The 40 Hour Conundrum: 40 hours does not make a professional

It is time for medical interpreting education to catch up to the times.

According to a seminal study conducted and led by Dr. Flores (Flores et al., 2003), common medical interpreter errors include the following: (a) omission, (b) false fluency, (c) substitution, (d) editorializing/distortion, and (e) addition. Flores’ subsequent study in 2012 showed that medical interpreters with at least 100 hours of training made fewer errors overall, and made fewer errors of consequence. “These findings suggest that requiring at least 100 hours of training for interpreters may have a major impact on reducing interpreter errors and their consequences in healthcare, while improving quality and patient safety” (Flores, Abreu, Barone, Bachur, & Lin, 2012). This was in 2012. Did anyone pay attention? Apparently not, as 40 hour courses are still the minimum training requirement in the US.

Other countries have higher requirements. In Japan, for example, most medical interpreter training programs are 100-200 hours. In 2006, Canada launched a program for community interpreters (LITP) at five colleges that require 180 hours of training, and further requires a medical terminology course for those who wish to specialize in medical interpreting.

In the US, there have been initiatives to improve this. In 2011, the National Council for Interpreting in Healthcare (NCIHC) developed the National Standards for Interpreting Training Programs, setting guidelines for interpreter educators. While the document did not recommend any particular hourly weight to a program, it did lay out important contents of training, which in my view are impossible to be adequately exposed in only 40 hours. In 2014, the International Medical Interpreters Association (IMIA) developed an full Third-Party Accreditation by audit process for medical interpreter education programs through it’s Division, the Commission for Medical Interpreter Education (CMIE). CMIE increased its hourly requirements gradually, and now 80 hours of interpreter education is required to even apply to receive the IMIA CMIE Accreditation. CMIE has also created standards for interpreter instructors, beginning with the fact that they should be bilingual, have experience, and be certified themselves. The Medical Interpreting and Translation Institute Online, (MITIO.org) offers an online 160 hour diploma (4 course-program) for medical interpreting, and has a similar diploma program for medical translation. Several university-based one-year certificate programs, (usually 3-5 courses) have been developed, hovering between 160-200 hours. Check out Boston University, Cambridge College, UMass Amherst and there are many other universities in the West Coast. There is a Bachelor of interpreting at University of Arizona. There is now also a Masters in Science in Healthcare Interpreting at the Rochester Institute of Technology (330 hours). These organizations are attempting to elevate the profession. Some training organizations have increased to 60 hours because they want to go in the right direction. They need to continue the process of professionalizing the education of interpreters. On the other hand, some private training organizations seem to have no incentive to do anything more than what is required (for national certification): 40 hours. When promised the world in 40 hours, candidates for the profession find a system with a high incentive to cut corners and do a shorter cheaper 40-hour course. However, this is deceiving, as this usually doesn’t take them very far these days, and only undercuts all the candidates that are working towards a more comprehensive interpreter education.

What are the consequences of this conundrum? Some individuals continue to enter and treat interpreting as a job, and not a career. Some trained interpreters simply do not pass national certification exams, even after training. Some can’t even sit for the exams because they don’t meet the language proficiency prerequisite of an Advanced Mid level in both languages, because their language proficiency was never tested. The reality is that there are trained interpreters who do not pass the employer’s internal interpreting exams. How did they pass a 40-hour training? This reality hurts the profession. Non-qualified interpreters should not be practicing, even if they have been trained, to protect patient safety. We need only qualified individuals entering the field. Patients need only qualified individuals interpreting. Providers also need qualified professionals for liability reasons.

Ten years have passed since national certification became available in the US. Back then there were not so many training programs. However, the scenario has changed. Unless CCHI or NBCMI increase the interpreting training requirement, training organizations will continue to offer the minimum hours possible, and interpreters will continue to enter the field with minimal and in my view, ‘inadequate’ training and many will be non-qualified trained interpreters which seems like an oxymoron. We will still have naive candidates being sold the idea that they will become a professional interpreter in a ‘comprehensive’ 40-hour course. There is nothing comprehensive about selling the idea that one can become a professional in 40 hours. To me that is deceiving and a case of over-selling. A 40-hour course shouldn’t even be called a program as a program requires more than one course. We all know 40 hours is not enough so why are we still pretending it is still ok? We are all shooting ourselves in the foot by living in the past. The time has come to require proper training. Let’s move to the future. It is time!

Whereas I am sure most trainers of 40-hour trainings are well intended and doing their best, it is still not fair to candidates nor to the profession to under-train. There is a group of advocates who argue that candidates can’t afford more than a 40-hour program, and that is just what they said when all available were 2-hour workshops. The reality is that many people are undertaking university one year multi-course programs versus a single 40-hour course. It is a fact that a 40-hour training can, in some cases, cause more harm than good. It is time; 40-hour trainings simply have to go. Training organizations need better materials, research-based education, the time they need to teach appropriately. They need to teach the NCIHC and the IMIA Standards well. They need to teach note-taking skills well. They need to teach sight translation well. They need to teach  simultaneous interpretation, as interpreters are going into the field without appropriate training. It is time.

“It is time for the National Board and/or CCHI should increase the training pre-requisite for national certification. This is the only way to force organizations to increase their training program. These training organizations could be given 2-5 years to comply, and require by 2022 that interpreter training programs increase from 40-100 hours of minimal training, and then to 200 hours in 2025. That would be a huge improvement from what we have today. Maybe in another five years we can increase to 200 hours of training and end up like yoga teachers or phlebotomists, who already require 200 hours of training to get certified. It is time! Medical interpreter education is in need of growth.”

Flores G, Laws MB, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6‐14. doi:10.1542/peds.111.1.6

Flores, G., Abreu, M., Barone, C. P., Bachur, R., & Lin, H. (2012). Errors of medical interpretation and their potential clinical consequences: A comparison of professional vs. ad hoc vs. no interpreters. Annals of Emergency Medicine, 60(5), 545–553.

International Medical Interpreters Association (2013). National Accreditation Standards for Interpreter Educational Programs. https://www.imiaweb.org/uploads/docs/National_Accreditation_Standards_For_Medical_Interpreter_Educational_Programs.pdf

National Council for Interpreting in Healthcare (2011). National Standards for Interpreting Training Programs. https://www.ncihc.org/standards-for-training

Ontario Council on Community Interpreting, (www.occi.ca)

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