How to Raise a Good Examination Room Interpreter
Takayuki Oshimi, MD (Primary Care Physician &
Occupational Health Physician)
Keiyukai Yoshida Hospital
20 October 2004
Dr Oshimi presented a guide to how to train an ideal clinical interpreter, who can work effectively in Japanese communities in countries outside of Japan.
What is a clinical medicine interpreter?
What skills should they have?
How should they be trained?
Dr Oshimi's Profile:
MD: Asahikawa Medical College
Currently a physician & occupational health physician at Yoshida Hospital in Hokkaido
Editor for East Wind Medicare (a medical interpretation company in Auckland)
Various medical translating duties, including various publications
Dr Oshimi has kindly provided the handout and full text of his presentation.
How to Raise a Good Health Care Interpreter
Title
Thank you Mr. Chairman. Good evening, ladies and gentlemen.
It’s my pleasure to present my views on "How to Raise a Good Health Care
Interpreter."
Currently, I work as a physician in Asahikawa, Hokkaido.
Personally, I am interested in promoting health care interpreting, as a
means to support equal access to the health care in English-speaking
countries for individuals with limited English proficiency.
Recently, with the increase of the Japanese who settle in
English-speaking countries, the need for language assistance in health
care settings is growing.
I have had the pleasure of visiting Vancouver, and Auckland, both of
which have large Japanese populations, and both have health care
interpreting services.
I’m also a member of the National Council on Interpreting in Health Care
in the United States. By studying health care interpreting models
already established in foreign countries, a workable standardized
training plan can be instituted here in Japan.
The purpose of today’s presentation is to introduce you to the health
care interpreting services that exist outside of Japan, and to promote a
national certification system in Japan.
Now, let’s get started.
Contents
First of all, what is a health care interpreter? We’ll take a look at a
definition. And then we’ll look over the existing models of health care
interpreting. Next, we’ll cover the roles of health care interpreters,
and existing training programs.
In the following section, we’ll go over health care interpreting skills,
which include basic language skills, a code of ethics, familiarity with
cultural issues, health care terminology, integrated interpreting
skills, and the paperwork health care interpreters need to be able to
translate.
And finally, we’ll conclude with a summary of the key points with
follow-up questions about a certification system in Japan.
1. What’s a Health Care Interpreter?
1 – a. Definition
Health Care Interpreting is defined by "The National Council on
Interpreting in Health Care" as;
That which "takes place in health care settings of any sort, including
doctor’s offices, clinics, hospitals, home health visits, mental health
clinics, and public health presentations. Typically the setting is an
interview between a health care provider and a patient. "
Health Care Interpreter is defined by "The California Standards for
Healthcare Interpreters Association" as one who:
1) Has been trained in health care interpreting
2) Adheres to the professional code of ethics and protocols of health
care interpreters
3) Is knowledgeable about medical terminology
4) Can accurately and completely render communication from one language
to another
Next, let’s take a look at…
1 – b. The Models of Health Care Interpreting
There are several models of health care interpreting. The models that
currently exist usually fall into the following categories. I’ll
describe each model here.
The First Model is…
No Interpreter
Providing no interpreter is an unacceptable approach, but frighteningly
common. Trying to provide health care across a language and cultural
barrier with no assistance, practically guarantees poor quality care,
which could, in the worst-case scenario, end up as a malpractice suit.
The Second Model is the…
Chance Interpreter Model
Chance Interpreter is also called an "ad hoc interpreter", which is an
untrained person who is called upon to interpret, such as a family
member interpreting for his or her parents, a bilingual staff member
pulled away from other duties to interpret, or a self-declared bilingual
in a hospital waiting room who volunteers to interpret.
These chance interpreters invariably have zero training as interpreters
and are unlikely to be able to provide accurate or even useful
interpretation.
Though family members have an important role to play in supporting the
patient, their personal relationship is in direct conflict with the role
of an interpreter. Family members routinely edit, add, change the
message, and end up taking control of the interaction between patient
and provider instead of facilitating it.
