The document covers a webinar by the National Council on Interpreting in Health Care that discusses the evolving role of healthcare interpreters and the cognitive skills necessary for effective interpretation. It emphasizes a 'possibilistic approach' to training, focusing on customizing education to the interpreters' skill levels, and highlights the importance of understanding memory and cognitive processes in interpreting. Core skills required for healthcare interpreting include fluency in multiple languages, cultural awareness, and the ability to manage communication effectively.

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Welcome!
Guest
Presenter:
Jaime
Fatás-­‐Cabeza
Associate
Professor
of
the
Prac;ce
Director
of
Transla;on
and
Interpre;ng
at
University
of
Arizona
USCCI,
Eng/Spa
and
CHITM,
Eng/Spa
Commissioner,
Cer;fica;on
Commission
for
Healthcare
Interpreters

6. PART I
Ø The dialogic, interactional dimension of CI as dialogue
interpreting and the role of the healthcare interpreter
Ø Pursuing this approach in the teaching of CI and dialogue
interpreting
PART II
Ø Development of cognitive abilities necessary for information
processing and linguistic expression and rendering
Ø Review of CI skills and techniques to improve
comprehension through analysis and synthesis, increase
accuracy, enhance memory, and (minimize dependency on)
note-taking.

7.
The
principle
that
language
is
a
reflec1on
of
culture,
and
that
translators
and
interpreters
therefore
provide
a
cultural
bridge
as
well
as
a
linguis1c
one,
is
a
theme
that
runs
through
virtually
all
wri1ngs
on
transla1on
and
interpreta1on.
Accuracy
vs.
Brevity
in
the
Use
of
Legal
Terms
by
Court
Interpreters,
by
Holly
Mikkelson

8. Nature and scope of the role
What is the nature of the role?
– 3 core values
What is the scope of the role?
– Support medical profession?
– Bridge the gap?
– Help navigate?
– Humanitarian: to promote human welfare? All of the
above
What kind of relationship is permissible for the interpreter
to establish with the patient and the provider?

9. • We have transcended the concept of the interpreter as a passive
instrument whose role is merely “message passing” to that of an
active interpreter, in which the interpreter holds a variety of
responsibilities and has relational ties that form the foundation of
trust and credibility.
• The conceptualization of the “interpreter as manager of the cross-
cultural/cross-language mediated clinical encounter” defines the
primary function of the role as the facilitation of the communication
process between two people who do not speak the same language in
order to make possible the goal of the encounter: the patient’s well-
being.
The role of the health care interpreter. An evolving dialogue,
by Maria-Paz Beltran Avery, Ph.D.

10. Assessing the capabilities and needs of the
participants to achieve goals
• Managing the flow accordingly (when the
participants are not doing so)
• Explicitly acknowledging the interpreter’s own
limitations, and pursuing a “possibilistic”
approach, pacing the communication
accordingly.

11. The best conditions for meaningful
participation and communication exist
when the participants…
• Recognize, engage and incorporate multiple
voices, each with its own perspective, its own
validity, and its own narrative weight;
• Manage to strike a balance, and
• Pace the communication to meet ideal levels
of language comprehension for interaction.

12. The interpreter in a dialogic setting
(Healthcare and CI) is a multilingual and
cross-cultural conduit and coordinator of the
interaction.
She is reactive to the primary parties'
utterances and provides modified versions
when needed.
Takes into account the interpreter's meta-
communicative activity as a facilitator and
meaning-making.
And uses reformulations and repairs, which
affect the progress and outcomes of the
encounter.

