Becoming a Certified Language Interpreter - Should I Bother?

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Got a quick question for the SDN EM Crew:

I'm starting residency next month in a state where approx. 30% of the population is Hispanic, with a sizable number of them being non-English-speaking patients that end up in the ED. Since I'm fluent in Spanish, would it be advisable/convenient/advantageous to become a certified medical interpreter? Having gone to med school in Texas, I found being able to translate for residents/attendings really useful, and something that can often expedite discharges/patient education. It's also something that I enjoy doing when the workload allows (patients tend to show a lot of gratitude to have a provider in the room speaking at their same level of language proficiency).

There were, however, instances in which attendings and other hospital staff members were unwilling to have me translate for them as I am not a certified interpreter and only certified interprets can be used for documentation purposes (I think?). So, with this type of scenario in mind, would it be worth it to become a certified medical interpreter? Checking this website, it seems that I already meet all the requirements and simply need to take an oral and written exam.

tl;dr: Entonces, ¿Me certifico o no?

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Does Certification = more $?

If it is worth and extra 5% YES.
If it is NOT worth and extra 5% NO.
 
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I say yes. No one can force you to interpret for them. If your attendings or co-residents try and take advantage, look down at your badge where it says "Doctor" and realize that no one hired you to be an interpreter. Politely offer to give them the number of interpreter services and move on.

Aat least at my institution, it basically allows you to use your language skills in an official capacity and not have to document that you got an interpreter or why you didn't bother getting one.
 
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No.

You will be abused for your skills.

Co-signed.

If your attendings or co-residents try and take advantage, look down at your badge where it says "Doctor" and realize that no one hired you to be an interpreter. Politely offer to give them the number of interpreter services and move on.

Personally, I wouldn't find it so easy to refuse.

It would seem like you are not being a team player.

Also, you can't take your own history if you speak a language fluently? Is there some rule about this? I've always talked to patients in the two other non-English languages I am fluent in. Unfortunately, my Spanish is too rusty to be one of these.

What if you are a native speaker of another language? Still need an interpreter??? Doesn't sound right.
 
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No one can force you to interpret for them. If your attendings or co-residents try and take advantage, look down at your badge where it says "Doctor" and realize that no one hired you to be an interpreter. Politely offer to give them the number of interpreter services and move on.

That's nice in theory. Do you honestly think that's how it will play out when he's a resident and his attendings ask him to come with them to translate for a patient?
 
Got a quick question for the SDN EM Crew:

I'm starting residency next month in a state where approx. 30% of the population is Hispanic, with a sizable number of them being non-English-speaking patients that end up in the ED. Since I'm fluent in Spanish, would it be advisable/convenient/advantageous to become a certified medical interpreter? Having gone to med school in Texas, I found being able to translate for residents/attendings really useful, and something that can often expedite discharges/patient education. It's also something that I enjoy doing when the workload allows (patients tend to show a lot of gratitude to have a provider in the room speaking at their same level of language proficiency).

There were, however, instances in which attendings and other hospital staff members were unwilling to have me translate for them as I am not a certified interpreter and only certified interprets can be used for documentation purposes (I think?). So, with this type of scenario in mind, would it be worth it to become a certified medical interpreter? Checking this website, it seems that I already meet all the requirements and simply need to take an oral and written exam.

tl;dr: Entonces, ¿Me certifico o no?
You should.
For scribes, it says that they cannot interpret anything even if they are fluent
 
So, I've thought about this: I think if you are a fluent speaker, and can fully understand another language, then you can just take the history in that language.

For scribes, it says that they cannot interpret anything even if they are fluent

Being an interpreter is a different story, since there is the in-between step of translating for a third party.
 
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Also, you can't take your own history if you speak a language fluently? Is there some rule about this? I've always talked to patients in the two other non-English languages I am fluent in. Unfortunately, my Spanish is too rusty to be one of these.

What if you are a native speaker of another language? Still need an interpreter??? Doesn't sound right.

I think you can. It is probably better to document that you are fluent in the language. In our EHR there is a field that's auto populated with the patient's language and another one next to it asking if interpreter was used. When I would click no, I would free text "MD speaks X".
 
Also, you can't take your own history if you speak a language fluently? Is there some rule about this? I've always talked to patients in the two other non-English languages I am fluent in. Unfortunately, my Spanish is too rusty to be one of these.