The Third Model is the…
Bilingual Support Staff Model
An untrained bilingual support staff member is not much better. These
staff members also tend to edit, add and change the message. Unless
their language proficiency is tested, it may be discovered that they
don’t have the language skills necessary to interpret well.
Even if they have enough proficiency, they may feel frustrated when they
are taken away from their regular jobs to interpret often. Some of these
problems can be solved by screening their language skills and by setting
up a more formal system for using bilingual staff services.
Next we have the…
Remote Interpreting Model
This is interpreting provided by an interpreter who is not in the
presence of the speakers, for example, interpreting by telephone, or
videoconferencing.
Remote interpreting is carried out with an interpreter connected
electronically to the principal parties. In health care settings, a
doctor and a patient are normally in the same room, but the interpreter
can be used to serve individuals who are also connected to each other
electronically.
Advantages of remote interpreting include on-demand access in a wide
array of languages.
These services are especially useful for emergencies, for uncommon
languages. However, the expense of installing such a system may be a
concern. And professional interpreters who are proficient in this model
will also expect higher remuneration than most on-site interpreters.
The AMDA International Medical Information Center is a major organization in Japan, which provides multilingual remote interpreting services.
And then we have the…
Bilingual Provider Model
The ideal model for providing language service is to assign a bilingual
and bicultural provider. However, it is difficult to find providers in
all the different languages a medical center might need. This model also
doesn’t serve the language needs of the patient outside the medical
interview: for example, at the pharmacy, at radiology, or at the
reception desk.
Finally there is the…
Professional On-Site Interpreter Model
A more reliable and reasonable approach is to use professional on-site
interpreters. Some institutions hire full-time staff interpreters, while
others have contracts with interpreters who are paid only for the time
they interpret. Other institutions, such as travel insurance companies,
have contracts with language agencies. Travelers who require health care
interpreting can get it as part of their travel insurance.
In Japan, demand for the on-site interpreters who have competent
professional skills, has been on the rise.
1 – c. The Roles of Health Care Interpreters
The fundamental purpose of health care interpreting is to facilitate
communication between two parties who do not speak the same language and
do not share the same culture. Various obstacles to cross-cultural
communication include language complexity, differences in cultural
norms, as well as organizational or systemic barriers facing the foreign
patient.
In this section, we’ll take a look at the roles of health care
interpreters.
Message Converter
In this role, interpreters are supposed to convert the meaning of all
the messages from one language to another, without additions, deletions,
or changes in meaning.
To do this role, interpreters must manage the flow of communication
between all the parties present. Interpreters need to intervene when
parties speak too fast or fail to allow the interpreter time to
interpret. They also manage turn-taking, indicating to individuals
speaking at the same time that they will be heard in sequential order or
that a party must be allowed to finish speaking.
Message Clarifier
In the message clarifier role, interpreters should identify possible
words or concepts that might lead to misunderstandings. When the
interpreters notice them, they need to interrupt the communication,
alert the parties that there are signs of confusion. They also need to
ask the speaker to describe the words or concepts in a simpler way. If
needed, interpreters need to explore ways to assist speakers to describe
concepts using analogies.
Culture Clarifier
The culture clarifier role goes beyond word clarification. When there is
evidence that any of the parties may be confused by cultural
differences, interpreters need to interrupt the communication process,
identify cultural concerns that could be impeding mutual understanding,
and assist each party in explaining the cultural concept. When
requested, interpreters need to explain cultural customs and patient’s
common beliefs with respect to health. They must also educate the
patient on the biomedical concept of the host country.
Patient Advocate
Patients with limited language proficiency find it difficult to advocate
for their own right to the same level of care as the native speakers. In
this situation, interpreters are often the only individuals in a
position to recognize a problem and advocate on behalf of the patient.
Health care interpreters have duty-of-care function.
However, this active supporting role must remain an optional role for
each health care interpreter.
1 – d. Health Care Interpreter Training Programs
Training models that currently exist beyond the level of short
orientations or periodic on-the-job training, usually fall into one of
the following categories.