13. Core skills usually listed as requirements
for healthcare interpreting
Primary
• (a certain level of) Fluency in at least two
languages
• Understanding of Role/Healthcare environment
• Cultural awareness
• Fundamentals of technique (CI v SI, memory)
Secondary
• Operational skills and intervention techniques
• Ability to manage the encounter, engaging in
situational control
• Cultural awareness
o Some social, emotional aspects

14. Pursuing a “possibilistic” approach
• Achieving the best possible results may require an
explicit acknowledgement of the interpreter’s own
substantial limitations.
• If limitations are substantial, interpreters should
explain the need to pace the communication to meet
their own level of language comprehension and
fluency in both languages with minimal interference.
• In many instances, interpreters with skills that do not
conform with a standard set constitute an
indispensable resource.
• Frequently, they show great potential when needs are
addressed and nurtured carefully.

15. Other socioeconomic factors
• Status, power differential, and balance of
power
• Socioeconomic implications: Poverty
• Cultural shock: cultural differences, the
culture of biomedicine v. folk culture
• Ethnic, racial, otherness, exclusion, gender
orientation, disability

16. INTERVENTIONS OF THE UTMOST
IMPORTANCE!!!
• Education of healthcare personnel
• Protocols
• Health literacy

17. Teaching CI: a possibilistic approach
A good way to teach CI and dialogue interpreting
is to follow a possibilistic approach: assess the
circumstances, preparedness, and possibilities of
a trainee, and then proceed customizing
conceptual and technical training and education
incrementally.
It is a common mistake to push trainees who don’t
have the required basic skills into scenarios that
greatly surpass their performance level. This is a
costly pedagogical mistake that usually leads to
frustration and deception.

18. Help trainees assess their own boundaries
Find out what are their limits, so they know if and how far
they can go to manage the flow with confidence
HOW?
Testing core fundamental abilities: literacy, fluency,
healthcare literacy, understanding of role, medical term,
memory
Then, applying remedial measures if needed, to promote
core fundamental abilities that guarantee an accurate,
complete transfer at a basic level.
Then, develop incrementally higher cognitive and technical
skills.

19. Core skills usually listed as requirements
for healthcare interpreting
Primary
• (a certain level of) Fluency in at least two
languages
• Understanding of Role/Healthcare environment
• Cultural awareness
• Fundamentals of technique (CI v SI, memory)
Secondary
• Operational skills and intervention techniques
• Ability to manage the encounter, engaging in
situational control
• Cultural awareness
o Some social, emotional aspects

20. General rule: it is SAFER to proceed with short segments,
checking frequently for comprehension.
The ability to interpret long segments is desirable for a number
of reasons:
• Participants may speak in paragraphs;
• People communicate differently (naturally) when they are not
interrupted frequently,
Having issues with retention, losing or altering content?
Engage in situational control!
Beware: cutting off the speaker at every turn is usually a
compensation strategy for a poor technique.
Ultimately, it is the interpreter’s responsibility to develop their
technique to allow the speaker to proceed in a comfortable way,
using reasonably long segments.

21. PART II
• Development of cognitive abilities
necessary for information processing and
linguistic expression and rendering
• Skills and techniques to improve
comprehension through analysis and
synthesis, increase accuracy, enhance
memory and (minimize dependency on)
note-taking
INCLUDING: (next slide, please)

22. • Overall importance of basic understanding of how the brain
and memory work
• Gile’s Effort Model of interpreting and implications of
automatic processes
• Discourse analysis applied to cross-cultural communication
• CI: skills and techniques
• Anticipation/Prediction
• Attentive listening
• Motor skills
• Memory: developing and strengthening memory HANDOUT
» Sensorial perception
» Types of memory
» Executive function
» Memory consolidation:
» awareness, repetition, manipulation
• Memory techniques
• Note-taking HANDOUT

23. Overall importance of basic understanding
of how the brain and memory work (1)
• Basic understanding of how the brain and
memory work is a must for cognitive and motor
integration and intellectual growth.
• Vision as dominant sense (exploit the power of
visualization)
• Using sensorial input from all senses can enrich
and reinforce perception and retention
(memory)
• What's memory and how it works, and
particularly, its functional aspects so we can
exploit them to enhance our memory.

