Transcript Training

Medical Interpreting Standards - IMIA/EDC
First Standard to Establish Roles and
Competencies for Medical Interpreters
Vonessa Costa, IMIA Secretary
(All slides adapted from IMIA Standards of Practice)
IMIA Conference 2008
Agenda
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Introduction to IMIA Standards
The Development Process
Organization - major task areas
– Interpretation
– Cultural interface
– Ethical behavior
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Potential Uses
Practical Application
Introduction to IMIA Standards
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Original standards of practice for spoken language
medical interpretation (1995).
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NCIHC voted to advocate use of IMIA Standards as the
“best statement of standards for medical interpreters
presently available” (1998).
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For over a decade, IMIA Standards a vital evaluation and
competency tool for interpreters across the country.
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2007 IMIA-sponsored Standards Campaign - to
demonstrate that multiple standards can be used together
to promote collaboration and the profession
The Development Process
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DACUM (Developing a Curriculum Process)
– Well-known and validated method of occupational analysis
– Practitioners are the experts in their practice
– Practitioners are engaged in describing and defining the tasks that make
up their job:
 Knowledge
 Skills
 Tools
 attitudes
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12 experienced medical interpreters representing six
language groups interviewed by DACUM facilitator over
two-day period
IMIA - EDC used this data to compile Standards
The Challenge
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Setting standards that uphold excellence in
accuracy and completeness while
responding to the urgent need for
interpreters in communities in which the
number of individuals proficient in English
was limited
The Solution
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First, to differentiate between two types of skills:
– Linguistic proficiency
– Interpreting skills
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Then, to conceptualize and define a broad range
of interpreting skills to be used as strategic
interventions to ensure accuracy and
completeness while accommodating differing
levels of linguistic proficiency.
Example: The Palpebra Inigma
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Dr. to patient, “Dear God! Your palpebra are
mighty thin!”
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Linguistic Continuum
– On one end, interpreters whose mastery of language
and breadth of understanding ensure little need to
interrupt speaker for retention or clarification
– On other end, interpreters who are somewhat limited
in comprehension and depth of expression
Example: The Palpebra Enigma
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IMIA Standards outline supportive skills
– How to ask for clarification
– How to manage flow of communication
– Awareness of personal limitations
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These skills enable interpreters at both ends of the
continuum, and everywhere in between, to be accurate in
their interpretation of “Dear God! You palpebra are
mighty thin!”
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How would you interpret this exclamation? What
standard helps you decide on your approach?
(Duty A-6, indicator C)
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IMIA Standards Major Task Areas
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Area #1 - Interpretation
– straight interpreting
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Understand the message
Retain essential elements of communication in the conversion
Clarification skills
Managing the flow of communication
– complementary skills
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Setting the stage (Pre-session activities)
– Setting expectations (confidentiality, completeness)
– Arranging spatial configuration
– Addressing discomforts about presence of interpreter
– Promoting direct relationship between provider/patient
Closure activities (teach-back, connection to services)
IMIA Standards Major Task Areas
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Area #2 - Cultural Interface
– Interpreter must understand the underlying, culturally based
propositions of the message
– Interpreter must understand the ways in which culturally-based
beliefs affect the presentation, course and outcome of illness
– Interpreter tasked with identifying occasions when unshared
cultural assumptions create barriers to understanding
– Interpreter to give provider and patient tools to further investigate
this intercultural interface, without resorting to stereotypes
Example: The Sugar Daddy
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Patient’s sugar levels off the charts
Patient swears he follows the diet and takes the medicine
Provider accuses patient of not doing so
Interpreter looks at diet plan - spots “orange juice”
Interpreter understands cultural differences in making the juice
Interpreter prompts provider to further investigate
How would you have handled this situation?
What Standard helps you plan your approach?
(Duty B-2, indicators A-C)
*Orange juice illustration used by instructors in the Art of Medical Interpretation program at CCCS, Inc.
IMIA Standards Major Task Areas
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Area #3 - Ethical Behavior
– Presence of interpreter changes dyadic
relationship between provider and patient
– Interpreter holds tremendous power
– Interpreter is individual with personal beliefs
and feelings
– Patients need to trust that interpreter will
uphold the private and confidential nature of
the provider-patient relationship
Example: The Gossip
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Interpreter finishes session with Patient A.
Nurse immediately asks interpreter to help with
Patient B.
Patient A and Patient B are neighbors.
Patient B says to interpreter, “I just saw you with
Ana. I’m so worried about her. Is she okay?”
How would you handle this situation? What Standard
helps you formulate your response?
(Duty C-1, indicators A-C)
IMIA Standards - Potential Uses
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Guideposts in the development of educational and training programs
– Developed by practitioners with years of experience on the job who are
also responsible for training and supervision
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Evaluation Tool
– Pre-selected criteria against which the performance of students, trainees,
or practitioners in the field can be evaluated
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Preparation of health care providers to work with interpreters
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Foundation for a certification exam
– Can be used as a basis for a performance-based portion of a certification exam
– Exam can include role-play with both routine interpretation and ethical dilemma
– Interpreter-examinee to integrate the various skills of professional resolution