Academic Training Programs
Academic training programs can be quite varied. They can offer
certificate programs, including a Bachelor or Master of Arts degree
program. However, only a small percentage of colleges and universities
offer interpreter training of any sort, especially for health care
interpreting.
Bilingual Health Care Employee Training Programs
The health care institutions, such as a medical center, or an HMO, give
training programs for its bilingual employees, such as receptionists,
nurses, or lab technicians. These employees are familiar with the
specific health care settings, but this model has the same disadvantages
as "the role of the bilingual support staff model".
Community Training Programs
Community organizations train the bilinguals living in the community.
The length of the training varies according to the facility and ranges
from one day (8 hours) to one week (40 hours). The providers of these
programs maintain close ties to the medical facilities and have a better
understanding of the health care system, but relevant topics of the
field may be omitted, and teaching ability and experience of the trainer
vary widely.
Intensive Training of at least 40 hours
Most of these courses serve as a basic introduction or an intermediate
training course designed for both new and experienced interpreters.
Agency Training Programs
Some agencies provide training for their interpreters, and the programs
vary greatly in their approaches to testing and training.
2. Health Care Interpreter Skills
To play all the roles of health care interpreting effectively, the
interpreters should have special skills. The following six components
are essential in determining whether or not a candidate is qualified to
be a health care interpreter.
2 – a. Basic Language Skills
The most basic skill that an interpreter must have is competence in
speaking and understanding the two languages to be interpreted. Every
interpreter, even the most skilled, will need to expand his or her
vocabulary through training and ongoing study. However, basic oral
proficiency in both languages is a prerequisite for anyone wishing to
serve as an interpreter. Demonstrating a will to improve oral
proficiency is the first step for the candidates.
There are a number of English oral proficiency tests. However, most of
them have literary and academic orientation, and are not very suitable
for testing the oral skills of interpreters. I want to emphasize that
interpreting is fundamentally an oral skill, and that even candidates
who do not read and write well can be excellent interpreters and should
not be initially screened out based solely upon inadequate written test
results. Indeed, for some minor languages, there are few interpreter
candidates who have had the opportunity to study the foreign language
formally. For this reason, many health-care-interpreting institutions do
not include formal testing of written language skills as a part of the
minimum screening necessary for an initial assessment.
2 – b. Code of Ethics
Some Questions to Discuss
Would anyone care to volunteer to read the questions for us, please?
1. In the course of an assignment, should an interpreter interpret
statements, which he/she knows to be untrue?
Next, please.
2. You arrive early for an interpreting assignment at a hospital. The
client recognizes you as the interpreter and starts to tell you that
he/she feels really depressed and is considering suicide. Would you
advise the doctor of this conversation or would you keep it to yourself?
3. Should an interpreter interpret for friends and relatives?
4. You are sent by an agency to interpret for a client. The client
brings a friend along to interpret and refuses your service. What would
you do?
Let’s think about some possible answers. Anyone care to share your
thoughts?
Let’s discuss together.
Health care interpreters should expect to face these types of difficult
situations.
A code of ethics is a set of principles or values that governs the
conduct of health care interpreters and provides guidelines for making
judgments about what is acceptable and desirable behavior in a given
context or in a particular relationship.
The following code of ethics offers a set of principles that are
generally accepted by a number of health care interpreter associations
in the United States.
As in all codes of ethics, it does not provide definitive answers to all
of the dilemmas interpreters face. As a profession, health care
interpreters need to come to a clearer understanding of the ethical
dilemmas that are unique to the field. This code of ethics for health
care interpreters is offered in the spirit of establishing a starting
point towards creating a common understanding of ethical practice in the
field of health care interpreting.
Confidentiality
The interpreter shall treat as confidential all information learned in
the performance of their professional duties. This means that
interpreters will not disclose to anyone any information acquired on the
job. Confidentiality is to be maintained in all situations except when
the government mandates the disclosure of information in specific
situations such as child abuse, elder abuse, or a person threatening
harm to him/herself or others. Currently there are no specific legal
guidelines for interpreter responsibilities regarding confidentiality.
