Guest post: Translating with and without medical background – a retrospective study

Medical Translation: A Retrospective Study on the Quality of Medical Translation Produced by Translators With and Without a Medical Background

Newest guest post on the Stinging Nettle! Yana Onikiychuk (MD and freelance medical translator and interpreter from Limassol, Cyprus), Ekaterina Chashnikova (freelance medical translator and editor from Moscow, Russia) and Artem Karateev (specialist on social research, PhD, Moscow State University in Moscow, Russia) conducted a study on medical translation by medical professionals vs. background translators. They give here very detailed results of the study – a fascinating read! We are very proud to have been allowed to publish it here as a guest post – many thanks to the authors for conducting the survey and this excellent article, but also for allowing us to publish it on our blog as well!

Abstract

During the last century, the volume of investigations and scientific knowledge in the field of medicine has grown exponentially. At the same time, the exchange of  information among medical professionals has increased to enormous amounts, becoming a fundamental aspect of the development of medical science. However, this exchange would not be possible if people were not speaking the same language. We can see that English is becoming a main language of science in the world scientific arena, as a vast majority of publications and reports are done in this particular language. Yet, some linguistic barriers to effective communication still exist.. Medical translation is a highly specialized field, dealing both with translation of medical-related written information and with interpreting of medical events. Healthcare interpreting is of particular interest because of its role in establishing communication bridges between healthcare practitioners and their non-native language patients. This report elucidates the role of medical translation and interpreting in modern society and in promoting medical and related sciences. We also bring out preliminary results on a new study in the field of medical translation, in which we compare medical translators with and without a medical background and the types of mistakes they tend to make more often when translating medical documents. According to the preliminary statistics, translators with a linguistic background are more prone to terminological and logical mistakes, while translators with a medical background are more prone to grammatical and stylistic mistakes. With an increase in years of experience, this difference becomes insignificant, and translators start to make fewer mistakes overall.

Introduction

For the last centuries, we have seen a burst of development and innovation in the field of medicine. New information arises everyday on diseases, therapy and patient management. And this new information has to be transformed into other languages and cultures to ensure its global use. The field of medical translation and interpreting serves this purpose. Medical interpreting plays a vital role in the exchange of oral information at medical meetings, conferences, workshops or even at the hospital unit between doctor and patient (so-called healthcare interpreting). Medical translation deals with all variety of medical documentation, from scientific articles to patient information leaflets for drugs or marketing materials for medical devices. These documents vary significantly in terms of style and terminology, but they have one thing in common: the price of a mistake during translation is enormously high and equals the health and life of a patient. What kind of professionals are involved in medical translation? We can divide alltranslators and interpreters working with medical information into two big groups. The first group is comprised of professionals with a linguistic background specialized in the translation/interpreting of medical content. They acquired such specialization with specific training or just with practice, frequently dealing with medical documents/events. The second group consists of professionals with a medical background. This could be medical/nursing school, or an education in biomedicine or pharmaceutical science. Such professionals usually have a good command in their native language and one or two foreign languages, which they learn at university or at different language courses. Some of them, but not all receive dedicated training on the translation of medical documents, which is included on the curriculum in many medical and pharmaceutical schools. Very few professionals from this group obtain additional education in translation and linguistics, and this is usually offered in a truncated curriculum. Medical translators/interpreters with a medical or relevant degree are not common within the translation industry, especially in Western Europe and the US, as the cost of obtaining a medical education and going into the medical profession is extremely high in those countries. However, in Russia and Eastern Europe (e.g. Poland, Hungary) there are some translators of this kind in the market. The reason for this is that specialized medical translators are in high demand in these countries, and the moderate income level of medical professionals forces them to find an additional part-time or even full-time translation job. These two groups of medical translators/interpreters have some significant differences in product quality when they work with medical information.
In our study, we reviewed test samples from medical translators with and without a medical background and assessed the differences in the types of mistakes they are prone to make while translating medical documents.

