National Medical Interpreter Certification

Yes, we can, and we will, in 2009!

Questions and Answers about the Process toward National Medical Interpreter Certification

IMIA • LLU • PSI
February 10th, 2009


Since the announcement of the National Medical Interpreter Certification developed by the International Medical Interpreter Association (IMIA) and Language Line University (LLU) collaborative, several questions and comments have arisen.

We hope this communication will provide insight into recent developments and openly and candidly address questions that may be on the minds of many.

Contact Jeanette Anders at janders@languageline for future updates.

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Questions regarding the National Certification for Medical Interpreters

Q. When will National Certification become available?

A. Interpreters will be able to formally register for the national medical certification in a matter of weeks. A specific launch date will be published shortly. The goal is to have certification in place this year! If you are interested in receiving information and updates directly, please send an email along with your contact information to Jeanette Anders at janders@languageline.com or to Izabel Arocha at iarocha@imiaweb.org. 

Q: What will the Registration Process entail?

A: The registration process is what interpreters will have to do to demonstrate that they comply with all the prerequisites for certification. After successful registration an applicant is scheduled for the written exams. Once the interpreter passes the written exams, they will be scheduled for the oral exams. After passing these exams, they will be conferred a CMI® (Certified Medical Interpreter) credential and listed in the International Registry of Certified Medical Interpreters. The interpreter will have to comply with post requisite requirements to maintain certification. To register for certification, candidates will go to: http://www.imiaweb.org/certification/register.asp

Q. Who owns the National Certification Process?

A. Medical interpreters own the process.

Q. Is one organization in charge of National Certification?

A. No. This is a public/private partnership which includes at the moment LLU, IMIA and PSI and will include other national testing organizations who want to join the process. All organizations will work collaboratively to make national certification not only a reality but successful in terms of credibility, inclusion, access, transparency, reliability, and validity.

Q. Who will administer the certification exams?

 A. The proctoring organization for the written and oral exams will be PSI, a world renowned testing development company. PSI offers a testing platform at hundreds of locations throughout the country. Please see www.psionline.com

Q. What are the current 22 languages available?

A. The Languages covered currently represent the most frequently requested languages;  Arabic, Bosnian, Cambodian (Khmer), Cantonese, Croatian, Farsi, French, German, Haitian Creole, Hmong, Italian, Japanese, Korean, Mandarin, Polish, Portuguese, Russian , Serbian , Somali, Spanish, Tagalog , and Vietnamese.


Q. What are the plans to expand these languages?

A. We plan to continuously add languages and will increase the number to 30 over the next year. We will seek input from the field through a collaborative process to determine which languages will be added.

Q. Will you consider pricing of training and certification and keep costs in check?

A. Training and pricing will be a significant factor in the development of the certification.  It is likely that due to the pooling of efforts and resources that this private/public collaboration can provide the best options and a more affordable and accessible process for interpreters.

Q. Will interpreters wishing to be certified through this program have to also be a member of IMIA?

A. No. IMIA membership will not be a requirement to undertake the certification exams.

Q. Will only Language Line interpreters be eligible for this certification?

A. No. There are no such restrictions on interpreters.

Q. I am frustrated with how long this process has taken. Isn’t it time someone took charge and finally get a national certification rather than continue the path we’ve been on?

A. There is no question that most interpreters wish certification was already a reality. This was one of the primary reasons for LLU and IMIA to join forces, to economize resources towards a common goal.

Q. Obviously it takes a significant investment of capital and resources to begin a certification process but won’t whoever gets to administer it stand to make a lot of money?

A. The national certification process will actually not be a huge profit maker because the commitment of both organizations towards access is significant, additionally, financial and resource investment is enormous. Actually it will take over a decade for each organization to recover the investment it has made to their individual processes.

Q. What is the benefit of a public/private partnership?

A. We are proud to have developed the first true private/public partnership to benefit the industry. Language Line University (LLU) had first brought the concept to the International Medical Interpreter Association (IMIA), the California Healthcare Interpreting Association (CHIA) and the National Council on Interpreting in Health Care (NCIHC) in early 2007 and has been supportive of a collaborative effort since that time. 

With the addition of PSI this is a multi-disciplinary and a multi-organizational effort. Contrary to other efforts, IMIA, LLU, and PSI do not require its members to surrender all of their intellectual property, patents and copyrights. There are organizations such as LLU that have invested millions and have a fully functional certification instrument already in existence today. There are others that have invested little or nothing in this endeavor. The true benefit is that we can apply the elements that have been validated and immediately build upon that to make certification a reality in 2009 as opposed to years from now.

Q. What authority or credibility will the National Certification Program have?

A, There is no legal requirement for any organization to adopt any specific tests or certification program and as such there is no agency to enforce any legal requirement.  In theory, various states and individual organizations can adopt any process as they see fit.

