For medical interpreters and translators, what counts as “qualified” today? Do you have staff who never had any formal interpreter training? Do you have agency interpreters whose credentials are dubious? Do you have complaints from your doctors and nurses about interpreters not understanding terminology?
Standards for medical interpreters have greatly increased in the last ten years. The care team expects the interpreter to be skilled in managing a session as well as competent to deal with the medical topic at hand, across a very large spectrum of medical disciplines and environments of care. Many doctors and nurses would not be competent to function across as many areas!
The challenge for the language program manager is to winnow out those interpreters who show no interest or capability of improving their performance, while supporting and encouraging the vast majority who are ready to continuously upgrade their knowledge and skills.
Staff interpreters are relatively easy to provide with learning opportunities. Many providers will volunteer to do in-services specific to their discipline, if asked. Patient education materials can be assigned to staff to practice voice-translating to each other within language groupings. Staff can be directed to attend classes online or locally, such that all eventually complete medical terminology as well as a set of discipline-specific classes. Staff access to computers at work makes it possible to post online learning modules, language-specific medical dictionaries, learning challenges, and so on. Changing the position description to prefer or require certification is a strong incentive to engage in lifetime learning.
Contracted medical interpreters are by definition not employees, and thus are not subject to direct oversight or training. However, the clinic or hospital can sponsor educational presentations or online information that is available to all interpreters in the community, not just to those who take assignments at that institution. One of the biggest limiting factors on the availability of locally presented interpreter classes is trainers not having a free venue.
Back to qualification. Imagine a client who had medical complications un-related to language. As part of building a case against the hospital, the lawyer may question the qualifications of every interpreter who attended that patient during the entire episode of care. The lawyer will look for weakness in hospital HR and vendor processes. Your aim is to show solid qualifications for each staff interpreter in her HR jacket and for each agency interpreter in the agency sub-contractor files. These are the same elements that a Joint Commission reviewer would look for. The gold standard qualification for medical interpreters today includes the elements listed below. (Compare this with our expectations back in the year 2000, which included only moderate spoken fluency in both languages plus punctuality and good customer service skills.)
High language proficiency in both languages. Language proficiency is measurable by various means. Staff interpreter positions now often require formal language proficiency testing in both English and the language pair. The core importance of proficiency is formalized by various organizations: The Certification Commission for Healthcare Interpreters (CCHI) requires language proficiency in each language that is at least equivalent to that of a high school graduate in language that speaks that language. The National Board of Evaluation for Medical Interpreters (NBCMI) has a similar requirement and equates this level of proficiency to Advanced-Mid on the ACTFL scale. The Interagency Language Roundtable (ILR), only qualifies individuals with at least a proficiency level of 3 (General Professional) as interpreters, which is comparable to proficiency requirements for court interpreters.
Post-secondary academic preparation in one or both languages is desirable but not yet required for foreign language medical interpreters. Medical interpreting today requires an understanding of biological science and complex use of language. RID, Registry of Interpreters for the Deaf, already includes a requirement of a Bachelor’s degree for people becoming certified.
Formal fundamental interpreter training of at least 40 hours and preferably 60 hours or more. Interpreters must learn a body of knowledge: mechanics of how to process information from one language to another; how to manage the flow, register, positioning, and interventions in an encounter; medical terminology; medical interpreter ethics and role boundaries; modalities of interpreting. These are fundamentals, as opposed to continuing education. See the CCHI, NCBMI, and Oregon references elsewhere on this page.
Strong interpreter resume. Interpreting is mentally challenging. It is good to have interpreting hours from any sector under the belt, but especially from a sector such as healthcare in which consecutive interpreting is the dominant mode. For example, the Oregon State interpreter certification program specifically requires hours of interpreting experience.
Health care experience and specialized language skills. A successful medical interpreter understands the processes of care, loves learning about medical science, is proficient in many sub-specialties of medical terminology, and thrives in the patient care environment. Many interpreters from other sectors do not make a successful transition to health care.
Continuing education. A key tenet of every medical interpreter code of ethics includes the commitment to continuous learning to support the work. This should involve both knowledge acquisition, or learning about the topics involved in patient care, as well as skill-building, or practicing and improving all the elements involved in performing interpretation. In any audit of an interpreter’s qualifications, a key question should be about what continuing education the person has undertaken in the past year. Check out this NCIHC publication, page 8.
National or state certification. The trend is toward proof of competence through validated exams covering medical interpreter practice. Washington and Oregon require State certification of medical interpreters. Interpreters can also become certified nationally through the CCHI (Certification Commission for Healthcare Interpreters) or the NCBMI (National Certification Board for Medical Interpreters). The number of medical interpreters who are state or nationally certified is growing every year. State and national certification require renewing the credential every few years, which requires a certain number of hours of continuing education in ethics, skills, and knowledge. The performance of a certified medical interpreter is unlikely to be challenged by a lawyer. Check out WA State’s certification webpage.
Proof of infection control and background check adherence. Today, any interpreter who balks at immunization or background checks is out of step and should probably not be in healthcare. The Oregon certification program specifically calls out good standing with the MCare fraud list and background checks. Washington State’s certification program requires adherence to infection control guidelines for health care staff.
Great references for performance, ethics, and customer service. Interpreters get different kinds of kudos from medical providers, language program managers, and patients. The best interpreters get high marks from all three.
Membership in or leadership in local, regional, or national medical interpreter professional organizations. Interpreters who belong to or are active in these organizations usually attend many more classes, as well as participate in opportunities to guide the industry.
Periodic audits of HR and agency files are recommended to uncover gaps and prompt quality improvement.
On a politically delicate note: Qualification for medical interpreters at the present moment has a sliding set of standards, based on the fact that many interpreters from smaller or refugee-based language communities did not have educational opportunities when young, and now have difficulty taking time out to catch up on formal schooling. The language communities that these interpreters serve are medically and socially vulnerable, and need capable interpreters. For these interpreters, local training opportunities are very important. Language program managers who organize training for these less educated interpreters can make a significant difference in raising the standard of local interpreting.
Managing an interpretation and translation program is a fast-paced and challenging job. Managers have an opportunity to raising interpreting standards whenever they post a new job, do a performance evaluation, and consult with agency vendors.