It is interpreter’s responsibility to understand the standard operating
procedures of the individual institution in question.
Accuracy and Completeness
The interpreter shall render the message faithfully, conveying the
content and spirit of the original message while taking into
consideration its cultural context. This means that interpreters shall
interpret everything the speaker says without changing the meaning,
conveying what is said and how it is said without additions, deletions
or alterations, but with due consideration of the cultural context of
both the sender and the receiver of the message. The interpreter must
convey the meaning of gestures, body language, and tone of voice.
Additionally, interpreters must reveal and correct any errors they have
made during the interpretation.
Impartiality
The interpreter shall maintain impartiality and shall not counsel,
advise or project personal biases or beliefs. Interpreters remain
impartial by suspending judgment and making no personal comment on the
content of the communication. They avoid distorting the message in favor
of one party or the other. Under no circumstances should interpreters
give advice to patients.
Professional Boundaries
The interpreter shall maintain the boundaries of the professional role,
refraining from personal involvement. Interpreters need to avoid getting
personally involved with the people for whom they interpret. This does
not mean that interpreters cannot be friendly and caring. The
development of rapport with patients and providers during a pre-session
is a part of the interpreter’s professional role and does not
necessarily represent personal involvement.
Professional Development
The interpreters shall strive to continually further their knowledge and
skills. Interpreters need to engage in ongoing professional development
activities. They should improve upon their linguistic knowledge and
maintain their interpreting skills by reading current literature and
taking advantage of educational opportunities such as workshops,
trainings, etc. They should also continue to expand their knowledge of
the medical contexts in which they may be called to function and of the
socio-cultural contexts including folk medicine and illnesses of the
patient populations for whom they interpret.
Cultural Competence
The interpreter shall develop awareness of their own and other cultures
in order to promote cross-cultural understanding. Interpreters should
strive to bridge the cultural differences between all participating
parties, by seeking to minimize, and if possible, to avoid potential
misunderstanding based upon stereotyping or differing cultural
practices, beliefs or expectations. Under certain conditions such as
clashing cultural beliefs or practices, a lack of linguistic
equivalency, or the inability of parties to articulate in their own
words, the interpreter should assist by sharing cultural information or
helping develop an explanation that can be understood by all.
Respect for All Parties
The interpreter shall strive to support mutually respectful interactions
among all parties. Interpreters can help build mutual respect within the
triadic relationship by responding in a supportive manner within the
interpreter role, using rapport-building skills, respecting the
experience or expertise of all parties, allowing physical privacy to the
patient, refraining from influencing patient decisions, and treating all
participating parties equally and with dignity.
Professional Integrity
The interpreter shall demonstrate professionalism and personal
integrity. The following are some aspects of professionalism:
If the interpreter believes at any time that they may have interpreted inaccurately or incompletely, they will make this known and, if possible, provide a corrected interpretation.
An interpreter shall not accept an assignment, or shall withdraw from an
assignment, in which they
1) Are not competent to interpret accurately and completely
2) Perceive a conflict of interest between their role as interpreter and
their personal involvement with one of the parties in the interpretation
3) Is so impacted by the content to be interpreted that they become
unable to interpret accurately and completely.
The fee agreed to between the interpreter and the contracting/employing agency shall be the only compensation the interpreter will accept. The interpreter will not accept additional compensation or considerations from any party in the interpreted session.
Ethical Decision Making Process
An ethical dilemma occurs when there is confusion about an appropriate
course of action.
To assist interpreters in determining a course of action in ethical
dilemmas, the following steps are useful.
1. Ask questions to determine whether there is a problem.
2. Identify and clearly state the problem, considering the ethical
principles that may apply and ranking them appropriately.
3. Clarify personal values as they relate to the problem.
4. Consider alternative actions, including benefits and risks.
5. Choose the action and carry it out.
6. Evaluate the outcome and consider what might be done differently next
time.