The only body that has authority to accredit certification programs is the National Organization for Competency Assurance, NOCA. The National Commission for Certifying Agencies (NCCA) was created in 1987 by NOCA to help ensure the health, welfare, and safety of the public through the accreditation of a variety of certification programs/organizations that assess professional competence. Certification programs that receive NCCA Accreditation demonstrate compliance with the NCCA’s Standards for the Accreditation of Certification Programs, which were the first standards for professional certification programs developed by the industry.

Q. How has this effort been transparent?

A. LLU and IMIA have made every effort to inform and provide transparency through general public announcements since March 2007 and through our own newsletters which are openly available and distributed monthly. Both have been transparent, providing frequent updates and postings on its website, via press releases, articles in several publications, and presentations in over thirty conferences just in the past two years, nationally and internationally. In fact there is an entire section dedicated solely to certification on the IMIA website. In addition, information is frequently disseminated to associations to share with their members. Both organizations have been and will continue to be fully transparent. Please see the press room of each organization at http://www.imiaweb.org/press/default.asp and http://www.languageline.com/page/news_room/ respectively. Our process has been open and transparent, and will lead to an inclusive, valid, credible and reliable National Certification Program.

Q. How has this effort been inclusive?

A. This process has included the collaboration of many groups, namely the Global Advisory Council (GAC), the National Medical Interpreter Certification open forums held on May 1, 2007 and 2008, the Consortium of Interpreter Associations (COIA), Forum of Coordinators of Interpreter Services (FOCIS), IMIA and other Conferences Panels, presentations, national surveys, and other venues which have enabled both the IMIA and LLU to receive much feedback over the past several years.

Q. Who is the Global Advisory Council?

The Global Advisory Council was created in May of 2008 as an independent body to advise LLU and the industry on best practices as well as help LLU revise their testing and training program. Additionally, the GAC focuses on conducting research from an international aspect among other activities. This group of stakeholders has been instrumental in moving the national certification process forward. The council has grown to 14 members and include representatives from the U.S., Canada, Taiwan, United Kingdom and China. Please see http://www.allbusiness.com/company-activities-management/operations-quality-control/10515863-1.html  for more information on the GAC and its members.

Q Who is the Consortium of Interpreter Associations?

A. This is another group of stakeholder organizations that has been meeting since November 2006. This group, founded by the IMIA, has been meeting on a monthly basis by conference call and has had three annual meetings at the IMIA Conferences. The next Annual Meeting is scheduled for October 10, 2009, in Boston. The mission of COIA is to provide a forum for the discussion and collaboration on issues inherent to leadership of interpreter associations as a means to promote advancement of interpretation as a profession. The group has discussed certification on many occasions and has served as a natural venue for interpreter associations to provide feedback on the national certification process. Much of the feedback received by these interpreter association leaders has been incorporated into this National Certification for Medical Interpreters.


Q. What is the National Certification of Medical Interpreters Forum?

A. The National Certification of Medical Interpreters Forum held each May 1 is open to the public and there are already many stakeholders supporting this process. This group was launched on March 2007 when Louis Provenzano, President and COO of Language Line Services, invited interpreter leaders to join efforts towards national certification through a Declaration to form the National Medical Interpreter Certification Task Force which stated:

• Form the basis of a nationwide committee dedicated to the movement of a National Medical Interpreter Certification program.
• Discuss and develop the roles and responsibilities for each Task Force member. -Determine first year objectives. -Identify key benchmarks and milestones.
• Key areas of focus and develop a national action plan.

IMIA was one of the representing organizations that signed the declaration.  The May 1 event in 2007 in Boston was a huge success, as was the May 1 event in Portland, Oregon in 2008. Both meetings were attended by over 30 organizations eager for national certification not to be further delayed and charging leaders on this issue to step up and move beyond talks so that by 2009 there would be an actual test in pilot. The third meeting of the NCMIF will take place in Denver on May 1, 2009 and information on this meeting is included at the end of this document.


Q. Will other stakeholders be able to provide input?

A. All industry stakeholders will continue to be invited to provide input and will have opportunity to participate in this program, whether by attending the May 1st Forum meetings, participating in our surveys or emailing directly to the LLU or IMIA websites.



Q. What were the results of the two national surveys on certification?

A. The 2007 and 2008 national surveys produced interesting results and were an important component of this inclusive effort. It has enabled the voice of the interpreter to be heard. Interpreters from across the country participated and expressed their opinions and concerns about national certification. Overwhelmingly, responses urged for stronger leadership and action. To see the results of the two surveys please go to www.languageline.com/llu

Q. Has a Job Analysis been done for this certification process?

A. Actually two job analysis have taken place. In 1995 the IMIA did a job analysis utilizing the DACUM process, which led to the first national standards for medical interpreters, see http://www.imiaweb.org/uploads/pages/102.pdf.  In January 2009 LLU did an updated job analysis with a nationwide survey, see http://www.languageline.com/page/news/125/. Over 1,000 interpreters responded and participated in this survey.