Methodology

Our study has a retrospective design and consists of two phases. In phase 1 we evaluated test translations from freelance medical translators. Translation was performed from English into Russian on medical text. This assessment was performed by two independent reviewers in a blinded fashion. Every sample was assessed for stylistic, grammatical and spelling mistakes, adequate translation of source terms and medical concepts. We also assessed the formatting and layout of the target text. After this assessment, the blinding was broken and results were matched with CVs from the translators who preformed those tests. Statistical analysis was performed by an independent expert in social studies and statistics. Primary information processing was performed with statistical grouping. The sample was divided into 3 cohorts: translators with a linguistic background (L), translators with a medical background (MD), and translators with a combined medical and linguistic background (MDL). Every subject was assessed by 2 endpoints: number of stylistic (St) and grammatical (Gr) mistakes and number of terminological (Tm) and logical (Lg) mistakes.Our initial hypothesis was that medical translation professionals with a linguistic background tend to make more ‘terminological’ mistakes, while professionals with a medical or relevant background make more ‘stylistic’ mistakes. With years of experience, the total number of mistakes decreases, and the difference between these two groups becomes insignificant. For phase 2 we developed a questionnaire for experts in medical translation to evaluate their opinion on training for medical translators/interpreters, the importance of a medical background for translating medical content, and potential problems with medical translation by professionals with and without a medical background.

Results

The study is still ongoing. At this moment, we have enrolled 60 sample translations. Four samples were excluded as non-evaluable. The enrollment plan is 2000 samples to provide statistical power for the study. Test samples were divided into 3 cohorts: translators with a linguistic background (L), translators with a medical background (MD), and translators with a combined medical and linguistic background (MDL). Primary endpoints were (1) number of mistakes per sample, (2) correlation between the number of mistakes and background and/or years of experience, and (3) quality of translation from MDLs. The following mistakes were assessed: terminological (Tm), logical (Lg), stylistic (St) and grammatical (Gr). For statistical analysis, Tm mistakes were combined with Lg mistakes, while St mistakes were assessed in combination with Gr mistakes. Preliminary results on sample distribution are shown on Figure 1.

According to the preliminary results, we can divide all translation samples into 3 groups: best-performing group (BPG) with the lowest number of mistakes, moderately performing group (MPG) with an acceptable number of mistakes, and poor performing group (PPG) with a high number of mistakes. BPG includes 8 professionals (2 Ls, 4 MDs and 2 MDLs), MPG includes the highest number of samples (37 professionals 18 Ls, 16 MDs and 3 MDLs), and PPG includes 11 professionals (3 MDs and 8 Ls). The method of averages confirms that MDs and MDLs make fewer Tm and Lg mistakes than Ls. MDLs also make fewer St and Gr mistakes than Ls and MDs. Surprisingly, MDs make fewer St and Gr mistakes than Ls. This result doesn’t correspond to the initial hypothesis, but more samples are needed to consider this difference significant. The yellow line in the plot separates the group of translators with a tolerable number of mistakes, and most of those professionals were hired by the translation agencies providing test samples for this research.

Discussion

The majority of mistakes from all three cohorts were done by Ls. Perhaps a better understanding of the source text makes a translator produce better target text in Russian. Working out on Tm and Lg mistakes improves St and Gr mistakes, as we don’t see subjects behind the blue line. The number and type of mistakes in L cohort was characterized by significant variability. This could be explained by differences in background, specialization and years of experience. MDs and MDLs make fewer Tm and Lg mistakes than Ls. MDLs also make fewer St and Gr mistakes than Ls and MDs. Surprisingly, MDs make fewer St and Gr mistakes than Ls. This result doesn’t correspond to the initial hypothesis, but more samples are needed to consider this difference significant. With these additional samples, we plan to analyze the type of distribution and the density of distribution, and also to reveal any correlation between years of experience and number of mistakes for all 3 cohorts.

References

Samoilov D. (2011) “On Medical Translation”. Publication on-line at http://www.practica.ru/Articles/medical.htm (in Russian)
Shahova N. (2012) “Discovering the Russian Translation Market.” in SlavFile. vol. 21(1), No. 1
Garbovskiy N. (2004). Translation Theory. Moscow: Moscow University Publishing House (in Russian)
Komissarov V. (1990). Translation Theory. Moscow: Vysshaya Shkola (in Russian)
Komissarov V. (2001). Modern Translation Science. Moscow: Vysshaya Shkola (in Russian)
Latyshev L. (2001). Translation Technology. Moscow: NVI-Tesaurus (in Russian)
Lvovskaya Z. (1985). Theoretical Issues in Translation Process. Moscow: Vysshaya Shkola (in Russian)
Alekseeva I. (2004). Introduction to Translation Science. Saint-Petersburg: Academia Publishing House (in Russian)
Buzadzhi D. (2009). New Approach to Classification of Mistakes in Translation. Moscow: Vserossiyskiy Center Perevodov (in Russian)
Kunilovskaya M. (2008). “Mistakes in Translation: Types and Classification”. Publication on-line at http://tc.utmn.ru/node/76 (in Russian)

