Should healthcare interpreters in the U.S. be concerned?

April 9, 2018 § 30 Comments

Dear colleagues:

For several weeks I have been contacted by colleagues who provide their services as interpreters in the health sector of the United States. They have all expressed the same sense of confusion, anguish, anger, and uncertainty many of us have noticed in social media and professional forums on line.

This environment started after the decision by the National Board of Certification for Medical Interpreters (NBCMI) to not renew the accreditation of their Spanish language interpreter certification program by the National Commission for Certifying Agencies (NCCA) effective January 1, 2018, and it ballooned after the video of a speech during the California Healthcare Interpreters Association (CHIA) annual conference in Irvine, California in early March was uploaded to the web and watched by interpreters all over the world. Apparently, most interpreters were upset about four things: (1) The decision to terminate the NCCA accreditation; (2) That many learned of this decision by the NBCMI at this conference; (3) That the NBCMI authorities did not informed those candidates scheduled to take the certification exam that the exam they would be taking in 2018, although the same test taken by interpreters certified in the past, was being offered after the Board had quit their accreditation of their Spanish language interpreter certification program by the NCCA; and (4) That many did not like NBCMI’s decision to change the wording on their website portal to show in a casual way, hidden in the text, or at least not highlighted, that they had not renewed said accreditation, and the unofficial explanations and assurances by apparently some people associated with NBCMI that such change would not impact their certification.

I am a veteran of the profession, but like many of you, even though I have interpreted my share of medical events as a conference interpreter, I have never been a healthcare interpreter. Let me explain the healthcare interpreting scenario in the United States.

Healthcare interpreting is an essential part of the health sector in modern society, but despite this and the need to elevate this service to a professional level, healthcare interpreting had a later start than other community-based fields of interpreting like court interpreting.

The United States was no exception, until finally, a few years ago, two organizations took the lead towards the professionalization of the field. Embracing the basic principles and values of the certification program the National Council on Interpreting in Health Care (NCIHC) had written about, the Certification Commission on Healthcare Interpreters (CCHI) and the National Board of Certification for Medical Interpreters developed and implemented two interpreter certification programs. Both understood the overwhelming need to certify interpreters in the most widely spoken foreign languages in the United States, and they both developed a program for interpreter certification in Spanish (there are other languages now. Please visit their websites to learn about the languages covered by each program).

Unlike court interpreting, which developed certification programs sanctioned by the government at its different levels (federal, state, and initially sometimes local), the healthcare sector had no government authority sanctioning the validity of its certifications; and even though this brought healthcare interpreters a professional freedom enjoyed by other professionals like physicians and lawyers, and denied to court interpreters who have no control over the administration of their certification exams, it also created an uncertainty about the validity of their interpreter certification programs.

Because in a private sector-oriented society like the U.S., the situation healthcare interpreter certification programs were facing is not the exception, but the rule, there is a reputable trustworthy entity that solves this problem: The Institute for Credentialing Excellence (ICE).

The Institute for Credentialing Excellence, or ICE, is a professional membership association that provides education, networking, and other resources for organizations and individuals who work in and serve the credentialing industry. ICE is a leading developer of standards for certification and certificate programs and it is both, a provider of and a clearinghouse for information on trends in certification, test development and delivery, assessment-based certificate programs, and other information relevant to the credentialing community. ICE created the National Commission for Certifying Agencies (NCCA) in 1987.

The NCAA’s Standards for the Accreditation of Certification Programs, which were created in the mid-1970s, were the first standards developed by the credentialing industry for professional certification programs. The NCCA Standards were developed to help ensure the health, welfare, and safety of the public. They highlight the essential elements of a high-quality program.

The NCCA standards follow The Standards for Educational and Psychological Testing (AERA, APA, & NCME, 1999) and are applicable to all professions and industries. Certification organizations that submit their programs for accreditation are evaluated based on the process and products and not the content; therefore, the Standards are applicable to all professions and industries. Program content validity is demonstrated with a comprehensive job analysis conducted and analyzed by experts, with data gathered from stakeholders in the occupation or industry.