2 – c. Familiarity with Cultural Issues
This skill is an ability to anticipate and recognize misunderstandings
that arise from the differing cultural assumptions and expectations of
providers and patients and to respond to such issues appropriately. Here
are the specific skills:
・Insight in cultural nuances in the communities
・Understanding the similarities and differences between the biomedical
culture and the foreigner’s own culture
・Broader perspective in the different health care service areas
・Familiarity with the health care systems in both the host country and
the country of origin
The Differences in Health Culture
Here’s a case study that addresses the differences in health care
culture and the problems that can arise from them.
Would someone like to volunteer to read the case study for us, please?
A young Japanese man living in Vancouver suffered a head injury playing
soccer. He went to a GP (General Practitioner) with a Japanese health
care interpreter.
After a thorough and extensive examination (History taking & Physical
examination), the young man was diagnosed as having a minor concussion,
and the GP concluded that a CT scan wasn’t necessary.
The young man was worried about the possibility of a serious head
injury, and he was doubtful that the doctor could make such a diagnosis
without a CT scan. He requested one to the doctor, but the proposal was
denied.
After the session, the interpreter present, who had worked in the
Japanese system for a number of years as a nurse, sympathized and agreed
with the young man. He experienced a number of similar cases, in which
Japanese doctors ordered a CT scan regardless of the physical result.
So, he told the man that he was right and that the Canadian doctor
should have ordered the CT scan.
As a result, the man felt that not only wasn’t he properly cared for,
but also that whole Canadian system was sub-standard or perhaps even
racist. He wished that he could see a Japanese doctor for "proper care".
A conflict arose because of procedural differences /between the health
care cultures. Whereas in North America, emphasis is placed on the
patient’s history and the physical examination, Japanese diagnostic
procedure emphasizes extensive test results.
So the per capital number of scans alone is a clear indication of
procedural differences. In the year 2000, there were only 13.2 scans in
the U.S.A., compared to 84.4 in Japan. Americans use health care systems
only in serious situations, and visit doctors about 6 times a year. But
Japanese tend to go much more often. They go as often as 16 times a
year.
The interpreter present made the mistake of sympathizing with the man
and agreeing with him. Working as a nurse for a number of years, he had
a bias for the Japanese system. This is a pitfall that must be avoided
at all costs. It is the interpreter’s duty and responsibility not only
to be linguistically and culturally proficient but also to understand
the procedural differences so as to properly facilitate communication
between the doctor and the patient. An appropriate course of action
would have been for the interpreter to explain to the young man that
doctors in Canada are trained to make a proper diagnosis through
thorough and extensive observation (History taking & Physical
examination). The man could have taken comfort in knowing that he was
being cared for in a competent and professional manner that differs from
the care that he was used to at home.
This terrible misunderstanding is a direct result of an incompetent
interpreter. It is essential that the interpreter recognize the power he
or she has to influence how a patient feels about the health care he/she
receives. After all, a patient’s assessment of care provided is based on
the patient’s interpretation of that care.
2 – d. Health Care Terminology
Health care interpreters should be familiar with health care
terminology. Here are some terminology categories that are presented for
easier study.
・Symptoms
・Anatomy
・Diseases
・Procedures / Tests
・Equipment
・Specialists / Departments
・Treatment
・ Medications
Learning tips
Layman’s terms not jargon
In learning this terminology, the learners should keep in mind that they
should learn the terms orally, and they should be familiar with the
everyday-usage, not jargon. Health care providers don’t use jargon to
explain the tests or treatments. Patients also use everyday expressions
for describing their symptoms. So, interpreters should be familiar with
everyday expressions.
Learning the context of the terminology
If the interpreter doesn’t know the context of the terminology, he/she
can’t find the appropriate word for it in another language. Here are a
few examples.
For example, "closed", as in "this shop is closed". What is the
appropriate Japanese word for it?
What’ the appropriate word for Acute Mountain Sickness?
Can anyone translate this word for us, please?
"Acute Mountain Sickness" is not 急性高山病. It should be translated into
山酔い.
