3 Workshop Goals (4 contact hours) Session I (1:00-2:50)Identify appropriate interpreter rolesIdentify types of ethical situationsElaborate techniques to analyze and resolve selected ethical dilemmasSession II (3:00-5:00)List interpreter skills for consecutive and simultaneous modesIdentify types of interpreter errorsAssess and apply skill improvement techniques to minimize errors
4 Tentative Workshop Itinerary 1:00-1:10Orientation and Introductionssign in with name, languages and s of participants1:10-2:15Interpreter RolesEthical CodesTypes Ethical Situations + Video2:15-2:35Breakout: mixed cultures/3 rooms (by name tag color) -groups of 4-5ID spokespersonGroup evaluates and resolves listed and/or personal interpreter ethical dilemmas2:35-2:50Whole group: share one ethical dilemma /solution per room2:50-3:00Snack break3:00- 3:45Skills for Consecutive and Simultaneous InterpretersInterpreter ErrorsVideo + critique3:45-4:15Breakout (groups of 3 same/related cultures/languages): 3 scripts, + assessmentinterpreter takes notes– prepare 1-2 minute role play for whole group discussion4:15-4:55Whole group: present 1-2 role plays per room4:55-5:00Workshop evaluation + Certificate of Attendance (to be mailed)
5 Who needs interpreters? About 32 million people in the United States, 13.8 % of the population, speak a language other than English at home. A recent study of public and private teaching hospitals found that more than 11% of patients required the use of interpreter services.In some cities, residents speak more than one hundred separate languages and dialects. According to the 2000 Census, the most common foreign languages spoken in the U.S. are: Spanish, Chinese, French, German, Tagalog, Italian, and Vietnamese.
6 Interpreters are VIPU.S. health care providers have a legal obligation to offer interpreting services to non-English-speaking patients under a variety of federal, state, and local laws. These laws are available on the following internet sites:Title VI of the Civil Rights Act of 1964 (p. 50)Medicaid law and related regulationsThe Hill-Burton ActMiscellaneous Federal programsThe Emergency Medical Treatment and Labor Act
7 Community Interpreters FIELD LOCALESLegal Law enforcement, lawyer onsult, courtroomMedical MD/DDS office, clinic, mental health, migrant outreach, CPREducation Classroom, IEP, PTASocial WIC, Welfare, Social Security ServicesPolitical Rallies, public hearingsCorporate Job interviewsTechnical Training: job related
8 What are ethical codes?A text document of a framework of standards with universal principles acknowledged and accepted by all practitioners within a field. These codes (or canons) are professional guidelines to standardize the norms and behaviors expected in a field.
9 Medical Roles and Codes As medical interpretation has grown around the country so too have ethical guidelines. Although codes for medical interpreters have often emerged independently in various institutions and locales, they express similar core values. These core values include: confidentiality, accuracy, and professionalism. Most codes give interpreters the responsibility and right to turn down or leave assignments they feel unable to handle in a professional manner, including interpreting for close friends or relatives, interpreting in situations which pose a conflict with the interpreter's own internal values, and interpreting in situations for which they feel untrained or unqualified.
10 Roles and CodesElements that do vary among different codes of ethics usually result from the definition of the interpreter's role. While most guidelines acknowledge that interpreters should be neutral and not impart personal opinions or advice, there are varying views on the interpreters' responsibility to add information on culture or to act as advocate for the clients. An institution's particular code of ethics will reflect these views.
11 Roles and CodesInterpreters and providers alike must have a clear and common understanding of the role and ethical guidelines in order to avoid conflict and confusion. At the same time, it is important to seek feedback from interpreters on their ability to follow through on these expectations. What makes sense for one cultural group may not make sense for another. Asking interpreters what a particular rule means for them individually and within their culture will help to clarify the code, support the interpreters in their efforts to comply, and adapt the code when it doesn't work.
