Using the results of research conducted with health care interpreters who work remotely, the following will provide a framework to categorize key areas of professional development for this growing modality.
Information contained in this article was presented for webinars for the California Healthcare Interpreting Association and the National Council on Interpreting in Health Care’s Home for Trainers in February 2018.
As the demand and opportunity for interpreting via remote modalities grows, so does the need for interpreters to develop their ability to perform effectively in these modalities. As a result, trainers and training programs need to offer initial courses or continuing professional development content targeted at helping students and working professionals close the gaps in their remote interpreting skills.
Using the results of research conducted with health care interpreters who work via telephone and video, the following will provide a framework to categorize key areas of professional development for remote interpreters and discuss perceptions and trends and how they impact training. While the examples shared are related to health care interpreting, the concepts may be applied to other areas of interpreting.
A Growing Trend
Over-the-phone and video remote interpreting are being implemented more quickly in medical settings than ever before. Momentum is also growing in the legal field. In 2016, for example, the Judicial Council of California approved a pilot project to evaluate and test video remote interpreting in three of the state’s superior courts (Merced, Sacramento, and Ventura).1 As of December 2017, two equipment vendors were completing equipment installation in all three courts and training was being scheduled.2 The pilot assessment period will last six months.
Regarding modality usage, three research studies have indicated a preference for in-person medical interpreting and video interpreting over telephonic interpreting, with one study adding evidence that the mode of communication affects perceptions of the quality of the encounter.3 Research also indicates that the cost of providing language services may be recouped through reduced testing, shorter visits, and better compliance with treatment and follow-up instructions.4
While debating the pros and cons of remote interpreting is beyond the scope of this article, it’s important to acknowledge that fears and concerns among interpreters do exist, such as the possibility that face-to-face interpreting will disappear completely, that lowering cost is more important than customer service, or that remote interpreting is not as effective as face-to-face interpreting. Nonetheless, access to a qualified health care interpreter by phone or video still outweighs the alternative of utilizing an untrained ad hoc interpreter, or not having an interpreter at all.
Survey Says
As a graduate student in 2014, I had the opportunity to collaborate with the Health Care Interpreter Network (HCIN) and conduct a front-end analysis concerning the professional development needs of remote interpreters.5 HCIN is a nonprofit organization led by former hospital executives and technologists dedicated to creating an efficient and high-quality service for video health care interpreting. At the time of my research, HCIN was composed of more than 40 member hospitals and provider organizations across the U.S. and offered service in 20 languages.
To collect data from as many respondents as possible, I created a 15-question online survey that was sent to 299 interpreters, with a completion rate of 41.8% (125). The survey was divided into three sections: 1) overall interpreting experience, 2) remote interpreting experience, and 3) professional development. It concluded with three demographic questions.
The study had two goals. The first was to explore the needs of health care interpreters who provide remote language services on a shared audio/video network. The second goal was to implement strategies that will increase access to professional development opportunities and improve morale, consistency, and the quality of service for this segment of interpreters.
This analysis was significant because, depending on the size and scope of their organization, interpreters in the network did not have equal levels of support or access to professional development opportunities. This could be said to be reflective of the larger health care interpreting community. Here is a summary of the results:
Interpreting Experience: The respondents’ years of overall interpreting experience regardless of modality were distributed evenly, with the majority (33%) reporting more than 15 years in the field. However, the same respondents reported much less experience in remote-only interpreting, with the majority almost evenly split at 0–3 (47%) and 4–7 (41%) years.
Working as a Remote Interpreter: To gather qualitative data on their experience working as a remote interpreter, respondents were asked five open-ended questions. Convenience emerged as the main theme for what respondents liked most about remote interpreting (26), while sound and connectivity issues (59) were found to be the most challenging part of this work.
In terms of advice they would give to an interpreter who is new to remote interpreting, most respondents recommended asking for repetition (30), followed by listening and taking notes (18). When asked what they would change about remote interpreting and why, the most common response (19) was better audio quality to allow for more accurate interpreting.
Professional Development: In this part of the survey, respondents were asked how they receive information related to professional development opportunities, which resources they find most valuable, what topics are of greatest interest to them, and how they prefer to learn.
Most respondents (99) received information about professional development opportunities from colleagues (66%), followed by leadership (62%) and association memberships (55%). On a scale of 1 to 5, with 1 being their first preference, online discussion boards were ranked highest by respondents.
When asked for topics of interest to develop educational material, five themes emerged. Most respondents showed an interest in material related to medical specialties (44), followed by medical terminology (20) as a sub-theme of language resources. When asked about preferred learning methods, the majority selected hands-on practice (73%) and listening (72%).
Demographics: Three demographic questions were included to help analyze the data, which 98 respondents (78%) answered. Most respondents had some college credit (22%) or an associate (24%) or bachelor’s degree (25%). In terms of age and gender, the majority were either 30–49 (45%) or 50–64 (36%) years old, and most were female (70%).
What’s in It for Me?
The most telling information about the professional development needs of remote interpreters came from five open-ended questions, which can be used to analyze your own remote-specific interpreter training needs.
- What do you like best about remote interpreting?
- What do you find most challenging about remote interpreting?
- What advice would you give an interpreter who is new to remote interpreting?
- If you could change one thing about remote interpreting, what would it be?
- Why would you choose to make that change?