Download the article as pdf here on Yana Onikiychuk’s website

Registration open for the 2013 IMIA Conference

Registration Opens for the January 2013 International Medical Interpreting Conference: Guadalupe Pacheco, from the Office of Minority Health, USHHS is Keynote Speaker

The International Medical Interpreters Association is happy to announce that Guadalupe Pacheco, Senior Health Advisor to the Director Office of Minority Health Office of the Secretary, U.S. Department of Health and Human Services is the keynote speaker and will speak on the revised National Standards on Culturally and Linguistically Appropriate Services (CLAS) as well as the National Stakeholder Strategy for Achieving Health Equity. “The 2013 IMIA Conference will provide a forum to hear national and international perspectives on the emerging practices of providing quality interpretation services to a growing global village,” said Guadalupe Pacheco.

Medical interpreters have been benefiting from an annual conference since 1996. The field of medical interpreting has grown in ways that few could have predicted. Innovative approaches have evolved into common practices that are being widely disseminated and adapted. Several standards and language access policies have been adopted at the state, national and international levels, spreading awareness about the importance of accurate communication and interpreting services to reduce health care disparities due to language access.

Registration just opened, and for the first time the IMIA has added a super early bird rate that expires July 15th, 2012. IMIA is encouraging early registration, which helps interpreters and other stakeholders better budget their trips. IMIA recommends the following to attendees: register first, book a hotel second, and buy the tickets last, as rates are not always cheaper earlier.

This IMIA led 3-day event has expanded and in just seven months will take place in Miami Beach Florida. “It was important to take the conference out of Boston to bring it to interpreters in other areas”, said Izabel Arocha, M.Ed., CMISpanish, and Executive Director of IMIA, “and Miami Beach seems like a great place to start”. The theme of the conference is Specialized Interpreting-Getting Beyond the Basics: Exploring Quality Interpreting for Multiple Specialtiesreflects on the in-depth level of skills and knowledge asked for by interpreters, and shared at the event.

It will take place in sunny Florida on January 18 – 20, 2013 at the Miami Beach Convention Center. “Florida is a state that is in constant motion and is more diverse than people think due to international tourism, medical tourism, and new residents from all over the world. There is a need for medical interpreters in many more languages, in addition to Spanish. We are happy to work in collaboration with IMIA to make this event a success”, said Gio Lester, President of the Association of Translators and Interpreters of Florida (ATIF). Panels and forums offer interactive discussion on relevant topics of the day, as well as over sixty very interesting workshops for interpreters, from Demystify Simultaneous Interpreting to New Trends in the Provision of VRI Services. To learn more about the conference, and to register, please visit the IMIA website .

About IMIA

The International Medical Interpreters Association (IMIA) is an umbrella association that promotes all standards and best practices in the field of medical interpreting. As an international non-profit organization of medical interpreters, it represents over 2,000 practicing medical interpreters as the ultimate experts in medical interpreting and as the best option for equitable care for minority language patients around the world. It promotes language access as a human right. The IMIA contains the only free international registry of medical interpreters, where they can be found by language, state, or country.

About ATIF

The Association of Translators and Interpreters of Florida-ATIF, a Chapter of the American Translators Association, is a 501(c)6 non-profit professional association incorporated in the State of Florida. Our association was established to provide support to professionals, students and end users of translation and interpreting services. ATIF is dedicated to promoting professional recognition and growth opportunities through educational and training initiatives targeting T&I professionals in the State of Florida. Website: http://atifonline.org

Source: IMIA – imiaweb.org
Photo: IMIA
Event schedule: http://www.imiaweb.org/uploads/pages/682..pdf

Language Barriers to Health Care in the United States

This perspective article was written and published back in 2006 by Glenn Flores, M.D. in the New England Journal of Medicine (N Engl J Med 2006; 355:229-231 - July 20, 2006) yet it remains dramatically and sadly true today, 6 years later.

A 12-year-old Latino boy arrived at a Boston emergency department with dizziness and a headache. The patient, whom I’ll call Raul, had limited proficiency in English; his mother spoke no English, and the attending physician spoke little Spanish. No medical interpreter was available, so Raul acted as his own interpreter. His mother described his symptoms:

“La semana pasada a el le dio mucho mareo y no tenía fiebre ni nada, y la familia por parte de papá todos padecen de diabetes.”(Last week, he had a lot of dizziness, and he didn’t have fever or anything, and his dad’s family all suffer from diabetes.)

“Uh hum,” replied the physician.