24. Overall importance of basic understanding of
how the brain and memory work (2)
Other interesting aspects:
• Plasticity of the adult brain allows for
enhancing cognition through sustained mental
or physical activities even in old age
• Fighting memory elusiveness
• How language influences memory
• Susceptibility of modifying memory by
addition, omission, distortion
• Relativity of meaning
• Collective and Personal nature of meaning
• Experience shapes meaning

25. Gile’s Effort Model of interpreting and
implications of automatic processes
• Interpreting (processing information, manipulating
difficult or unusual concepts or syntax, retrieving items
from memory) requires mental energy available only
in limited supply
• When there is an overload (too much information, too
difficult, technical problems) interpreting deteriorates.
Errors increase.
• Controlling the flow of information and good
technique help to streamline these processes,
minimize error, and reduce consumption of energy
and effort

26. Implications of automatic processes
• Some cognitive tasks can become automatic,
routine. Routines, demand little attention
• Turning into routine some tasks such as:
• Sequential cognitive processing, mnemonic
procedural steps, sequences and patterns,
simultaneous writing and attentive listening
– Prevents the depletion of energy and attention
– Allows allocation of mental energy to listening,
analysis, conversion and production.
– Improves performance, reduces error

27. Discourse analysis applied to cross-cultural
communication
Discourse analysis is the analysis of any extended written,
spoken or gestural piece that has unity, meaning, and
purpose, taking into account pragmatics (language usage in
context) and any significant semiotic event (signs and
symbols).
Discourse analysis includes the assessment of:
• intentional structure-coherence, purpose, mental state
and
• informational structure--content, and how it is packaged
• discourse markers
• paralinguistic features (body language)
• conventions and ways of taking turns
• physical appearance, environment

28. Discourse analysis applied to cross-cultural
communication (cont’d)
• Competent discourse analysis is paramount to
reliable capture and prioritization of
information.
• This is indispensable in CI, especially when
editing is necessary due to excessive input or
limited memory, or because there is a need to
summarize.

29. CI: skills and techniques
Anticipation/Prediction
Recognizing, studying and incorporating frames, patterns, and schemas to
personal experience to organize knowledge, improve accessibility (how
easily a schema comes to mind), and provide a framework for future
understanding, and gain expertise.
Then, use that information to prepare for the encounter by reviewing the
patterns and associated terminology, protocols, and scripts and get ready,
technically and emotionally
OBVIOUS DANGERS HERE:
Unexpected turns, creative usage, STEREOTYPING
Context adjustment (incorporate feedback from what you hear
to re-assess and correct

30. Attentive listening and observation
To be able to process the SL message accurately, the
interpreter must be able to listen effectively,
attending to meaning.
“Attending” is the most alert, deliberate form of
listening.
It is indispensable for SL content processing,
analysis and synthesis, the hallmarks of good
chunking/segmentation

31. Motor skills
Understanding and speaking a language are
two interrelated but distinctive skills
• Locate problematic phonemes and syllabic
combinations
• Practice pronunciation, diction, prosody
• Shadow native speakers

32. Understanding, developing, and strengthening memory
YOU CAN IMPROVE YOUR
MEMORY IF YOU WORK AT IT!
The plasticity of the brain is
amazing!
It has myriads of overall beneficial
side effects;
Makes you smarter!
Fences-off aging!

33. Understanding, developing, and
strengthening memory
OPEN HANDOUT

34. Memory: understanding, developing, and strengthening memory (cont’d)
Working model of memory after Atkinson and Shiffrin, as explained by Dr. Luongo, MD, PhD, Chair,
Department of Neurology, Stanford University (2010)

35. Memory techniques SEE HANDOUT
Keep memory in good shape by making the right
lifestyle choices and by exercising it.
Main procedures:
• Repetition, association, chunking, visualization,
loci/memory palace
• Techniques can/should be combined
• Encourage students to try the techniques to
figure out what works for each of them

36. Note-taking (NT)
HANDOUT

37. Main points
• Our teaching should be geared towards
preparing highly sophisticated multilingual
and cross-cultural interpreters.
• In order to perform effectively, interpreters
need technical expertise and work
environments where good conditions for
meaningful participation and communication
exist.
• This is a joint responsibility. It is necessary to
educate healthcare staff and patients about
the role of the interpreter.