Figure 1: Summary of Qualitative Findings
When participants were asked, “What do you find most challenging about remote interpreting?” most responses were related to sound, connectivity, and noise issues, while a few mentioned exposure to sensitive situations. In other words, the tools provided—in this case technology—can have a significant impact on the interpreter’s ability to provide quality service.
As another example, when asked, “What advice would you give to an interpreter who is new to remote interpreting?” the most common responses were related to asking for repetition, followed by listening and taking notes. These are certainly skills that can be transferred from on-site interpreting experience, and become even more critical when there is a lack of context or nonverbal cues.
In terms of the topics of greatest interest for continuing education, the top responses included medical terminology, mental health, ethics, oncology, cardiology, diabetes, and anatomy and physiology.
The participants’ responses were then categorized into five groups (Motivation, Information, Tools, System, and Skills), together with levers (advantages) and obstacles, to identify opportunities and make recommendations. The results ultimately demonstrated a need for more than just training in the traditional sense. (See Figure 1.)
Implications for Training
As health care organizations continue to look for ways to provide language services more efficiently and cost-effectively, remote interpreting is likely to impact the performance of experienced and entry-level interpreters in different ways.
Visualization and Note-Taking: Experienced interpreters who have worked face-to-face with patients and providers have the benefit of transferring their familiarity with medical settings (e.g., sights, sounds, smells, space, and protocols) to visualize what is taking place. Note-taking becomes especially critical without context and nonverbal cues, leading to the need for more emphasis on this skill for remote interpreters. As an instructor, I’m curious to know what percentage of health care interpreters have worked exclusively in call centers and how their training and visualization skills compare to those with on-site experience who also work remotely.
Flow and Consistency: Experienced on-site interpreters may also feel more comfortable increasing their level of assertiveness to manage the flow of the conversation when working remotely than an interpreter who is new to the field. Regardless of experience, to improve consistency of service for all parties involved, it’s important for the interpreter to include the same key elements every time he or she makes an introduction. Here’s an introduction checklist:
- Greeting
- Name
- Language
- Use first person
- All speech will be interpreted
- Confidentiality
- Hand signal (video) or verbal prompt (phone)
An effective introduction can be accomplished in three sentences. Thus, the introduction becomes a mini pre-session and the interpreter is ready to start. Here’s a sample introductory dialogue:
Hi, I’m [name], your [language] interpreter.
Please speak directly to each other in the first person. Please understand that everything that is said will be interpreted and kept confidential.
I will [do this/say this] if I need to interrupt for clarification. Let’s begin!
Self-Care: While risks like exposure to bodily fluids and radiation are removed when interpreting remotely, factors that are sometimes beyond the interpreter’s control (e.g., workspace available, volume of requests, quality of technology, and administrative support) may increase an interpreter’s stress level and decrease their ability to focus on interpreting.
For an interpreter working in a call center, there is a greater need to mitigate background noise and other distractions than in a home office where the interpreter works alone. On the other hand, working alone may lead to a greater feeling of isolation for new and experienced interpreters alike.
Resources and Guidelines: When working remotely, access to resources, such as online glossaries and protocols preferred by the hiring organization become essential to ensure the accuracy and consistency of the services provided. Finally, training for health care providers on how to effectively interact with a remote interpreter, as well as the importance of bringing a qualified interpreter into the encounter regardless of modality, should continue to be a priority for health care organizations.
Next Steps
Whether you have experience with remote interpreting or are new to this modality, I hope this article has helped you identify ways to leverage your skills, set priorities, and implement changes that will positively impact your interpreter training and quality of service.
Notes
- “Video Remote Interpreting (VRI) Pilot Project” (Judicial Council of California), www.courts.ca.gov/VRI.htm.
- Faes, Florian. “Court Interpretation in California Goes Virtual,” Slator (March 23, 2017), http://bit.ly/California-court.
- Locatis, Craig, Deborah Williamson, Carrie Gould-Kabler, Laurie Zone-Smith, Isabel Detzler, Jason Roberson, Richard Maisiak, and Michael Ackerman. “Comparing In-Person, Video, and Telephonic Medical Interpretation,” Journal of General Internal Medicine (Society of General Internal Medicine, April 2010), 345–350, http://bit.ly/Locatis-interpretation.
- Masland, Mary, Christine Lou, and Lonnie Snowden. “Use of Communication Technologies to Cost-Effectively Increase the Availability of Interpretation Services in Healthcare Settings,” Telemedicine Journal and e-Health (American Telemedicine Association, August 2010), 739–745, http://bit.ly/Masland-interpretation.
- Couture, Suzanne. “Identifying Professional Development Opportunities for Remote Healthcare Interpreters on a Shared Network,” Instructional Design Capstones Collection (University of Massachusetts Boston, 2014), http://bit.ly/Couture-remote-interpreters.
Suzanne (Sue) Couture is a certified health care interpreter and ATA-certified translator (Spanish>English) with 17 years of experience in translation and interpreting. She has studied and lived in Central and Northern Mexico, and has a BA in Spanish and MEd in instructional design. She has worked as a medical interpreter, language services supervisor, and instructor of medical translation and health care interpreting. She is currently a full-time instructional designer and freelance linguist, and volunteers as a member of the National Council on Interpreting in Health Care’s Home for Trainers Webinar Work Group. Contact: couture.suzanne01@gmail.com.