What if you are a native speaker of another language? Still need an interpreter??? Doesn't sound right.
At least at my hospital, it's against policy to take your own history without a certified interpreter, even if you are fluent in the language. We've recently had attendings told they had to stop doing so. We do have some residents who are native Spanish speakers who have gone though the process to become certified as interpreters so they could use their native language with patients.
 
At least at my hospital, it's against policy to take your own history without a certified interpreter, even if you are fluent in the language. We've recently had attendings told they had to stop doing so. We do have some residents who are native Spanish speakers who have gone though the process to become certified as interpreters so they could use their native language with patients.

Wow, that's ridiculous.
 
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That's nice in theory. Do you honestly think that's how it will play out when he's a resident and his attendings ask him to come with them to translate for a patient?

It depends, I suppose. If it is one that they are seeing together, I don't see why not. If it another resident's pt, I don't see how it would be any different than if the attending asked him to do something else, like suture, splint, disimpact, etc. If he had time, he could help, if he didn't he could politely decline. I understand that there is a power dynamic here that is not present on other situations, but it is as big of a deal as you allow it to be.

Of course work environments are different, but none of my attendings would be offended if I declined because I was too busy with my own work. And I am positive my PD would back me up with this decision.
 
At least at my hospital, it's against policy to take your own history without a certified interpreter, even if you are fluent in the language. We've recently had attendings told they had to stop doing so. We do have some residents who are native Spanish speakers who have gone though the process to become certified as interpreters so they could use their native language with patients.
That's insane. I fully understand not having any random MA, student, resident, nurse etc. who happens to speak X language interpret, but not allowing then to do their own job in that language?

At the risk of sounding like the millenial that I am, I almost think that you could make a case that not allowing a physician who was born and raised in Latin America to speak Spanish with Spanish-only patients borders on discrimination.


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That's insane. I fully understand not having any random MA, student, resident, nurse etc. who happens to speak X language interpret, but not allowing then to do their own job in that language?

At the risk of sounding like the millenial that I am, I almost think that you could make a case that not allowing a physician who was born and raised in Latin America to speak Spanish with Spanish-only patients borders on discrimination.


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Or think about the situation of a Chinese-born FMG doctor whose mother tongue is Mandarin with a Chinese patient who only speaks Mandarin. NO, YOU CAN'T TALK MANDARIN. You must speak in English and have an interpreter. Absurd.

As someone who is multi-lingual, I can tell you that interpreters often alter the meaning of what someone says (which is a bit unavoidable), which is the entire reason that an untrained person can't serve as an interpreter. But, to then say that an interpreter is needed even when both parties understand the language, that's absurd.

In any case, this is all theoretical. The reality is that if you speak the person's language you will use it. I sometimes speak another language with a patient even when they speak English in order to build rapport.
 
Although I would hate if such a policy was established at a hospital I work at, I can see one potential argument for it. I have seen physicians overestimate their skill in the medical aspect of a language they otherwise speak fluently.

I am a native Russian speaker, but my medical training was in English. While I speak Russian fluently, I noticed that I was deficient in certain terms that come up often in the medical context but rarely in casual conversation (for example: angina means something entirely different in Russian, there is some complex overlap in words that describe seizures, syncope and rigors, etc). I made a specific effort to brush up on medical Russian and now I feel very comfortable in it. But at the same time I have seen US trained/Russian speaking physicians misinterpret what their patients were saying because they relied on their general fluency in Russian.
 
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Although I would hate if such a policy was established at a hospital I work at, I can see one potential argument for it. I have seen physicians overestimate their skill in the medical aspect of a language they otherwise speak fluently.

I am a native Russian speaker, but my medical training was in English. While I speak Russian fluently, I noticed that I was deficient in certain terms that come up often in the medical context but rarely in casual conversation (for example: angina means something entirely different in Russian, there is some complex overlap in words that describe seizures, syncope and rigors, etc). I made a specific effort to brush up on medical Russian and now I feel very comfortable in it. But at the same time I have seen US trained/Russian speaking physicians misinterpret what their patients were saying because they relied on their general fluency in Russian.
That makes me think of the "Law and Order" episode with the guy who said he didn't speak English, so they needed an interpreter. So, the interpreter is dutifully translating, and the guy says, in English, "Hey, I didn't say that!"
 
