Vonessa Costa, IMIA Secretary (All slides adapted from IMIA Standards of Practice)

1. Medical Interpreting Standards - IMIA/EDCFirst Standard to Establish Roles and Competencies for Medical Interpreters Vonessa Costa, IMIA Secretary (All slides adapted from IMIA Standards of Practice) IMIA Conference 2008

2. Agenda • Introduction to IMIA Standards • The Development Process • Organization - major task areas • Interpretation • Cultural interface • Ethical behavior • Potential Uses • Practical Application

3. Introduction to IMIA Standards • Original standards of practice for spoken language medical interpretation (1995). • NCIHC voted to advocate use of IMIA Standards as the “best statement of standards for medical interpreters presently available” (1998). • For over a decade, IMIA Standards a vital evaluation and competency tool for interpreters across the country. • 2007 IMIA-sponsored Standards Campaign - to demonstrate that multiple standards can be used together to promote collaboration and the profession

4. The Development Process • 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 • 12 experienced medical interpreters representing six language groups interviewed by DACUM facilitator over two-day period • IMIA - EDC used this data to compile Standards

5. The Challenge • 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

6. The Solution • First, to differentiate between two types of skills: • Linguistic proficiency • Interpreting skills • 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.

7. Example: The Palpebra Inigma • Dr. to patient, “Dear God! Your palpebra are mighty thin!” • 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

8. Example: The Palpebra Enigma • IMIA Standards outline supportive skills • How to ask for clarification • How to manage flow of communication • Awareness of personal limitations • 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!” • How would you interpret this exclamation? What standard helps you decide on your approach? • (Duty A-6, indicator C)

9. IMIA Standards Major Task Areas • Area #1 - Interpretation • straight interpreting • Understand the message • Retain essential elements of communication in the conversion • Clarification skills • Managing the flow of communication • complementary skills • 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)

10. IMIA Standards Major Task Areas • 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

11. Example: The Sugar Daddy • 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.

12. IMIA Standards Major Task Areas • 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

13. Example: The Gossip • 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)

14. IMIA Standards - Potential Uses • 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 • Evaluation Tool • Pre-selected criteria against which the performance of students, trainees, or practitioners in the field can be evaluated • Preparation of health care providers to work with interpreters • 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