Research and situation so far
Research on healthcare interpreting in multilingual and multiethnic environments and the situation in Slovenia
Interpreting for healthcare institutions is extensively studied in pronouncedly multiethnic societies such as Australia (e.g. Ozolins 1998) and the U.S. (e.g. Angelelli 2004). It is also investigated in European countries with a very high percentage of immigrants such as the UK (e.g. Cambridge 2008) and Germany (e.g. Meyer 2004). In recent years Slovenia's neighbouring country Austria has also played a very dominant role in research on community and healthcare interpreting (for further reference see Grbić and Pöllabauer 2006; Pöllabauer and Prunč 2003). But the new EU member states seem to ignore the problem posed to their healthcare systems by an ever growing increase in immigration flow. At least does the lack of research in these countries suggest that there is no real awareness of the need for healthcare interpreting. Slovenia, which has experienced one of the highest increases in immigration in the last few years among the new member states (Vertot 2009), is no exception. The only existing studies on healthcare interpreting in Slovenia (Pokorn et al. 2009; Morel 2009) come to the conclusion that there are neither training opportunities nor organized networks for medical interpreting and that medical personnel have to rely on lay or ad-hoc interpreters (e.g. family or community members and bilingual staff) or simply have to improvise. Pokorn et al. (2009:171) point out »that Slovenian public institutions still seem unaware of the problem and do not place any value on community interpreting. The legislation regulating public service interpreting is confusing and unclear, revealing ignorance of the basic competences needed for working as an interpreter in the public sector.«
Research on the role of the medical interpreter
Scientific perspectives on the role of the medical interpreter have evolved with the growth of the profession. Recent studies have redefined traditional interpreting roles in the interests of producing more effective communication. Traditionally the interpreter has been viewed as a neutral and (preferably invisible) linguistic facilitator, whose role is limited to language conversion and who has little power over the actual medical encounter or influence on the relationship between patient and healthcare provider. Thorough studies in discourse analysis and interpreting conducted at the turn from the twentieth to the twenty-first century (e.g. Cambridge 1999; Davidson 2000; Metzger 1999; Roy 2000; Wadensjö 1998) have begun to challenge the notion of neutrality and invisibility. These studies have created an image of interpreters as essential partners and co-constructors to the interaction in a three-party conversation. According to research there are various degrees of interpreter agency in medical encounters which are evident in one or more of the following typical behaviours: (1) interpreters set communication rules, such as turn-taking and control of the traffic of information (Roy 2000); (2) they paraphrase or explain medical terms or concepts and filter information (Davidson 2000); (3) interpreters adapt and expand health care providers’ communication, provide cultural explanations and advocate on behalf of patients (Kaufert and Putsch 1997); (4) in the asymmetrical relations between patient and healthcare provider and between speakers of dominant and less dominant languages, the interpreters actively manage issues of power and solidarity (Angelelli 2004); (5) they align with one of the parties in the interpreted communication event (Wadensjö 1998) or even replace one of the parties (Roy 2000).
Dysart-Gale (2007) points out that the still quite dominant view of interpreters as language conduits is based on the »transmission model of communication«. The medical discipline has traditionally followed this model as well: The doctor talks and the patient listens. The author suggested that a more appropriate model for all parties involved is the »semiotic model«, which envisions meaning evolving through the collaboration of the participants. Dysart-Gale proposes additional roles for the interpreter: clarifier, cultural broker, and patient advocate. As clarifier, the interpreter might add information when a cultural difference renders the message unclear. An interpreter acting as cultural broker would provide a cultural framework that allows the receiver to understand the message, and an interpreter in an advocate role might act on behalf of the patient inside and outside of the medical interview, with the goal of promoting quality of communication as well as quality of care.
Research on learning and training opportunities for medical interpreters
A number of studies describe the benefits of using educated, professional interpreters in medical settings, and promote their exclusive use when dealing with foreign-language patient populations (e.g. Cambridge 1999; Roy 2006). But in many European countries learning and training opportunities tailored specifically to medical interpreters are still rare and effective practices for the education of interpreters working in healthcare have yet to be identified. The development and implementation of comprehensive curricula is the most urgent issue in this respect. A few sources suggest topics that might be included in a curriculum for medical interpreter training.
Angelelli (2006) recommends that health care interpreter education should aim to develop skills in six areas: (1) cognitive processing; (2) interpersonal issues, such as role visibility/neutrality and power; (3) linguistic factors, such as vocabulary and changing registers to accommodate patient needs; (4) professional issues, such as ethics and certification; (5) medical settings; and (6) sociocultural issues, such as the impact of the institution and society. The author stresses that the current model of interpreter education is based on preparing conference interpreters, but that new models need to account for the special duties and responsibilities of the medical interpreter. Students need to be exposed to medical discourse so that they see the connections between medical settings, expectations of patients and providers and actual interpreting performance. Angelelli recommends »problem-based learning« and suggests the following course sequence: introduction to medical interpreting, language enhancement for medical interpreting, strategies for medical interpreting, the role of the medical interpreter, and a practicum in medical interpreting.
A survey of medical interpreter training options available for spoken language interpreters in California (U.S.A.) in 2002 found that programmes ranged from 30 to over 360 hours, with most 40 hours long. Two-thirds of these programmes required no practicum experience as part of the training. Typical courses included role and ethics, basic interpreting techniques, controlling the flow of the session, medical terminology, professional development and the impact of culture in medical interpreting. Longer programmes included more interpreting practice and more analysis of the conversation process (for further reference see Dower 2003).
The EU LLL project MedInt – Development of a curriculum for medical interpreters (134007-LLP-2007-AT-GRUNDTVIG-GMP), in which the applicant organisation participated, aimed at designing a sample curriculum that can be adapted to national requirements in the partner states. In a first step the project partners have defined and meticulously described the competences expected from a medical interpreter: interpreting-service-provision competence, language competence, intercultural competence, technological competence, information-mining competence, and thematic competence. Based on this set of competences a sample curriculum with the following course units was developed: introduction to the healthcare system and legal background, basic medical knowledge in the languages at stake, introduction to professional ethics, computer and information-mining skills and terminological aids, interpreting training (practical training with case studies), interpreting practicum or mentoring, exam (interpreting a medical examination). Then follows a very detailed description of the individual course units, including proposals for course content, educational objectives, teaching and learning methods as well as materials, and recommended literature (for further reference and more detailed information see http://www.uni-graz.at /en/wp6_curriculum_final.pdf).
