1. Module 7: Cultural Competency What is culture
Module 7: Cultural Competency What is culture? How does it influence a medical encounter? What is the role of the Culture Broker? How to identify and navigate Cultural Bumps?

2. Definition of culture:
Culture is a shared set of
belief systems
values
practices
assumptions
which determine how we interact with and interpret the world.

3. Culture in Medical Encounters
Culture of patient
Culture of doctor
Culture of interpreter
Culture of health care system
Interpreter must be aware of all cultures present to facilitate communication

4. Nonverbal Communication
Behavior varies across cultures:
Voice – tone, pitch, volume
Gestures and posture
Eye contact
Personal space and physical contact
Punctuality

5. Culture and Power Dynamics
Different cultures = different power dynamics among individuals
Between doctor and patient
Between younger person and elder
Between family members
Between man and woman

6. Medicine Across Cultures
Biomedicine approach vs. popular/traditional approaches
Paying for care and insurance

7. Interpreter as Culture Broker
Interpreters must look at situations within the appropriate cultural framework and use this to facilitate communication
Cultural competency = understanding someone’s actions from their own point of view
Interpreters look out for “cultural bumps”

8. Navigating Cultural Bumps
A cultural bump occurs when cultural differences create a barrier to understanding between patient and provider
Interpreter can help overcome cultural bumps by:
Awareness of situation – look for nonverbal clues
Understanding cultural causes of bump
Following rules for intervening
Providing brief explanation to facilitate understanding
Maintaining transparency
Returning to Conduit role as quickly as possible

9. Module 8: Legislation and Regulations behind Medical Interpreting
What are the major laws and regulations behind medical interpreting?
What are the laws regarding abuse reporting and informed consent that interpreters must be aware of?

10. Title VI of the Civil Rights Act of 1964
Commonly referred to as “Title VI,” this section of the Civil Rights Act reads:
No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.
In other words, this law prohibits all public and private health care providers who receive any type of federal assistance from conducting their programs in a way that discriminates or limits access on the basis of race, color, or country of origin.

11. What does Title VI mean for medical interpreters?
“Country of origin” includes spoken language
Federal assistance includes:
- Grants
- Use of equipment
- Training
- Accepting Medicare/Medicaid funds as payment

12. Executive Order 13166
Titled “Improving Access to Services for Persons with Limited English Proficiency”
Signed by Clinton in 2000
Increases Federal oversight to ensure that recipients of Federal financial assistance (including hospitals) are providing meaningful access to their LEP (Limited English Proficiency) applicants and beneficiaries
Information from lep.gov

13. CLAS Standards
National Standards on Culturally and Linguistically Appropriate Services (CLAS) developed in 2000
Principal Standard:  
Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

14. Bottom Line
Hospitals and other health care providers MUST provide qualified and trained interpreters at NO COST to patients It’s the LAW

15. HIPAA and Medical Interpreters
HIPAA = Health Insurance Portability and Accountability Act
Main purpose = protect patient privacy
Helpful to understand HIPAA form as may have to sight translate
Bottom Line for Interpreters = Maintain Confidentiality
Do not share any info that could identify patient
Inform parties of confidentiality during pre-session
Only exceptions:
Patient gives consent to disclose
Mandatory reporting

16. Mandatory Reporting of Abuse
Any person who knows or has reasonable cause to suspect abuse of child or ‘vulnerable adult’ must report to FL Abuse Hotline
Vulnerable adult = age or disability
Hospital personnel = Mandatory Reporters [- does this apply to freelance interpreters?] – must provide name
Failure to report = 3rd degree felony
Adult abuse: may not be reported without informed consent
Exception: hospital personnel must report life-threatening injury indicating act of violence
Source:

17. Informed Consent and the Interpreter
? – is this mainly just confidentiality rules? Couldn’t find much info

18. Learning Strategies Vocabulary building
Learning words in context better than memorization
Study prefixes and suffixes
Prepare as much as possible before appointment
Review new words and concepts after appointment

19. Module 9: Medical Interpreter Certification
What is the value of certification for interpreters and institutions? How do you become a certified medical interpreter? What is the importance of continuing education for interpreters?

20. Medical Interpreter Certification
Interpreters: Why become a certified medical interpreter?
Institutions: Why hire certified medical interpreters?
Certification Process:
Meet basic requirements
Pass Written Exam
Pass Oral Exam
2 Organizations provide Certification:
National Board of Certification for Medical Interpreters (NBCMI)
Certification Commission for Healthcare Interpreters (CCHI)

21. Comparing CCHI and NBCMI
Both are nationally recognized and equally accepted
Cost is about the same ($450-$500 for whole process)
Written and Oral Exams very similar
Main deciding factor for interpreter
Testing dates
Locations
Languages available

22. CCHI vs NBCMI Spanish, Mandarin, Arabic
Alternative certification available for others (just written)
Written Exam focuses slightly more on managing interpreting encounter
Small Simultaneous component on Oral Exam
Spanish, Russian, Mandarin, Cantonese, Korean, Vietnamese
Alternative certification for others in the works
Written Exam focuses slightly more on medical terminology
No Simultaneous on Oral Exam
40 hours approved Medical Interpreter Education required by both
Additional requirements vary slightly & include
- proof of language proficiency - professional experience - general education

23. Continuing Education Required to maintain certification
Important to continue improving skills & stay current
Can be earned through
Attendance of professional interpreters’ conferences/conventions
In-person workshops
Online courses
Providers: DLMIT, IMIA has complete listing