12 Minnesota Code of Professional Responsibility Canon 1: Accuracy and CompletenessCanon 2: QualificationsCanon 3: ImpartialityCanon 4: Professional DemeanorCanon 5: ConfidentialityCanon 6: Restriction of Public CommentCanon 7: Scope of PracticeCanon 8: Reporting ImpedimentsCanon 9: Reporting Ethical ViolationsCanon 10: Professional Development
13 Basic principles of the Code of Ethics (legal and medical) 1. Confidentiality2. Impartiality3. Integrity4. Fidelity (Accuracy)Respecting the privacy of othersNot taking sides in a transactionBeing honest about one’s own skill level and qualifications for a jobEnsuring that the message is faithful to the original utterance, appropriate to the original context
14 Differences in Codes Legal interpreting considerations: Representation of qualificationsImpartiality and avoidance of conflict of interestsAssessing and reporting impediments to performanceDuty to report ethical violationsConsiderable knowledge of legal systems, laws and legal procedures in the societies concerned(Mayo Clinic Interpreter Code of Ethics-p. 31)
15 Four basic roles of the medical interpreter (see next slide) A pyramid with Advocate at the top of the point, followed by Culture Broker, Clarifier, and Conduit at the bottom represents the amount of time that medical interpreters routinely spend in any one role. As you go up the pyramid, the roles become increasingly intrusive, but the role is used relatively less often. For example, interpreters always act as Conduits; however, because of the complexity of medical terminology, medical interpreters are routinely called to be Clarifiers. Some patients and encounters require culture brokering or advocacy as well.
16 Medical Interpreter Role Pyramid AdvocateCulture BrokerClarifierConduit
17 Definitions of roles:I. Conduit: This is the most basic of the roles and involves rendering in one language the meaning of what has been said in the other: no additions, no omissions, no editing or polishing, This is the "default" role of the interpreter, which you should adopt unless you perceive a clear potential for misunderstanding.
18 Definitions of roles:II. Clarifier: In this role, the interpreter adjusts register, explains or makes word pictures of terms that have no linguistic equivalent (or whose linguistic equivalent will not be understood by the patient) and checks for understanding. You should take this role when you believe it is necessary to facilitate understanding.
19 Definitions of rolesIII. Culture Broker: In this role, the interpreter provides a necessary cultural framework for understanding the message being interpreted. You should take this role when cultural differences are leading to a misunderstanding on the part of either provider or patient.
20 Definitions of roles:IV. Advocate: Advocacy is any action an interpreter takes on behalf of the patient outside the bounds of an interpreted interview. The advocate is concerned with quality of care in addition to quality of communication. An on-site interpreter would appropriately become an advocate when the needs of the patient are not being met due to a systemic barrier such as the complexity of the health care system or racism.
21 What is the appropriate role for the interpreter? The more invasive a role you take, the greater the risk of "getting in the way" of the patient-provider relationship. However, if you limit yourself to an inappropriately limited role, fundamental misunderstandings may occur that not only undermine the patient's relationship with the provider, but may endanger the patient's life.
22 What is the appropriate role for the interpreter? In a given session, you may have to switch between different roles because every patient will have different needs. The "appropriate role" for the interpreter is the least invasive role that will assure effective communication and care.
23 Roles: What is the most effective response in these situations? The nurse asks you to take the patient’s history while s/he sees another patient. Or s/he asks you to explain to the patient how to collect a urine sample.The mother asks you to watch her children while she makes a phone call and/or assumes you will give her a ride home.
24 Video: Role play of ethics topics As you watch the short role play vignettes, identify the ethical problem and how the interpreter handled it. Would you have done or said anything differently?
25 Breakout I: ethics discussion groups First, choose a group spokesperson/ leader. Then, discuss the 5 situations in the following slides as each participant suggests how the interpreter should manage the situation. Answer the following questions to guide your decision.What is the interpreter’s role?What is the use of good judgment and common sense?What are the interpreter’s options and consequences of each?Choose the best response and discuss effective ways of communicating your response.