"High Altitude Illness"
Medical interview protocol
To be a good examination room interpreter, the interpreter should know
the H & P extensively. The H & P protocol is as follows:
1. Chief complaint
2. History of present illness
3. Review of systems
4. Past medical history
5. Past surgical history
6. Family history
7. Social history
8. Medications
9. Allergies
10. Physical examination
For example…
1. I have a sharp pain in the abdomen.
2. When & how did it start? Questions about provoking & palliating
factors.
3. Other symptoms they may have. Have you been eating normally? Have you
had any nausea, vomiting, or diarrhea?
4. Have you ever had measles, or chicken pox?
5. Have you ever had an appendectomy?
6. Does any member of your family have diabetes, or heart disease?
7. This includes the categories, such as alcohol, tobacco, sex, travel,
occupation, and drugs.
8. In some cases, medication side effects may be responsible for the
patient’s symptoms.
9. So allergies may be.
Recommendation of materials for learning health care terminology
Vocabulary
By role-playing medical interviews, the learners can acquire the basic
knowledge of the protocol. If you are personally interested in learning
the medical interview protocol, I recommend the following readings.
Medical Interview Protocol
In addition to that, watching "ER" is very beneficial. It contains a lot of terminology and you can learn various medical protocols.
The lists of basic terminology by MMIA
MMIA (the Massachusetts Medical Interpreters Association) has useful
terminology lists on its website:
http://www.MMIA.org/MedTermCover.htm
2 – e. Integrated Interpreting Skills
Integrated interpreting skills refer to the full complement of skills
that a competent interpreter calls upon to ensure the accuracy and
completeness of each message.
In addition to the central skill of oral language conversion, there are
other skills that a competent interpreter should have.
These skills include asking for pauses and clarification, using a
variety of devices to remember important information, and managing the
flow of communication.
Here are the skills at each session stage.
Pre-Session Skills
Before the session begins, interpreters establish the basic guidelines.
・State that they will maintain the confidentiality of the session
・Inform the parties of the elements necessary for a smoothly interpreted
session, including
1. The requirement for interpreters to interpret everything
2. The importance of direct communication
3. The need to pause for interpreting
4. The need to intervene for clarification
In-Session Skills
During the session, interpreters facilitate communication to support the
patient/provider relationship by acting to:
・Position the parties to encourage direct communication
・Remind the parties to communicate directly to each other
・Use the first person ("I") as the standard form of interpreting to
enhance direct communication
・Manage the smooth flow of communication
・Intervene for clarification when interpreters do not fully understand
the terminology or the message
Post-Session Skills
To provide closure to the session, interpreters take measures to:
・Inquire about any questions or concerns the parties may have for each
other
・Facilitate the scheduling of follow-up appointments
・Document the provision of interpreting services, as required by each
organization’s policies
・Debrief providers or the interpreter’s supervisor, when appropriate,
about concerns arising from the session
Health & Well-Being of the Interpreter
Following the interpreted session, it is important for interpreters to
recognize and address their need to recover from an emotional and
stressful session by following these steps:
・Acknowledging that healthcare interpreting is hard work
・ Understanding patient’s responses in various situations
Health professionals are trained to deal with the five most common
responses to "loss" situations, such as terminal diagnosis.
1. Denial: No, it’s not true! You must have mixed up the test result! It
must be somebody else!
2. Anger: Why me? It’s not fair! I have always lived such a healthy
life! I am too young to die!
3. Bargaining: What if I give up smoking? What if I try this new wonder
diet?
4. Depression: The patient may be withdrawn and refuse to speak.
5. Acceptance: The patient may accept that he or she is going to die,
may only wish to speak to those closest to him or her.
・Understanding the health care provider’s minds
・Working as a team
・Offering workshops
2 – f. Simple Translating Skills
Basically, health care interpreting requires only oral skills. In the
health care setting, however, information is not always presented in the
spoken form.