Q. Will interpreters be able to take only one test wherever they are seeking employment, giving consistency to employers about the interpreters they hire?

A. This is the goal and intent. The IMIA and LLU realized that it each had already established multi-state certification programs. Interpreters, providers and patients could benefit now rather than wait years out. As of January 21, 2009, these organizations have agreed to pool their patent-pending processes to form a single instrument to be available to interpreters. While there very well may be other organizations that decide to develop other tests down the road, the reality is that this will be the first full-bodied national certification where none existed until now.

Q. What about access? How about the rural areas? How will interpreters there get certified?

A. Access is very important and LLU and IMIA are very committed to making certification available to the largest number of interpreters possible, regardless of language or location. The plan intends to provide this test in 800 sites across the country with the goal of independently administrating the test by PSI, the largest testing organization in the country, see www.psionline.com. The plan also includes a qualification and screening process for minority languages. ALL interpreters, regardless of language or location, will have access to this National Certification Program.


Q. What I see now is that companies are each coming up with their own certification. So as an independent contractor how many exams will I have to pass in order to work for multiple agencies?

A. According to the report published by The California Endowment on national certification (Certification of Health Care Interpreters in the U.S., Cynthia Roat and The California Endowment, Sept. 2006), the one company which invested in the development of a certification process is Language Line Services. All the other companies offer “interpreter testing” products, which are in another category altogether. The single national certification program to be launched in 2009 will be the only test available that an interpreter will have to pass, regardless of what company employs them.

Q. What is different than what we already have today?

A. Previously we had several tests available from several sources, some validated, some not, to fill the void. What we now have is a single National Medical Interpreter Certification Program available for interpreters in the U.S. This new combined National Certification Program will make a huge difference to interpreters. It will allow them to only be tested once, regardless of employer, but more importantly will give them true recognition to their professional status.


Q. Will National Certification make a difference in terms of reimbursement?

A. Yes. Many reimbursement processes in existence require some form of qualifier, or smaller certification programs that are built usually by entities that are not testing organizations and are not experts in medical interpreting. Now organizations such as IMIA, LLU and others can start advocating for the reimbursement of medical interpreter services on a national federal level. We call on other organizations, and the many interpreter trade and advocacy associations around the country to do the same. Hospitals cannot continue to pay out of pocket for professional services that should be reimbursed by insurance companies.

Q. If we as interpreters need our profession to move forward it seems we need to have a consistent process and not leave it up to each state to create its own process?

A. This collaboration is a unification of what is valid and is in existence today. It is a misconception for individuals to say that there is nothing available today and one needs to be created.  Our unification allows the hope of certification to become a reality now, not in years to come. To avoid inconsistency we believe we must work together to educate, inform and lobby for adoption of a unified certification, qualification and screening process for medical interpreters across the country and in all languages and dialects. State efforts lead to inconsistency, and therefore a certified interpreter in one state may not have the same proficiency as a certified interpreter in another state. It will be unlikely that others would or could develop other certifications given the patents that both IMIA and LLU have on record. Investing resources in a duplicate effort would be wasteful and misguided when the industry needs a collaboration now on education, awareness, training and advocacy.

Q. Will states have separate criteria, or will they all be under one set of standards?

A. The National Certification of Medical Interpreters Program is already in communications with each state’s department of public health with the message that this effort is national and that it is to the interest of the state to endorse a national process rather than trying to reinvent its own process.  This will free up moneys to enforce the standards the state adopts versus actually trying to obtain funds to develop, administer, and monitor interpreters in that state.

Q. What is this National Certification of Medical Interpreters process going to do to guarantee that “rare and hard to find” languages will also be included in any certification process?

A. The other good news of this collaboration is that we already have available in 22 languages – this will increase to 30 in the next year. This National Certification is going to ensure that minority languages are included.  However, this is not a simple issue. A certification process needs to be “legally defensible” and not a process that is driven by “availability” (which is relative), but by a process that is criterion based and driven by “competency”.

The National Certification cannot and should not create different “versions” of the certification test. Likewise, there is no market demand that warrants the research and testing development investment required for the development of a “certification program” in a language for which there might be very few applicants, if any. Therefore, most countries in the world have solved this dilemma by having a “qualification” program which would include the current testing products of national testing companies in the market such as other language service providers (LSP) in addition to LLU in over 100 languages spoken in the US.

The Qualification program will incorporate an independent testing organization to calibrate these tests so that they are “equivalent” in difficulty and are able to render an applicant “qualified” to interpret in the medical setting, bestowing the credential of Qualified Medical Interpreter (QMI). For rarer languages for which there are no testing companies available to test across the country, there will be a screening program by which interpreters will undergo a “portfolio” process so as to be given the credential of a “Screened Medical Interpreter”, or (SMI).

