Context matters in the practice of interpreting but too often the complexities and implications of context are not adequately defined in interpreter training. Instead, learning about the many and varied contexts that interpreters are called into is left to on-the-job experience. Over the last twenty years, Robyn Dean and Robert Pollard have offered practitioners, educators, and trainers ways to identify and talk about the interpreting context and how to more effectively prepare interpreters for working in those contexts. Much of that work has been devoted to the contexts of medical and mental health. This presentation explains how medical interpreting educators can help to not only define context but teach it and assess practitioners’ ability to understand and apply it in professional practice. As medical education has worked to improve the clinical skills of providers so too should medical interpreter education. This can happen by bringing interpreter practitioners incrementally closer to the medical contexts, that is to improve and assess their clinical skills.

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IN
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2. NATIONAL
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INTERPRETING
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CARE
Housekeeping
• This session is being recorded
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*must attend full 90 minutes
*certificates will be emailed by October 20, 2021
• Use “Q&A” to send comments / questions to the hosts
Home for Trainers Interpreter Trainers Webinars Workgroup, an initiative of the Standards and Training Committee
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Welcome to our guest presenter!
Robyn K. Dean, CI/CT, PhD

4. • The interactive nature of work:
• Effectiveness, ethics, & job satisfaction
(Dean & Pollard, 2001)
• Practice profession & related pedagogies
• Dean & Pollard, 2005, 2009, 2014
• Normative ethics:
• Teleology & Reasoning Skills (2011)
• Judgment & perception skills
• Developed over time /through practice &
reflection (Dean & Pollard, 2009)
• Supervision and reflective practice (2018)
Contributions

5. Big Ideas
vs. “Technology”
Theory
vs. Technique

6. Ethical analysis requires a learned vocabulary
- DANIEL KAHNEMAN, 2011
…requires a richer vocabulary than is
available in everyday language.”

7. Where we’re going…
• Professional education and the quest for “clinical” preparedness
• How community interpreters might frame clinical
preparedness (Rest’s (1984) “moral sensitivity”)
• Standardized Patient Program materials in RIT’s MS in
Healthcare
• Measuring the effectiveness of understanding “context”

9. Κλινικń
“at the bedside”

10. Problem-Based Learning

11. What is
C.I.’s
Κλινικń
(at the
bedside)?
Context

12. Context Matters
Angelelli, 2004
Davidson, 2001
Dean & Pollard, 2011
Napier, 2004
Hsieh, 2006, 2007
Pöchhacker, 2004
Roy, 2000
Wadensjö, 1998

13. Shared framework
for context

14. Demand
Categories
Dean & Pollard, 2013
Environmental
Interpersonal
Paralinguistic Intrapersonal

15. Schemas
Organize thoughts in constructive ways

16. EIPICategories
– Environmental Demands
– are specific to the setting (e.g., the goal of the setting, personnel or
clientele present, the unique terminology of that setting, and the
physical surroundings);
– Interpersonal Demands
– are specific to the interactions that occur between the service users, and
the interpreter as well (e.g., cultural factors, communication goals of the
encounter, moods/emotional tone);
– Paralinguistic Demands
– are specific to the quality of the expressive skills of the deaf and hearing
service users (e.g., pace, volume, accents, visual or auditory
impediments to perception);
– Intrapersonal Demands
– are specific to the internal experiences of the interpreter (e.g., thoughts,
feelings, physical states).
Demands Comprise the Interpreting Context

18. Rest’s
Moral Sensitivity
To interpret the situation in
terms of how one’s actions
affect the welfare of others
(1984: 27 and 35)

19. What are the
influences on
moral
sensitivity?
– There is ambiguity of people’s needs, intentions and actions.
– There is a lack of familiarity with the situation or the people in it.
– There is insufficient time for interpretation or apprehension of the situation.
– There is the susceptibility to pressure.
– There is a high number of elements in the situation or demands of the job.
Chances of a moral sensitivity failure increase when:

20. Professional Seminar
Healthcare Practical Interpreting 1
Healthcare Practical Interpreting 2

21. Standardized
Patient Programs
Medical students/ Actors:
Chief complaint &
backstory
Assessing clinical skills:
Communication,
interview &
diagnostic skills
Each video is 20 minutes,
includes: Interview,
physical exam, &
treatment plan
•Health education
• Cancer screenings, safe sex
•Physical exams
• Neurological
•Diagnostic interviews
• Typical chief complaints
•Chronic diseases
• Diabetes, high blood pressure

22. • Dizzy
• Stressed
• Chest pain 1 & 2
• Abdominal pain
• Back pain
• Well-child visit
• Physical exam
• Missed period
SPP Videos per
Presenting complaint
• Headaches
• Cancer screenings
• Wrist injury*
• Slurred speech
• Asthma
• Blood pressure check
• Diabetes check
• Inpatient consult

23. Chief Complaint: Abdominal
Pain

24. Worksheet for Chest Pain
The HCP to describe the quality of the pain used “sharp,
dull, ache”. What are the strategies that you use to
convey those descriptors?
The patient mentions being on dialysis. What do you
already know about dialysis?
Watch the YouTube video on kidney disease /dialysis:
What new information did you learn from this video that
you imagine will help you in your future medical work:

25. Worksheet for Chest Pain
Worksheet for knee Pain
How would you interpret the provider’s statement of:
“that’s the thing we have to worry about most.”
How might you interpret the distinction that is made
between penicillin and azithromycin?