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Although I would hate if such a policy was established at a hospital I work at, I can see one potential argument for it. I have seen physicians overestimate their skill in the medical aspect of a language they otherwise speak fluently.

I am a native Russian speaker, but my medical training was in English. While I speak Russian fluently, I noticed that I was deficient in certain terms that come up often in the medical context but rarely in casual conversation (for example: angina means something entirely different in Russian, there is some complex overlap in words that describe seizures, syncope and rigors, etc). I made a specific effort to brush up on medical Russian and now I feel very comfortable in it. But at the same time I have seen US trained/Russian speaking physicians misinterpret what their patients were saying because they relied on their general fluency in Russian.
I was about to use the same example. I might be fluent in the language for a general conversation over dinner, but start asking me to describe medical terms without sounding like a child and I'll struggle. I can barely remember what half of the internal organs are called, much less describe a reasonably complex plan of care. I'd have brushed up on medical terms, but in 3 years of residency I've had exactly one Russian speaking patient, and he was a demented guy with a head bleed and a family that spoke English. If I had another one who didn't have the English speaking family? If it's more complicated than DM or HTN, I might have to bite the bullet and call a translator to listen in and fill in the blanks for me.

Ex: How many people feel comfortable in a language but have no clue how to say the word spleen or thyroid? I certainly don't, and I've been speaking the language since birth.
 
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No. You will expose yourself to legal risk in med mal cases where you aren't the physician of record.
 
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Also, in addition to what everyone else said above, you are horribly underestimating how stressed and time crunched you will find yourself. The last thing you would want is someone asking you to translate, even if it is something you normally enjoy doing.
 
In my very large, urban hospital system, NATIVE speakers of any language across all disciplines are allowed to interview, take hx. Obviously, each practitioner is supposed to know whether they are up to the task, as with many other competencies. And no, there is not an official definition of "native." The records need to state that you interviewed in xxxxxx and you are a native speaker.
 
Co-signed.



Personally, I wouldn't find it so easy to refuse.

It would seem like you are not being a team player.

Also, you can't take your own history if you speak a language fluently? Is there some rule about this? I've always talked to patients in the two other non-English languages I am fluent in. Unfortunately, my Spanish is too rusty to be one of these.

What if you are a native speaker of another language? Still need an interpreter??? Doesn't sound right.
Certain hospitals have policies in place that would not allow a physician who speaks (Example) Spanish, if they have not been evaluated. I am an interpreter and part of the Language Services Dept of a hospital, all staff licensed or unlicensed has to be checked off by our dept in order to communicate in this second language, also to perform their duties in a second language. If they do not pass this examination they are to never communicate in the second language with any patient. This goes from the most highly decorated physician to someone who works the main desk of one of our clinics. I have met people who are fluent and native speakers but can not use this language to communicate with patients because they failed to pass our assessment. It sounds harsh and to some point a bit ridiculous but rules are rules. In return our hospital offers a wide arrange of interpreter services, in person (in house interpreter), contractors (external interpreters), over the phone interpretation (phones in virtually every room of our facilities), and Vireo Remote Interpreters.
 
Got a quick question for the SDN EM Crew:

I'm starting residency next month in a state where approx. 30% of the population is Hispanic, with a sizable number of them being non-English-speaking patients that end up in the ED. Since I'm fluent in Spanish, would it be advisable/convenient/advantageous to become a certified medical interpreter? Having gone to med school in Texas, I found being able to translate for residents/attendings really useful, and something that can often expedite discharges/patient education. It's also something that I enjoy doing when the workload allows (patients tend to show a lot of gratitude to have a provider in the room speaking at their same level of language proficiency).

There were, however, instances in which attendings and other hospital staff members were unwilling to have me translate for them as I am not a certified interpreter and only certified interprets can be used for documentation purposes (I think?). So, with this type of scenario in mind, would it be worth it to become a certified medical interpreter? Checking this website, it seems that I already meet all the requirements and simply need to take an oral and written exam.

tl;dr: Entonces, ¿Me certifico o no?
It is all up to you. If you feel this is something you really want to do and want to take on then go for it.

But keep this in mind:
- in order to be certified you first have to complete a 40 hours training course which runs about $400-$700 depending on where you go, also some courses are like a semester long, others are intensive and have to be complete in 1 week (a full 7 days of mandatory classes).

-You can substitute your 40 hours training for 3 credit hours of a college level course in medical interpreting and translation.