The mother went on. “A mí me da miedo porque el lo que estaba mareado, mareado, mareado y no tenía fiebre ni nada.” (I’m scared because he’s dizzy, dizzy, dizzy, and he didn’t have fever or anything.)

Turning to Raul, the physician asked, “OK, so she’s saying you look kind of yellow, is that what she’s saying?”

Raul interpreted for his mother: “Es que si me vi amarillo?” (Is it that I looked yellow?)

“Estaba como mareado, como pálido” (You were like dizzy, like pale), his mother replied.

Raul turned back to the doctor. “Like I was like paralyzed, something like that,” he said.

If Raul received inappropriate care owing to his misinterpretation, he would not be alone. One interpreter, mistranslating for a nurse practitioner, told the mother of a seven-year-old girl with otitis media to put (oral) amoxicillin “in the ears.” In another case, a Spanish-speaking woman told a resident that her two-year-old had “hit herself” when she fell off her tricycle; the resident misinterpreted two words, understood the fracture to have resulted from abuse, and contacted the Department of Social Services (DSS). DSS sent a worker who, without an interpreter present, had the mother sign over custody of her two children. Clearly, catastrophes can and do result from such miscommunication.

Some 49.6 million Americans (18.7 percent of U.S. residents) speak a language other than English at home; 22.3 million (8.4 percent) have limited English proficiency, speaking English less than “very well,” according to self-ratings. Between 1990 and 2000, the number of Americans who spoke a language other than English at home grew by 15.1 million (a 47 percent increase), and the number with limited English proficiency grew by 7.3 million (a 53 percent increase, see graph). Percentages of Americans Who Speak a Language Other Than English at Home or Who Have Limited English Proficiency.). The numbers are particularly high in some places: in 2000, 40 percent of Californians and 75 percent of Miami residents spoke a language other than English at home, and 20 percent of Californians and 47 percent of Miami residents had limited English proficiency.

Yet many patients who need medical interpreters have no access to them. According to one study, no interpreter was used in 46 percent of emergency department cases involving patients with limited English proficiency. Few clinicians receive training in working with interpreters; only 23 percent of U.S. teaching hospitals provide any such training, and most of these make it optional. Data collection on patients’ primary language and English proficiency is frequently inadequate or nonexistent. Although no federal statutes require the collection of such information, no statute prohibits it, either.

Language barriers can have deleterious effects. Patients who face such barriers are less likely than others to have a usual source of medical care; they receive preventive services at reduced rates; and they have an increased risk of nonadherence to medication. Among patients with psychiatric conditions, those who encounter language barriers are more likely than others to receive a diagnosis of severe psychopathology — but are also more likely to leave the hospital against medical advice. Among children with asthma, those who confront language barriers have an increased risk of intubation. Such patients are less likely than others to return for follow-up appointments after visits to the emergency room, and they have higher rates of hospitalization and drug complications. Greater resources are used in their care, but they have lower levels of patient satisfaction.

Inadequate communication can have tragic consequences: in one case, the misinterpretation of a single word led to a patient’s delayed care and preventable quadriplegia. A Spanish-speaking 18-year-old had stumbled into his girlfriend’s home, told her he was “intoxicado,” and collapsed. When the girlfriend and her mother repeated the term, the non–Spanish-speaking paramedics took it to mean “intoxicated”; the intended meaning was “nauseated.” After more than 36 hours in the hospital being worked up for a drug overdose, the comatose patient was reevaluated and given a diagnosis of intracerebellar hematoma with brain-stem compression and a subdural hematoma secondary to a ruptured artery. (The hospital ended up paying a $71 million malpractice settlement.)

In 1998, the Office for Civil Rights of the Department of Health and Human Services issued a memorandum regarding the prohibition, under Title VI of the Civil Rights Act of 1964, against discrimination on the basis of national origin — which affects persons with limited English proficiency. This memorandum states that the denial or delay of medical care because of language barriers constitutes discrimination and requires that recipients of Medicaid or Medicare funds provide adequate language assistance to patients with limited English proficiency. In 2000, a presidential executive order was issued on improving such persons’ access to services. Thirteen states currently provide third-party reimbursement (through Medicaid and the State Children’s Health Insurance Program) for interpreter services. Unfortunately, most of the states containing the largest numbers of patients with limited English proficiency have not followed suit, sometimes citing concerns about costs. Although the Office for Civil Rights issued guidelines in 2003 that seem to allow health care facilities to opt out of providing language services if their costs are too burdensome, Title VI provides no such exemption.