26. Worksheet for Chest Pain
Worksheet for knee Pain
Worksheet for shoulder Pain
Provocation/Palliation:
What were you doing when it started?
What makes it worse or better?
Quality/Quantity:
What does it feel like? What kind of a
pain is it? Stabbing, aching, dull?
Region/Radiation:
Where is the pain located? Does it move or radiate?
Severity Scale:
On a scale from 1 to 10, does it interrupt life activities?
Timing:
How long does an episode last? When/at what time did the
pain start? Have you had this pain before?

27. Chief Complaint: Abdominal
Pain

28. Sample Dialogue
Provider: Ok, alright…now have you had anything like this (the pain) before?
Patient: Something like this when I was a junior in high school.
Provider: Mm hm…
Provider: What helped the pain then?
Patient: I went to the doctor’s and they said it was gonorrhea, PID. [Pelvic Inflammatory Disease]
Provider: And PID…
Patient: And he gave me a shot of some medication.
Provider: I know this is not an easy subject to talk about but have you had any sexually transmitted
diseases since…just the gonorrhea once?
Patient: And the PID
Provider: And since that time nothing…no other symptoms?
Patient: No.

29. Benefits
• Contextualized learning, motivates participation
• Problem-solving of practical and pragmatics ‘problems’
• Demonstrates for interpreter practitioners what is ‘typical’ for situations/ providers
• Can be used with any degree of experience
• Accesses ‘tacit knowledge’ of the practitioners
• Highlights practice-based or moment-to-moment decisions (instead of dilemmas)

30. Benefits
• Creates a shared context for discussions and analyses
• SP videos are stimulus material for teaching (all levels of complexity) and assessing
• Can combine with traditional teaching / learning methods
• Researching medical material (e.g., Crezee), social dynamics, biases, etc.
• Gets early access to intrapersonal demands (psychological, emotional, etc.)
• May serve to develop meta-cognitive moments (Schön’s reflection-in-action)

31. https://robyn-k-dean.ck.page/560e88b422

32. TAPping Into…

33. 1. Identifies environmental demands
2. Identifies paralinguistic demands
3. Notes examples of translation challenges
4. Proposes translation suggestions
5. Notes possible thought world components of patient
6. Notes possible thought world components of provider
7. Identifies potential intrapersonal demands
Assessment for healthcare interpreting contexts:
The student…

34. 8. Identifies the dynamics between patient and provider and or interpreter
9. Notes decision junctures
10. Offers liberal (action-oriented) or conservative (inaction-oriented) control decisions
11. Notes how possible decisions might impact service users or the situation
12. Uses conjecture/prediction about patient-provider semantics or thought worlds
13. Articulates content knowledge or the need for it regarding the interview
14. Identifies examples of provider’s effective / ineffective practice techniques
15. Recognizes aspects of the medical interview
Assessment for healthcare interpreting contexts:
The student…

35. Chief Complaint: Shoulder Pain

36. 1. Identifies environmental demands
2. Identifies paralinguistic demands
3. Notes examples of translation challenges
4. Proposes translation suggestions
5. Notes possible thought world components of patient
6. Notes possible thought world components of provider
7. Identifies potential intrapersonal demands
Assessment for “Jill’s” TAP:

37. 8. Identifies the dynamics between patient and provider and or interpreter
9. Notes decision junctures
10. Offers liberal (action-oriented) or conservative (inaction-oriented) control decisions
11. Notes how possible decisions might impact service users or the situation
12. Uses conjecture/prediction about patient-provider semantics or thought worlds
13. Articulates content knowledge or the need for it regarding the interview
14. Identifies examples of provider’s effective / ineffective practice techniques
15. Recognizes aspects of the medical interview
Assessment for “Jill’s” TAP:

38. Dean, in press

39. https://robyn-k-dean.ck.page/560e88b422

40. Questions or comments?

41. robyn@demandcontrolschema.com
References available upon request

42. NATIONAL
COUNCIL
ON
INTERPRETING
IN
HEALTH
CARE
Robyn K. Dean, CI/CT, PhD
Home for Trainers Interpreter Trainers Webinars Workgroup, an initiative of the Standards and Training Committee
www.ncihc.org/home-for-trainers
Use “Q&A” to
send comments
and questions to
the hosts.
Q&A

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