26 Breakout I: ethics discussion groups What has been your experience in interpreting situations that provoke ethical dilemmas? Can each of you give us one specific example, including what/who provoked the situations (provider, interpreter, patient, other) and how it was resolved?Does your organization have a designated staff person available to help deal with ethical issues?Name (s): _________________
27 Ethical Situation 1A provider gives a non-English-speaking patient a prescription, explaining that it is for some suppositories. The interpreter is too embarrassed to admit that he does not know the equivalent word for "suppository" in the patient’s language, so s/he uses the word for "pill" instead. The patient takes the medication orally and ends up in the emergency room.
28 Ethical Situation 2After her appointment, a patient's husband asks the interpreter what the doctor said to his wife. Trying to be helpful, the interpreter discloses the happy news that the patient is pregnant. This is not happy news to the husband, as his wife has just arrived from their home country, after being apart from him for 6 months. The couple leaves the clinic with the husband angrily muttering thinly veiled threats of violence.
29 Ethical Situation 3The doctor asks the patient a question. The interpreter and the patient get into a long discussion, while the doctor sits and waits, completely left out. Finally the interpreter turns to the doctor and says "She said no." When the doctor asks exactly what the patient said, the interpreter smiles and says, "Oh, it wasn’t important. She just means no."
30 Ethical Situations 4 (choose one) Case 1: The patient becomes very angry with the doctor when the doctor tells him he is ready to go back to work. The patient uses profanity and insults the doctor.Case 2: During a physical exam, the doctor asks the patient if she is sexually active. Since the patient is not married, she is embarrassed and uncomfortable to be asked such a question and does not respond.
31 Ethical Situation 5The hospital asks you, the staff interpreter, to assist. The patient has brought her own untrained interpreter and no longer requires your services. The physician asks you to stay anyway. Before long you realize that the untrained interpreter has made major linguistic errors, omitted crucial information and added unnecessary information during the encounter. If these errors are not addressed, you know the outcome may be detrimental for the patient as well as the hospital.
32 Ethical Situation 5 Discussion: Does the interpreter have an ethical obligation to say something or would this be interfering with the patient’s right to conduct her own business? What factors would influence your decision to “interfere” with the errors committed by the untrained interpreter?
33 Session II: Workshop Goals Identify appropriate interpreter rolesIdentify types of ethical situationsElaborate techniques to analyze and resolve selected ethical dilemmasSession II (3:00-5:00)List interpreter skills for consecutive and simultaneous modesIdentify types of interpreter errorsAssess and apply skill improvement techniques to minimize errors
34 Court: Consecutive or Simultaneous? Consecutive interpretation, in which the interpreter waits until a complete statement has been spoken and then begins interpreting is used primarily to interpret witness testimony, a situation in which everyone in the courtroom needs to hear the interpretation. Simultaneous interpretation is generally considered inappropriate for witness testimony because hearing two voices at once is too distracting. In your work as a court interpreter, you will find that simultaneous interpretation is called for much more often than consecutive, because most cases are settled without a trial.
35 Medical: Consecutive or Simultaneous? The three stages of a consecutive interpreter's work are the understanding of the speaker's original message, the immediate analysis of its content and the re-expression of the same content in another language, with the help of some notes the interpreter writes down upon hearing the original message.In most medical encounters, the consecutive mode is preferred. Are there any medical situations where the simultaneous mode might be more appropriate? What would the considerations be?
36 What skills/knowledge do interpreters need? language fluency in source and target languagesinterpreting skills: shadowing, chunking, main idea, paraphrase, attending/focusing, sight translation, etc.wide general knowledgeknowledge of specialized terminologycultural knowledgeEthics (Ethics Exam, Federal Exam info–pp )Professionalism (includes proper attire and responsible behavior such as respect and promptness)
37 Specific Tips On Preparation for Consecutive Interpretation 1. Strengthen your retention skills. The administrative hearing interpreter exam requires the interpreter to retain speech up to 40 words in length. If given, the medical interpreter exam requires the interpreter to retain speech up to 30 words in length.2. To enhance your retention skills, develop a note-taking technique that works for you. Note taking is an aid to the interpreter when it is second nature. It is very hard to improvise abbreviations and symbols on the spur of the moment.3. Always be ready with pencil and notepad in hand.