-After this you are now eligible to take the test with any of the certificating agencies such as the one you posted, there are a few others. You have to be aware that in some of these tests you will have to do translation, site translation, consecutive interpretation, and in some cases simultaneous interpretation (like the interpreters at the UN who interpret in real time). The test is also another 200-300 $bucks$.

whatever you decide, you have already done a great service to those people who had a language barrier.
best of luck.
 
Certain hospitals have policies in place that would not allow a physician who speaks (Example) Spanish, if they have not been evaluated. I am an interpreter and part of the Language Services Dept of a hospital, all staff licensed or unlicensed has to be checked off by our dept in order to communicate in this second language, also to perform their duties in a second language. If they do not pass this examination they are to never communicate in the second language with any patient. This goes from the most highly decorated physician to someone who works the main desk of one of our clinics. I have met people who are fluent and native speakers but can not use this language to communicate with patients because they failed to pass our assessment. It sounds harsh and to some point a bit ridiculous but rules are rules. In return our hospital offers a wide arrange of interpreter services, in person (in house interpreter), contractors (external interpreters), over the phone interpretation (phones in virtually every room of our facilities), and Vireo Remote Interpreters.
This is so bizarre. We've all had experiences with physicians who clearly have English as their second, third, or Nth language. All of us have had patients complain because they couldn't understand their doctor because of "insert country" dialect. And no, not all of them are racist. But your hospitals standards for spanish are clearly tougher than the standards for English that so many others have passed. Does this not seem a bit strange to anyone else?
 
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This is so bizarre. We've all had experiences with physicians who clearly have English as their second, third, or Nth language. All of us have had patients complain because they couldn't understand their doctor because of "insert country" dialect. And no, not all of them are racist. But your hospitals standards for spanish are clearly tougher than the standards for English that so many others have passed. Does this not seem a bit strange to anyone else?
And its not just spanish, we delegate all the other languages to a contracting company who checks people off for us. Trust me we have had plenty of professionals throw a fit in our office but thats how it goes. Do not get me wrong, many physicians do pass the test, even some who are not native speaker. The test is not just simple hello! where does it hurt? but medical terminology that they will use in their practice. Some doctors are just waiting to get cleared off by us, it takes a while, in the mean time they must use an interpreter. And this also does not help the interpreters, well especially the newbies. Interpreting is an art, but one can easily lose their train of thought or lose control of the conversation (interpreter must control the conversation) if they are nervous. We have some doctors who can actually understand everything the interpreter is saying, some have actually been checked off but still rather use an interpreter for difficult conversations. And these docs can dismiss the interpreter if they feel they are not performing their job properly. It is a very high standard, even I was surprised coming from a hospital who never even used a language phone line.
 
And its not just spanish, we delegate all the other languages to a contracting company who checks people off for us. Trust me we have had plenty of professionals throw a fit in our office but thats how it goes. Do not get me wrong, many physicians do pass the test, even some who are not native speaker. The test is not just simple hello! where does it hurt? but medical terminology that they will use in their practice. Some doctors are just waiting to get cleared off by us, it takes a while, in the mean time they must use an interpreter. And this also does not help the interpreters, well especially the newbies. Interpreting is an art, but one can easily lose their train of thought or lose control of the conversation (interpreter must control the conversation) if they are nervous. We have some doctors who can actually understand everything the interpreter is saying, some have actually been checked off but still rather use an interpreter for difficult conversations. And these docs can dismiss the interpreter if they feel they are not performing their job properly. It is a very high standard, even I was surprised coming from a hospital who never even used a language phone line.
My question was, do you do this for people who don't speak English well?
 
My question was, do you do this for people who don't speak English well?
Got it! this is something I have wondered myself. From what I have heard people who come to practice in the US have to go through a process in order to prove they can communicate in english. This would fall outside of our "jurisdiction" because english proficiency is regulated by schools or by the agencies international grads/professionals go through in order to be able to work in the US. Your statement is very true, many people do practice in the US without being proficient in the english language which is dangerous.
 
Got it! this is something I have wondered myself. From what I have heard people who come to practice in the US have to go through a process in order to prove they can communicate in english. This would fall outside of our "jurisdiction" because english proficiency is regulated by schools or by the agencies international grads/professionals go through in order to be able to work in the US. Your statement is very true, many people do practice in the US without being proficient in the english language which is dangerous.
That's the TOEFL - Test Of English as a Foreign Language. It's a written exam. There's no spoken component.
 