Therefore, the interpreter may be asked to translate written messages
into spoken messages, or to translate short passages of written text
into written form in another language. The documents, which the
interpreter may be asked to translate, include the following:
・Medical documents
・Questionnaires
・Registration forms
・Brochures
・Patient education materials
・Invoices
・Appointment cards
・Prescription labels
・Discharge instructions
It is important to keep in mind, however, that an interpreter is not
necessarily qualified as a translator and does not have the means, while
interpreting, to perfect a written translation. Therefore, the
interpreter’s responsibility for providing written text is strictly
limited to brief instructions, and if needed, interpreters must
recommend that a qualified translator come in to do the job.
3. Follow-Up Questions
What are the issues in the certification of Health Care Interpreters in
Japan?
As some of you may already know, formal certification of health care
interpreters currently exists only in a few English-speaking countries,
including Australia, and Britain.
Washington State, in the U.S., where the Department of Social and Health
Services certifies medical and social service interpreters, is the only
state, which has formal certification of health care interpreting in the
U.S.
In Japan, there has been a growing desire among communities to establish closer ties with others in the field of health care interpreting, with the goal of establishing national standards, training programs, and certification. Here are a few examples.
This is an article in the Asahi Shinbun, a major Japanese newspaper on July 15th. The author, Makiko Mizuno, an assistant professor at Senri-Kinran University and a nationally renowned interpreter, insists that it be necessary to establish a certification system to provide competent professional interpreters in the community.
This symposium was held on Sep. 26th, and the topics discussed included health care interpretation in some communities and language comprehension and working memory.
This symposium will be held on Nov. 6th in Osaka, and the topics to be discussed include breaking down the barriers to communication, and the demands for language services in health care settings.
These multiple regional efforts will provide valuable experience with different approaches to certification, which can later inform the development of a national process.
While there have been suggestions that a national certification might be
in order, we have a lot of problems to be solved.
We actually know little about what works in the certification of health
care interpreters to institute a national program.
What is the purpose of certification?
First question. What is the purpose of certification?
Certification has different merits to different people. Some see
certification as a way to guarantee quality interpretation to health
care providers and patients. Many institutions see it as a way to avoid
legal liability.
Some interpreters see it as a way to create skilled elite, who can then
compete for higher wages.
Others see it as a way to create some standards in an emerging
profession.
So, we have to think about this question.
Is it better to certify or to accredit interpreters?
Certification links testing with employability, i.e. only certified
interpreters can work.
This approach can backfire for those seeking to certify in order to
guarantee high quality service to populations of
limited-English-proficiency.
If not enough interpreters get certified in certain language groups,
those communities, and the providers that serve them, will find
themselves with no interpreters at all.
Certification Test
Talking about certification test;
What exactly do we test?
How to best test? Written? Oral? Demonstration? Real time?
Standardized written tests are cheapest to apply and correct, but do we
really want to test literacy and test-taking skills?
Real-time testing may be more accurate, but it is also time consuming
and expensive. How do we devise a process that is both accurate and
cost-efficient?
What is a minimum standard?
What languages should be tested?
Do we test in only the most common languages, such as in English?
Which are those?
How many do we include? What happens to the interpreters in other
languages?
Is there any equivalent process for them?
Same test for every language?
Can you use the same testing methods with every language group?
Who will pay for the test?
How much to charge?
Who will pay for developing and implementing a certification process?
Can we just pass the cost on to interpreters?
How much can community interpreters be expected to pay, when they may be
earning only a minimal fee or interpreting only infrequently?
We face these problems in developing a certification system.
Suggested Roles of MITA
It could be argued that higher pay, language screening, basic training,
and accessible continuing education would do more to guarantee good
interpreting than certification.
An organization or association with the expertise in both the health care setting and in cross- cultural communication, would be the best one for organizing the national standard.
MITA, which has a number of experienced medical interpreters and translators, would be the best association to organize the national standard of English-Japanese interpretation.
I hope interest in health care interpreting grows and that Japan becomes well established in the field.
Thank you very much for your attention and it would be my pleasure to address any of you personally with any questions or comments about anything you’ve heard today so please don’t hesitate.