38 Specific Tips On Preparation for Consecutive Interpretation 4. Stay focused - concentrate; it is imperative that you not let your mind wander. It takes time to develop this discipline.5. Speak clearly and audibly; people requiring the services of an interpreter need and deserve clarity.6. Ask for a repeat if you are concerned you may make an error. It is better to ask for a repeat than to be inaccurate.(additional skill-enhancing exercises – pp )
39 Core Competencies 1. Introduces self and explains role 2. Positions self to facilitate communication3. Reflects the style and vocabulary of the speaker4. Uses consecutive interpretation mode and speaks in first person when appropriate5. Accurately and completely relays the message between patient and provider
40 Core Competencies 6. Show of dignity and respect 7. Remains neutral 8. Identifies and separates personal beliefs from those of the other parties.9. Identifies and corrects own mistakes.10. Addresses culturally-based miscommunication when necessary.
41 Categories of Interpreter Error Literal TranslationInadequate Language ProficiencyGrammatical ErrorsLexical ErrorsRegister ConservationDistortion, Substitution, CondensationOmissionAdditionProtocol, Procedure and EthicsConservation of Paralinguistic Elements, Hedges, Fillers
42 1. Literal TranslationThe language-deficient interpreter focuses on the exchange of words, rather than the essential ideas, conserving the source language message.
43 2. Inadequate Language Proficiency Lack of proficiency and language fluencyPredicting skills absentCognitive and linguistic association for processing is restricted by wrong choicesLimited attention span in least developed languageInterference present from one language to another at all levelsSpeed and accuracy compromised
44 3. Grammatical ErrorsGrammar errors include verb tenses, gender and number agreement, syntax, etc.Ouch!
45 4. Lexical Errors Lack of generalized and specialized vocabulary Language-deficient interpreters rely on false cognates, and tend to paraphrase, define, invent, omit, guess
46 5. Register Conservation Interpreters have trouble preserving the frozen, formal register of court and the informal, casual register of idioms and slang.
47 6. Distortion: Substitution, Condensation Mistranslation errors distort the overall or partial meaning of the original message.Substitution: the tendency to replace conceptsCondensation: the tendency to simplify and explainCauses include deficient language skills, memory or interpreting skillsLack of understanding of the interpreter’s role which includes preservation of profanity and sexually explicit language
48 6. Distortion: Substitution, Condensation Lengthy (more than 35 words in one response) and short discourse (less than 15 words) can cause problems.False starts, emotional intensity, hedges, unfinished sentences and incoherent language may be involved.
49 7. OmissionThe interpreter partially or completely deletes a message sent by the speakerOmits words from articles to portions of discourse because of fatigue, little knowledge of technical terms, regional variants, and information overload.
50 8. Addition Includes information not expressed by the speaker The unskilled interpreter cannot retain the contextual ideas of the source message so s/he uses synonyms and “thinks aloud”.
51 9. Protocol, Procedures and Ethics Interpreters do not understand their role as an objective medium of communication:Role exchange: the interpreter assumes the role of the interviewerLack of self-correctionInitiates conversations with witnesses or uses inappropriate tone, summarizes, guesses and does not take notes when necessary
52 10. Non-conservation of Paralinguistic Elements, Hedgers, Fillers Interpreters do not conserve hesitation words, fillers, interrupted and incomplete sentences, etc.English: um, ah, you know, likeYour examples in your other working language: ????