38. Main points
• Frequently, interpreters with a non-standard
set of skills constitute an indispensable
resource. Their needs should be addressed.
When limitations are substantial, interpreters
should explicitly acknowledge them.
• In order to accommodate all levels and meet
all needs, the teaching of CI should pursue a
possibilistic approach, customizing education
and training according to the level and
possibilities of the trainee, to promote core
abilities that guarantee accuracy, and good
basis for future development.

39. Main points
• However, the ability to interpret long
segments is desirable. This requires superior
cognitive and technical competence, including
great memory function and note-taking skills.
• Ultimately, it is our responsibility to help
interpreters develop their technique to reach
their highest potential.

40. Resources and Bibliography (1)
Cirillo and Niemants. Teaching Dialogue Interpreting. Research-based proposals for higher
education. 2017. https://benjamins.com/catalog/btl.138
Damasio, A. Self Comes to Mind: Constructing the Conscious Brain. Chapter 6, An architecture of
memory. Pantheon Books. 2010
Eagleman, D. The Brain: The Story of You, Vintage, 2017
European Masters in Conference Interpreting. On line lectures:
http://www.emcinterpreting.org/?q=node/197 Note-taking in Consecutive Interpreting, by Zsuzsa G.
Láng, PhD, ELTE, from the University of Budapest
Gillies, A. Note-taking for Consecutive Interpreting. A Short Course, 2nd Edition.
https://www.routledge.com/Note-taking-for-Consecutive-Interpreting-A-Short-Course-2nd-Edition/
Gillies-Washbourne/p/book/9781138123205
Gonzalez, R. Vasquez, V and Mikkelson, H. Fundamentals of Court Interpretation. Theory, Policy, and
Practice (Second Edition). Chapter 35: Consecutive Interpretation.
https://redshelf.com/book/507879/fundamentals-of-court-interpretation-507879-9781531002428-roseann-
d-gonzalez-victoria-f-vasquez-and-holly-mikkelson
Luongo, F. Learning and Memory: How it Works and When it Fails. Stanford University (2010).
https://www.youtube.com/watch?v=a_HfSnQqeyY&t=891s

41. Resources and Bibliography (2)
Note-taking examples (2-column page layout): https://m.youtube.com/watch?v=fBMhJDjkS2c;
https://m.youtube.com/watch?v=Ni34Am19XFA
Ohio State University. Department of Linguistics. Language Files. Materials for an
Introduction to Language and Linguistics, 12th Edition. Department of Linguistics. Ohio State
University. 2016. https://ohiostatepress.org/books/titles/9780814252703.html
Robinson, A. Bakhtin Dialogism, Polyphony and Heteroglossia..
https://ceasefiremagazine.co.uk/in-theory-bakhtin-1/
Rozan, J. F. La prise de notes dans l'interpretation consecutive/Note-taking in Consecutive
Interpreting, (1956 Geneve, Georg), 2005 Tertium, Cracow.
Tipton and Furmanek. Dialogue-Interpreting-A-Guide-to-Interpreting-in-Public-Services. 2016
https://www.routledge.com/Dialogue-Interpreting-A-Guide-to-Interpreting-in-Public-
Services-and-the/Tipton-Furmanek/p/book/9781138784628
Valencia, V. Note-taking Manual: A Study Guide for Interpreters and Everyone Who Takes Notes.
https://www.interpretrain.com/products/note-taking-manual

42. THANK YOU VERY MUCH!
Jaime

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