This is already done in Canada and Australia, and other countries which have had certification of interpreters in the community for several years.


Q. In terms of equivalences for hard to find languages, and education levels, what will determine a certification standard? Will certification standards be created to include a process for this level of education?

A. The National Certification of Medical Interpreters Programs has an education prerequisite of completion of a high school diploma or equivalent precisely to respond to the question posed above.

Q. Does this process involve an exclusive agreement between LLU and IMIA or is it inclusive?

A. No. This is an inclusive process that has as a core principle to recognize other organizations patents, copyrights, and intellectual property, related to interpreter testing and certification. That is why LLU and IMIA chose to mutually endorse the work done up until this point independently to coalesce while respecting each organization’s contributions and rights. Likewise the process will be opened to national testing companies that wish to participate in the qualification and screening portions of the certification program.

Q. It is a good idea NOT to reinvent the wheel, but to look at what is out there already and put forward the tools that have already been proven to work. Other countries have existing models, such as the EU’s immigrant friendly hospitals. Right?
   
A. Agreed. The EU hospitals are looking to us for some leadership in an international medical interpreter certification program that allows for the mutual endorsement of other court or other interpreter certifications in some countries. We are already working on this.

Q. We don’t want to see what happened with the state court certification: too difficult for people to pass, and as a result, few available interpreters. How do you intend to address this? 

A. The interpreting profession is a specialized, difficult craft. The role of a certifying body is not to make certification any more difficult than it has to be. However, it is testing the minimal qualifications necessary in order to certify that an individual can accomplish accurate interpretation for safe communication between providers and patients. This is a safety issue. As it was said earlier about for profit companies, the same can be said for minority languages; you can’t set the bar lower in order to sustain a labor base.

Philosophy aside, the concrete measures we have put in place to ensure fairness and appropriateness of the tests include the engagement of professional test development organizations and the adherence to industry standards in professional assessment tools developed by the American Educational Research Association, the American Psychological Association and the National Council on Measurement in Education. The professional assessment development process includes focus groups of subject matter experts and survey of practicing interpreters in the field in order to inform the job analysis. Assessment tools are designed based on this information.

Q. How will sign language interpreters fit into this process as we move forward?

A. The Registry of Interpreters for the Deaf (RID) and the National Association of the Deaf (NAD) certified interpreters have been inquiring about whether or not their certification will be recognized and to what extent. While the IMIA and LLU recognize that the RID certification covers the skills areas, it does not cover the knowledge areas inherent in interpreting in the medical setting. Therefore, we will be asking RID interpreters to pass all the steps (prerequisites, written assessment, and post requisites) but not the oral assessment, for which we endorse the RID certification process. LLU will provide an equivalency certificate to the oral assessment to RID/NAD certified interpreters. We are proactively reaching out to these organizations.

NEXT STEPS!

Q. How do I endorse this process?
 
A. IMIA/LLU/PSI are working to have this "Certified Medical Interpreter" process recognized by all relevant bodies, be they federal/state governments, accrediting bodies, hospital associations, or associations representing the medical interpreter profession or patients that utilize these services.  With that in mind, we welcome any support that will enable us to take this effort forward.  Please submit any endorsements of this collaborative process via a letter on your organization's stationery to the International Medical Interpreters Association (IMIA) at this e-mail address nationalcertification@ircmi.org  or by fax to 1 866 406 IMIA (4642).

Q. What do I tell my interpreters is the first step to get certified?

A. The medical interpreter certification program presents an opportunity for interpreters to be recognized and certified as competent medical interpreters. Sharpen your skills and get ready to participate in the process. If you haven’t taken a medical interpreter training yet, it’s a good time to sign up for one now and familiarize yourselves with interpreting ethics, medical terminology and other areas that are essential for medical interpreting. Sign up for information and alerts and also register to take the test by sending an email to either of the contacts listed at the end of this document.  

Q. Can I take a practice test?

A. There will be pilot testing in April. You can volunteer to take part in the pilot test so you will have a chance to “practice.” If you are interested in taking the pilot test, please contact either of the contacts listed at the end of this document.  

FOR MORE INFORMATION:

Check www.imiaweb.org for more details about its certification program, specifically the FAQ section and www.languageline.com under the Language Line University section.

Direct questions to:

• Jeanette Anders at janders@languageline.com or to
• Izabel Arocha at iarocha@imiaweb.org

We seek your input through collaborative opportunities such as surveys, focus groups and we also invite
you to join us at the 3rd Annual May 1st event on National Medical Interpreter Certification
Program in Denver, Colorado.  Contact Jeanette Anders janders@languageline.com for more information.