I say yes. No one can force you to interpret for them. If your attendings or co-residents try and take advantage, look down at your badge where it says "Doctor" and realize that no one hired you to be an interpreter. Politely offer to give them the number of interpreter services and move on.

Aat least at my institution, it basically allows you to use your language skills in an official capacity and not have to document that you got an interpreter or why you didn't bother getting one.

In residency Attendings can absolutely pressure you to be there interpreter. In residency refusing to do something even though it's not your job. You can easily be labeled as "not a team player," "difficult" and "doesn't put the patient first." If your attendings want you to do something you are expected to do it. Such is residency.
 
In residency Attendings can absolutely pressure you to be there interpreter. In residency refusing to do something even though it's not your job. You can easily be labeled as "not a team player," "difficult" and "doesn't put the patient first." If your attendings want you to do something you are expected to do it. Such is residency.
Pretty sure mine didn't say transporter, phlebotomist, "professional IV starter", penultimate foley placer, or any of those other things that I did in residency that I no longer do either.
 
In residency Attendings can absolutely pressure you to be there interpreter. In residency refusing to do something even though it's not your job. You can easily be labeled as "not a team player," "difficult" and "doesn't put the patient first." If your attendings want you to do something you are expected to do it. Such is residency.

Not where I am at and not if it were me. Saying, "Such is residency" is a cop out. It's one thing to wipe someone's butt even though "that isn't your job" as a physician - that is clearly an example of putting the patient first and not being a tool while you make them wait for a nurse or tech to be available. It is altogether different if they're asking you to do something that runs contrary to institutional policy. If it isn't a big deal, then of course you should do it. But if it were to run contrary to the rules of the institution, I don't see the point.
 
Don't do it. It's extra work to get the certification. It's extra work for you to translate for someone when you're super busy.

By all means, offer to translate for people if you want to.

How will it ever get you in trouble if you speak to patients in spanish but are not "officially certified"? If you're sued for a bad outcome, no jury is going to rule against you because you're a native speaker but not "certified". They're probably less likely to sue you because you speak their language.
 
This is so bizarre. We've all had experiences with physicians who clearly have English as their second, third, or Nth language. All of us have had patients complain because they couldn't understand their doctor because of "insert country" dialect. And no, not all of them are racist. But your hospitals standards for spanish are clearly tougher than the standards for English that so many others have passed. Does this not seem a bit strange to anyone else?

It might be that these policies were created by physicians, rather than the administration. I have rotated through multiple hospitals where translators, though technically available, were so scarce that physicians were actually pushed to translate far beyond their comfort zone. A policy that no one can translate without a certification might have been negotiated by the hospitalist group (or whatever) to force the admin to invest in translation services.

Following that logic, it may be that the policy isn't in place for FMGs because the physicians who negotiated the translator policy had no incentive to lobby for that.
 
In my program, the residents who are certified get an extra like a decent hourly bonus just for being certified, regardless of whether or not they use their skills on that shift. I can't remember how much it is, but enough those who can pass the test generally do it.
 
JCAHO cares.
No they don't.
From “New” Joint Commission Standards for Health Care Interpreting: Myths and Truths | CyraCom
Myth #3: The Joint Commission requires interpreters to be certified.

Fact: The Joint Commission does NOT require that hospitals use certified interpreters. The standards were clarified to set the expectation that interpreters are qualified and competent to perform the service of interpretation. Qualifications and competencies can be met in a variety of ways (not simply through certification), and The Joint Commission references several options for meeting the requirements for qualified interpreters, such as:

  • Language proficiency testing
  • Training in the practice of interpreting
  • Interpreting experience in a health care setting
  • Knowledge of medical terminology

I swear, the amount of false TJC standards out there is greater than the actual number of real ones.
 
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No they don't.
From “New” Joint Commission Standards for Health Care Interpreting: Myths and Truths | CyraCom


I swear, the amount of false TJC standards out there is greater than the actual number of real ones.
My hospital was just cited for exactly this, so I'm positive that as of this past month they do care. (That is, you do need to have some process for proving proficiency/competency at using a non-English language. Not necessarily certification, but more than claiming to be a native speaker of that language.)
 