53 Video: The Professional Interpreter 1. Who is the interpreter?2. How are the parties addressed?3. Is the interpreter prepared?4. Were introductions made?5. Where is the interpreter positioned?6. Which interpreting mode was used?7. Which inappropriate roles were noted?8. Was there awareness of cultural dimensions?9. Did the interpreter ask for clarification and pauses when needed?10. Was the interpreter aware of his/her own limitations/biases?1. Family member, untrained person, professional2. I, you, he/she3. Yes No4. Yes No5. Beside, behind, hidden from client6. Simultaneous, consecutive, summary7. Editing, giving advice, adding information8. Yes No9. Yes No10. Yes No
54 Video: The Professional Interpreter 11. Did the interpreter use eye contact and the first person in addressing the parties?12. Does the interpreter treat all parties with respect?13. Is the interpreter sensitive to ethical issues as they arise? Explain.14. Was the interpreting done accurately and completely?11. Yes No12. Yes No13. Yes No14. Yes No
55 Breakout 2A: Medical role-play (consecutive mode - bidirectional) 1) If possible, form groups of 3 people who speak the same other working language. All use the dialogue script “The Eye“. The “patient” will sight translate to the other working language. The Spanish language interpreters may use dialogue scripts “Getting a Prescription“, “Child Medical” and “Pediatrician”.2) Each participant will take turns acting as the interpreter for the script provided in your packet (one page per interpreter). The interpreter assumes all parties have never met each other and have never before worked with an interpreter. Be prepared to take notes.3) After your role playing, discuss together the 5 self-assessment questions that follow.
56 Breakout 2B: Legal role-play (consecutive mode - bidirectional) 1) If possible, form groups of 3 people who speak the same other working language. Spanish language interpreters may use “Firearm Testimony” script.2) Each participant will take turns acting as the interpreter for the “Witness Testimony: Burglary” script provided in your packet (one page per interpreter). The witness (A) will sight translate script into other working language.The interpreter assumes all parties have never met each other and have never before worked with an interpreter Be prepared to take notes.3) After your role playing, discuss together the 5 self-assessment questions that follow.
57 Breakout 2C: Legal role-play (simultaneous mode - monodirectional) 1) If possible, form a pair who speak the same other working language. Use the “Closing Argument” script.2) Each participant will take turns acting as the interpreter for the script provided in your packet (one page per interpreter).3) After your role play, discuss together the 5 self-assessment questions that follow.
58 Self-assessment (5+ questions) 1. Overall, how do you assess your interpretation of the dialogue or monologue? Were you able to convey the overall meaning and information? If not, what types of information caused you the most difficulty? How effective were your note-taking skills?2. Did you ask the speakers for repetition or clarification? How did this work for you? How does it seem to affect the speakers’ ability to convey what they wanted to say?
59 Self-assessment continued 3. What was the most difficult part of this interpretation? What are the factors that make this the most difficult part (vocabulary, speed, speech concerns)?4. How would you rate yourself in terms of vocabulary usage, grammar and accuracy of the interpretation?5. What do you consider to be the skill area (strong and weak) you would want to focus on based on your interpretation of the dialogue or monologue?
60 General Preparation READ, READ, READ! Attend courses, workshops, trainingMake yourself available to listen to and observe health providers as they discuss patient care; ask to accompany the health providers during rounds; attend courtroom proceedings or shadow legal counsel/paralegals.Build a resource manual of Web glossaries, field specific bilingual dictionaries, court/legal documents, translated patient education materials from CDC, etc.Build a network of interpreter colleagues for consultation and support.
61 Additional reading materials in your packet: Mayo Medical Interpreter Code of EthicsSuggested Skills-Enhancing ExercisesHow to Practice for the Federal ExamSuggestions for Independent StudyInterpreter StandardsMayo Clinic Code of EthicsYour questions, comments and suggestions regarding the interpreting profession are welcome.(office) (home)Please respond to the questions on the workshop evaluation form and return it to the facilitator.
62 Let us go forth and interpret accurately, confidentially, completely, with integrity and professionalism.