How did you know that? Because you know that Marie’s sister is, well, a woman! You instinctively know, without ever having learned it, that the vast majority of emergency-services jobs are held by men. See how you knocked off that option? Good. Let’s look at the other options.

You’re thinking it’s unlikely that the scuba diving instructor is the answer. You realize that you just eliminated the “firefighter” option by reasoning that women don’t usually have that occupation. But you’re eyeing this carefully. You’re wondering: Maybe there is something very unusual about this woman! Maybe that’s why this showed up on a question! Ok, fair enough. But where does the sister live? In Rochester NY! Aha! You suddenly remember that TV commercial from Subaru several years ago showing the man all bundled up in a blizzard with his dog sled and his vehicle. The commercial ended by saying that Rochester NY is the most snowed-upon city in the United States. Hmmmmmmm. Not likely that this woman spent her career doing something that could be done only a few months of the year.

OK, you’ve eliminated two options. Your gut is telling you “school teacher.” But you’re afraid to go with your gut. You wonder if you’re overlooking something here. You’re really, really wondering because, of course, you really don’t know the answer! You know you don’t know the answer! You know you’re taking a WAG (wild-ass guess). So you’re pondering the possibility of the chemical engineer. Rochester was a big Kodak city in its heyday. They surely employed chemical engineers, right? Ok, so you’re thinking that’s possible. But then you realize: If she started working in 1962, she probably went to college in the late 1950s. What were the three top occupations of women in those days? Secretary (not an option here) … nurse (also not an option) … teacher.

And sure enough, there you have it. Marie’s sister went to college to become a teacher, and she taught Special Education in the Rochester City School District for about 45 years. Marie’s other sister went to college to become a secretary. And Marie went to college to be, umm, yes, that’s right: a nurse!

See? There is no way you could have known this information by studying. But by thinking about the information in the stem of the question, you can improve your chances for picking the correct option for your answer. Think. Call up some information from your subconscious (like the Subaru commercial.) Use some logic. Think about likelihoods. You can almost always narrow your choices down to the two best options and improve your odds of success.

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What Comes First … the Photo or the Text?

Question from Five Keys participant: “Should I look at the photo first, or look at the question first?”

I could make an argument for either approach. I’ve spent much of my career with one foot in the clinical camp while the other foot is in the academic camp.  How I approach a test item depends, to a degree, on what kind of camp I need to be in to answer the question.

If I was in front of a patient who had a question about her sore nipples, I would listen to her question and then look at her nipples. Generally, in the real-life clinical setting, I first hear the question posed and then I get to see the situation–whatever it is–myself. I do not see the patient and say to myself “I wonder what this problem is?” I don’t see the nipples or the incision or the lochia or the jaundice first and then say, “Gee, I wonder what she wants to ask me about this?” So, in general, I suspect I’m better at looking at photos after I’ve taken in the question. That gives me a sense of context.

But as an educator, I do sometimes find compelling photos and think “Oh, this is an interesting photo. I bet I could cook up a good question on this.” I bet the same thing happens to IBLCE exam writers!

When I’m taking the IBLCE exam, I sometimes do try to examine the photo first, so that I read the question in the context of the photo.  If I can do that successfully, I’m usually much quicker at answering the question. The only downside: This approach can backfire on me if I focus on the baby’s nose, and discover that the question is about what’s on his forehead!

Ultimately, reading the question first feels more clinically comfortable for me, and it may improve the accuracy of my initial thinking. However, if I focus on the right thing and recognize what’s going on in the photo, seeing it first can improve the speed of my answer.

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Is a Picture Worth 1,000 Words on IBLCE Exam?

“Should I tackle the text-only questions first, or do the photo questions first?” is a question I received during a recent (FREE!) Five Keys to Passing the Exam webinar.

I’d love to give an evidence-based answer, but honestly, it’s really a matter of personal preference. On the IBLCE exam, the questions are arranged with the 75 text-only questions first, followed by the 100 photo-based questions. If you want to do them in the order in which they are presented, then you have your answer.

Personally, I have always tackled the photo-based questions first. I really believe that old saying “If you must eat a frog, eat the biggest frog first!” I have taken the exam 3 times, and in my opinion, the “biggest frog” is the photo-based portion of the exam. Interpretation of photos seems to take more expertise and energy than the text-only exam items. I would rather use my energy to knock out the toughest questions when I’m fresh and more able to focus. After a few hours, I am more tired and less focused. (If you think that teaching lactation courses makes this exam somehow “easier” for me, I assure you, that’s not the case! Like everyone else, I have test anxiety.)

Of course, the photos-first strategy isn’t for you if you choke while eating the biggest frog. Back in the Fred Flintstone days–when tests were written on paper and nurses used pens–I sat for the NCLEX exam. To this day, I can recall that the first question I faced was about eye surgery. I gulped. I didn’t know anything about eye surgery then; I still don’t! That question was a real downer for me. It caused me to feel fearful that the whole exam would be questions for which I wasn’t prepared. The third or fourth question was about gastroschisis. I was freaking out. If this kind of frog-eating destroys your self-confidence, you may want to eat the smaller frogs first and build confidence. And for the record, I had a “Yabba dabba doo!” day when I found that I passed the NCLEX on the first try!

About twenty years later, I had my first experience on the panel of experts who prepare the NCLEX exam! That’s proof positive: There is life after exams–even if you don’t know the answer to the first question!  Use the approach that feels best to you.

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