2. 1 TrIn 3101: Introduction to Interpreting Unit 9: Overview of Medical Interpreting Settings This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab Type in action items as they come up Click OK to dismiss this box This will automatically create an Action Item slide at the end of your presentation with your points entered. Dec. 1, 2004

3. 2 Class agenda for Dec. 1, 2004 Turn in assignment #7: Ethical Situation (2 paragraphs – 20 pts)+thought questions: 34-36, 143-44, 140-42, 165-72 Unit 9 goals: 1. Guidelines and linguistic concerns 2. Analyze and discuss at least one case study specifically related to the health care context 3. Mikkelson/Downy topics 4. Peer discussion for introduction assignment #8 Assignments: Dec. 8 – Self-assessment of Introductions + videotape (30 pts.)

4. 3 Review: Sight Translation Sight translate the attached document from last week into your other language. Later, discuss the accuracy of marked words or phrases, delivery, and fluency. When you are ready, set your timer to 5 minutes, turn to the handout and begin.

5. 4 Sight Translation practice 1) Sight translate for your classmate from English to your other language a paragraph of unfamiliar reading material from your text. Reader and observer comment on difficulties noted (hesitation vs. consistent flow, voice modulation) 2) Do the same with familiar material or study a portion of unfamiliar reading material before interpreting.

6. 5 Interpreting for 3+ groups Discuss strategies for: A. a group therapy situation B. a medical appointment with husband and wife C. a school conference with teacher, psychologist, principal and both parents If time allows, act out one of the situations with an interpreter.

7. 6 Telephone techniques Special factors: Unable to see either party Vocal sounds may be distorted Conference vs. single caller Language line Using cell phones, enact an interpreting session.

8. 7 Interactional Issues Discuss interactional issues in medical situations: stress, high emotional content, family dynamics, sharing bad news, seeing pain and death. Discuss feelings upon entering the situation, dealing with anxiety, stress, emotionally charged cases, interpreting for patients or family members in distress, and coping with the death of a patient.

9. 8 Interactional Issues How might the interpreter avoid the “nodding syndrome” with regard to register? Is it the interpreter or the provider who must simplify medical language? The flowery style and tendency to “go on and on” of Hispanics may create communication problems. What problems may develop and how does the interpreter cope ?

10. 9 Terminology Discuss resources for medical terminology for various languages and ways that interpreters can start their own terminology banks and resource files of medical information.

11. 10 Accepting Assignments 1. How do you know whether or not you are qualified for a medical interpreting assignment? 2. What skills and knowledge does a medical interpreter need? 3. What are the Minnesota state guidelines for medical interpreters?

12. 11 Accepting Assignments 1. What are the repercussions of accepting jobs that you are not qualified for? 2. Is some service better than no service? Under what circumstances? 3. If you hear something that you don’t understand, what are your options?

13. 12 Cultural and Linguistic Issues Video: how to work with interpreters (from the health care provider’s perspective) Vignette #1: Identify errors Vignette #2: Identify appropriate interpreting techniques used Discussion: Holly Mikkelson article

14. 13 Summary of Tips …for the health care provider (Downing pp. 34-36)

15. 14 Guidelines for Working with Interpreters Use qualified interpreters who know their role, limitations and responsibilities. Don’t depend on children, relatives, friends or ad hoc interpreters (bilingual coworkers) to interpret. Have a brief pre-interview meeting with the interpreter. Establish a good working relationship with the interpreter. Plan to allow enough time for the interpreted session (all utterances are stated twice).

16. 15 Guidelines Address yourself to the interviewee, not the interpreter. Don’t say anything that you don’t want the other party to hear. Use words, not gestures, to convey your meaning. Speak in a normal voice, clearly, and not too fast. Avoid jargon, technical terms and cultural references.

17. 16 Guidelines Keep your utterances short, pausing to permit the interpretation. Ask only one question at a time, not chain questions. Expect the interpreter to interrupt when necessary for clarification. Expect the interpreter to take notes or consult the dictionary when things get complicated.

18. 17 Guidelines Be prepared to repeat yourself in different words if your message is not understood. Have a brief post-interview meeting with the interpreter to assess how things went. If the interpreter has limited interpreting skills: Make sure the interpreter understands his/her role before you begin. Use the simplest vocabulary that expresses your meaning. Speak in short and simple sentences. Check to see if the message is understood. Ask the interpreter to repeat the message back to you before attempting to interpret to the patient.

