MMIA Medical Interpreter Standards

(reprinted from Cross Currents, Fall 1995)

After several years of development and review, the first comprehensive medical interpreter standards of practice have been released by the Massachusetts Medical Interpreter Association (MMIA) in conjunction with Education Development Center, Inc.. The standards are included in a report that addresses the rationale guiding the development process, as well as recommendations for use of the standards in health care and educational settings.

While there have been other efforts to create protocols, ethics, or certification for medical interpreters, the MMIA standards are unique. They establish guidelines for several different aspects of the medical interpreter's role, based on a content analysis of interpreter skills and work responsibilities.

According to the report, among the key concerns behind the development of the medical interpreter standards were the frequent misconceptions surrounding the practice of interpretation in health care settings. These include the belief that any bilingual individual can be an effective interpreter, and that the task is a simple one requiring no formal training. "Standards of practice provide a defining baseline of expectations for consumers and practitioners. They provide a measure against which individual interpreters can monitor the quality of their own performance, [and they] establish criteria for certification and/or entry into the profession, ensuring quality and consistency of performance," the report states.

Members of MMIA have already begun to find practical applications for the standards. " I find them extremely useful in my job as mentor and coordinator for orientation of new interpreters, and in the evaluation of students at practicum," said Estela McDonough, a medical interpreter in Worcester, MA.

The standards were developed using a method of occupational analysis for professional and technical jobs known as the DACUM process. Expert workersó in this case, members of the MMIA with at least three years paid interpreting experience in health care setting ógenerate information on the major duties, responsibilities, and tasks of the medical interpreter, including the specific knowledge, skills, tools, and attitudes needed to perform the role.

In converting the collected information into practice guidelines, the group struggled to balance the goal to set standards that promote accuracy and completeness of interpretation while responding to the immediate need for interpreters in languages where the number of individuals fluent in both English and another language was limited. Accordingly, the standards differentiate between two types of skills: linguistic proficiency and interpreting skills. The standards accommodate a range of proficiency by defining a variety of interpreting techniques that can be employed by interpreters at different levels of linguistic ability.

The MMIA standards of practice are based on the premise that while an interpreter's primary task is interpretation, s/he must go beyond conversion of dialogue to applying an understanding of how to address the nuances and hidden sociocultural issues that may arise during an interpreted en-counter. The standards also recognize and contain strategies to facilitate the important therapeutic connection between provider and patient.

Three skill areas defined

The standards of practice are organized into three major task areas: interpretation, cultural in-terface, and ethical behavior. Under the heading of interpretation, the subtasks are defined as

1. setting the stage,
2. interpreting,
3. managing the flow of communication,
4. managing the triadic relationship, and
5. assisting in closure activities.

The category of cultural interface addresses methods for interpreters to recognize and communicate the ways in which culturally based beliefs affect the presentation, course, and outcomes of illness, as well as perceptions of wellness and treatment. The section on ethical behavior discusses ethical and power dynamic issues an interpreter may encounter.

The MMIA foresees a number of areas in which the standards of practice could be applicable. These include use in the development of interpreter education and training programs; use in the preparation of health care providers to work with interpreters; as an evaluation tool; and as a foundation of certification examination.

For more information, contact Maria-Paz Beltran Avery, Educational Development Center, Inc., 800-225-4276.

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