Ad hoc interpreters, including family members, friends, untrained members of the support staff, and strangers found in waiting rooms or on the street, are commonly used in clinical encounters. But such interpreters are considerably more likely than professional interpreters to commit errors that may have adverse clinical consequences. Ad hoc interpreters are also unlikely to have had training in medical terminology and confidentiality; their priorities sometimes conflict with those of patients; and their presence may inhibit discussions regarding sensitive issues such as domestic violence, substance abuse, psychiatric illness, and sexually transmitted diseases. It is especially risky to have children interpret, since they are unlikely to have a full command of two languages or of medical terminology; they frequently make errors of clinical consequence; and they are particularly likely to avoid sensitive issues. Given the documented risks associated with the use of ad hoc interpreters, it is of concern that the 2003 guidance from the Office for Civil Rights states that such use “may be appropriate.”

Later this year, the California legislature will consider a bill prohibiting state-funded organizations from using children younger than 15 years of age as medical interpreters. Leland Yee, the California speaker pro tempore, proposed the bill, prompted by his experiences interpreting for his mother and, later, as a child psychologist. The bill requires organizations receiving state funding to establish a procedure for “providing competent interpretation services that does not involve the use of children.”

Although this legislation may emerge as a state model, as an unfunded mandate, it will have limited power to improve care. Perhaps the time has come for payers to be required to reimburse providers for interpreter services. The provision of adequate language services results in optimal communication, patient satisfaction, outcomes, resource use, and patient safety. A 2002 report from the Office of Management and Budget estimated that it would cost, on average, only $4.04 (0.5 percent) more per physician visit to provide all U.S. patients who have limited English proficiency with appropriate language services for emergency-department, inpatient, outpatient, and dental visits. This seems like a small price to pay to ensure safe, high-quality health care for 49.6 million Americans.

SOURCE INFORMATION

Dr. Flores is director of the Center for the Advancement of Underserved Children and a professor of pediatrics, epidemiology, and health policy at the Medical College of Wisconsin and the Children’s Research Institute of the Children’s Hospital of Wisconsin, Milwaukee.

Glenn Flores, M.D.- New England Journal of Medicine 2006; 355:229-231 July 20, 2006 - original article: http://www.nejm.org/doi/full/10.1056/NEJMp058316

IMIA International Medical Interpreters Conference 2013 – Call for papers

The next IMIA (International Medical Interpreters Association) Conference will take place in Miami Beach, Florida, January 18-20, 2013.

The topic of the 2013 event has been chosen by IMIA members directly via poll and will be “Specialized Interpreting - Getting Beyond the Basics: Exploring Quality Interpreting for Multiple Specialties”

“The overriding mission of this conference is to offer an international forum to showcase the latest developments in the field, to investigate its opportunities and challenges, and to advance the quality in services provided to language minority patients worldwide.”

Thematic Questions:

Research:
1. What research is taking place regarding how medical interpreters are addressing specialized terminology with no term equivalents in the target language?
2. Is adequate knowledge of medical specialties a plus or a must for medical interpreters?
3. How are medical interpreters being defined in current research?
4. How much interpreting is occurring in non-specialized environments?
5. How can we narrow the divide between research and practice?

Education:
1. What medical specialties should be included in initial interpreter educational programs?
2. Are training/educational programs getting beyond the basics?
3. Is 40 hours of medical interpreter training enough to develop competency that ensures safe and accurate communication in a health care setting?
4. Can community interpreter training meet the educational needs of medical interpreters?
5. How are the established university interpreting programs responding to the growing demand for quality education in health care interpreting?

Practice:
1. What are some of the best practices in specialty subject matter expertise sharing?
2. Are interpreters specializing in one or more fields?
3. What happens when interpreters practice in a particular specialty, for example, a Women’s Health or Behavioral Health Clinic?
4. What are the benefits of specialization to interpreter practitioners?
5. How is national certification for medical interpreters affecting the profession?

Ethics:
1. What is actually happening when interpreters are called to interpret in cases of rare diseases or specialties that they are not familiar with?
2. How are medical interpreters coping with daily ethical dilemmas?
3. Interpreting for family when you are a professional. Is that ethical?
4. How do medical ethics converge with interpreter ethics?
5. How do professional interpreters who are not specialized in health care respond ethically to situations unique to the health care setting?

Continue reading on the IMIA webpage here – more information on the conference and how to reply to the call for speaker are also available on the page.

Deadline for the call for papers is April 20, 2012.

Complete info: http://www.imiaweb.org/conferences/2013callforpapers.asp