Which isn't what you said. So yes, competency is required. But they don't have to be certified, which was not only mentioned in the post you quoted, it was in quotation marks.
 
Which isn't what you said. So yes, competency is required. But they don't have to be certified, which was not only mentioned in the post you quoted, it was in quotation marks.
Quotation marks mean it's not to be taken literally, like the word new in the title of the blog post you linked to. So... it is what I said.
 
At least at my hospital, it's against policy to take your own history without a certified interpreter, even if you are fluent in the language. We've recently had attendings told they had to stop doing so. We do have some residents who are native Spanish speakers who have gone though the process to become certified as interpreters so they could use their native language with patients.

Certain hospitals have policies in place that would not allow a physician who speaks (Example) Spanish, if they have not been evaluated. I am an interpreter and part of the Language Services Dept of a hospital, all staff licensed or unlicensed has to be checked off by our dept in order to communicate in this second language, also to perform their duties in a second language. If they do not pass this examination they are to never communicate in the second language with any patient. This goes from the most highly decorated physician to someone who works the main desk of one of our clinics. I have met people who are fluent and native speakers but can not use this language to communicate with patients because they failed to pass our assessment. It sounds harsh and to some point a bit ridiculous but rules are rules. In return our hospital offers a wide arrange of interpreter services, in person (in house interpreter), contractors (external interpreters), over the phone interpretation (phones in virtually every room of our facilities), and Vireo Remote Interpreters.

Our hospital has the same rule, but I know of a medical student who passed the test with the interpreters to be able to speak to patients in the foreign language, but not translate for others; he's not a native speaker but pretty fluent with lots of relevant classes and foreign travel, so I'm not really sure how hard the test is
 
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Got a quick question for the SDN EM Crew:

I'm starting residency next month in a state where approx. 30% of the population is Hispanic, with a sizable number of them being non-English-speaking patients that end up in the ED. Since I'm fluent in Spanish, would it be advisable/convenient/advantageous to become a certified medical interpreter? Having gone to med school in Texas, I found being able to translate for residents/attendings really useful, and something that can often expedite discharges/patient education. It's also something that I enjoy doing when the workload allows (patients tend to show a lot of gratitude to have a provider in the room speaking at their same level of language proficiency).

There were, however, instances in which attendings and other hospital staff members were unwilling to have me translate for them as I am not a certified interpreter and only certified interprets can be used for documentation purposes (I think?). So, with this type of scenario in mind, would it be worth it to become a certified medical interpreter? Checking this website, it seems that I already meet all the requirements and simply need to take an oral and written exam.

tl;dr: Entonces, ¿Me certifico o no?

Don't waste the time getting certified unless you want to work as an interpreter. If you do, sure as hell don't tell anyone. The last thing you want is to be taken away from your own work, to be someone else's 1-800-language-line.


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Don't waste the time getting certified unless you want to work as an interpreter. If you do, sure as hell don't tell anyone. The last thing you want is to be taken away from your own work, to be someone else's 1-800-language-line.

It's literally the worst. I'm a registered Green Party liberal, first generation American of immigrant parents. But, when I have non-English speaking patients without family there to translate, I turn into Donald Trump. Even listening to the language line is torture.
 
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Our hospital has the same rule, but I know of a medical student who passed the test with the interpreters to be able to speak to patients in the foreign language, but not translate for others; he's not a native speaker but pretty fluent with lots of relevant classes and foreign travel, so I'm not really sure how hard the test is
Every institution has their own way of evaluating proficiency of a secondary language. In our hospital, there is a computer based exam developed by the dept. and a follow up interview. And you are right, this is only for someone to fulfill their work duties in another language other than English and not interpret. I do not know how hard our test is, but I do know that there are some people that do fail it. Also, in our institution, the tests are personalized for the department in which the provider works. So of course a person who works in the ER will have a differetn test than someone who works in our Genetics Clinic or Maternal Fetal Med. Clinic.
 
It's literally the worst. I'm a registered Green Party liberal, first generation American of immigrant parents. But, when I have non-English speaking patients without family there to translate, I turn into Donald Trump. Even listening to the language line is torture.
I did Over The Phone Interpreting for a whole 2 months, worst experience ever. Ended up in the ER a couple of times and needed bi-monthly visits with my neurologists because the OPI environment triggered my migraines.
 
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Sorry posted on wrong thread. Please delete
 
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