19. 18 Guidelines There may be less eye contact with you and more with the interpreter. A gesture by the patient may not mean what it would mean if done by the provider. Remember: the interpreter is only there because the patient and health care provider do not speak the same language Do not expect the interpreter to function in an inappropriate manner, i.e., give dismissal instructions, checking on patients at home, etc. BE PATIENT!

20. 19 Prior to the interview Allow extra time for an interpreted patient consultation. Meet with the interpreter briefly before seeing the patient to discuss any issues that may arise during the interview. Ask the interpreter for the correct form of address and the correct pronunciation of the patient’s name. Decide on simultaneous or consecutive mode of interpretation. What do you consider when deciding? Encourage the interpreter to inform you of any problems that arise.

21. 20 During the Interview Introduce yourself to the patient Address the patient directly Observe the patient for non-verbal signals If you need to consult with the interpreter, explain to the patient what you are doing Speak slowly and clearly with frequent pauses Try to avoid technical jargon or idioms

22. 21 After the Interview Discuss any linguistic or cultural issues that arose Examples?

23. 22 Medical Glossary Preparation for medical encounters: 1. READ, READ, READ! 2. Make yourself available to listen to and observe providers as they discuss patient care; ask to accompany the providers during rounds. 3. Build a resource manual of Web glossaries, field specific bilingual dictionaries, translated patient education materials from CDC, etc. 4. Build a network of interpreter colleagues for consultation and support.

24. 23 Terminology Discuss resources for medical terminology for various languages and ways that interpreters can start their own terminology banks and resource files of medical information.

25. 24 False cognates (Medical) English: Constipation (intestinal blockage) Drugs Spanish: Constipación (nasal congestion) Drogas vs. medicamentos

26. 25 Register variations (anatomy) English HighEnglish LowTL HighTL Low stomachtummyestómagopanza

27. 26 Mayo Job Posting (sample) Temporary 6 months (Posted 3/01) Title: Medical Interpreter – Spanish/Somali/Korean No benefits, 80 hours/2-weeks, 100FTE, M-F schedule, day shift, 0 weekends, located Mayo 1 st floor, $13.70/hr. Job Summary: Accurately transmits messages between non-English speaking patients and health care providers or support personnel at Mayo Clinic. Translates accurate, written version of documents or medical records upon request. Explains and/or teaches cultural differences or practices to medical center personnel. Work on as needed and as available basis. No regular work schedule. May participate in an on-call rotation. Works with people from diverse cultures.

28. 27 Job Posting Qualifications: Medical interpreters must successfully demonstrate oral proficiency based on a test demonstrating fluency in both English and the target language through the American Council of Teachers of Foreign Languages (ACTFL). A ranking of Advanced Low or above is required for the position. A basic understanding of medical protocol and terminology is necessary. Post-secondary education is preferred.

29. 28 Ethical Situation You are a full-time staff interpreter at a clinic. A patient calls to schedule an appointment as soon as possible because she has missed her period and thinks she may be pregnant. She is scheduled to come in the following day. The next day, when you are interpreting for her, this same patient tells the doctor that she is there for birth control pills. The doctor does not do an examination or pregnancy test but does write out a prescription for birth control pills. You, the interpreter, believe that the patient is pregnant and wants the pills in order to miscarry.

30. 29 Discussion What are the moral and ethical issues involved in this case? Should the interpreter mention her/his concerns to the doctor or the patient? How should the interpreter handle information that s/he receives outside of the interpreted situation? Using the guide for ethical decision-making, analyze the situation and determine possible ways to handle it.

31. 30 Introductions VCR: Bring your videotape, your evaluation sheet and a classmate or two to view your recorded introduction skit. Both you and your partner(s) discuss which aspects were done appropriately and suggest ways to improve the content and/or presentation. Interpreters take notes of all suggestions by classmate reviewers.

32. 31 Homework for Dec. 8, 2004 1. Assignment #8—Bring your completed evaluation (blue sheet) for your introductions and the recorded videotape (30 pts) 2. Browse at least 10 medical websites from the handout. 3. Locate on the internet an ACTFL site with a speaking evaluation rubric.