NCCA accredited programs certify individuals in a wide range of professions and occupations including nurses, automotive professionals, respiratory therapists, counselors, emergency technicians, crane operators and more. To date, NCCA has accredited approximately 330 programs from over 130 organizations.

Accreditation for professional or personnel certification programs provides impartial, third-party validation that your program has met recognized national and international credentialing industry standards for development, implementation, and maintenance of certification programs. This solved the problem for both programs and two certification programs were born:

The Certified Healthcare Interpreter credential (CHI) developed by the Certification Commission on Healthcare Interpreters (CCHI) that offers a certification exam in Spanish, Arabic and Mandarin in 2 steps: First, a core exam consisting of 100 multiple-choice questions, to be answered in English, on medical terminology, healthcare scenarios and ethics; and to those who pass the core exam, an interpreting exam that tests the candidate’s skill on sight and written translation, and simultaneous and consecutive interpreting.

The Medical Interpreter credential (CMI) developed by the National Board of Certification for Medical Interpreters (NBCMI) that offers a certification exam in Spanish, Russian, Mandarin, Cantonese, Korean, and Vietnamese to those who pass (with a score of 70 percent, 80 percent in Mandarin) an interpreting exam that tests skills on sight translation and consecutive interpreting (no simultaneous interpreting or written translation).

Besides competing for interpreter candidates in the same market, both programs needed to convince healthcare providers, insurance companies, patients, and attorneys, that their credentials were reliable, trustworthy, and standard. They started an intensive and successful education campaign that used the NCCA accreditation as one of its most valuable resources.

Even today, CCHI’s website proclaims the validity of its program and skill of its certified healthcare interpreters:

“…Just as healthcare interpreters work hard to get credentialed as “certified healthcare interpreters,” certification programs can also “get certified!” The process is called “accreditation” and, today, it is administered by the National Commission for Certifying Agencies (NCCA), the accreditation arm of the Institute for Credentialing Excellence (ICE). Accreditation is the process by which a credentialing or educational program is evaluated against defined standards by a third party and is awarded recognition when found in compliance with these standards. It’s more than just a voluntary membership in an association. Accreditation (and renewal of accreditation) involves a rigorous process that ensures the quality of examinations and certification offered by organizations like CCHI. In fact, NCCA accredited programs certify individuals in a wide range of professions and occupations, including nurses, pharmacists, counselors, EMTs, HR professionals, defense security specialists, and more. CCHI is proud to represent the healthcare interpreter profession as equal among other allied health professions…today, CCHI is proud to offer the only nationally accredited certifications in the interpreting industry. NCCA’s accreditation validates all aspects of CCHI’s certification programs and CCHI as a certifying body…”

To this day NCCA accreditation continues to be a crucial element of the CCHI program.

Apparently, the National Board of Certification for Medical Interpreters (NBCMI) disagrees with this principle, and even though their website lacks detailed explanations or reasons for the decision not to renew accreditation; some colleagues claim they have unofficially argued that continuing NCCA accreditation is unnecessary because their program is now well-established, the accreditation only covered the Spanish certification program, and their exams have not changed from the ones offered during the accreditation era. Several interpreters have indicated that NBCMI claims that a renewal was too expensive; that they had spent fifty thousand dollars on the initial accreditation, and that their Board had directed those financial resources to the development and administration of certification exams in other languages; activity that would be more profitable.

On its official website, NBCMI addresses its decision to end NCCA accreditation:

“…Prior to 2018, the Spanish CMI certificate was subjected to an additional level of NCCA accreditation, but while the National Board remains a member of the Institute of Credentialing Excellence (ICE), each of the National Board programs have been standardized to ensure the CMI certification in each offered language best meets or exceeds nationally accepted standards, including transparency, inclusion, and access…”

It mentions they continue to be members of the Institute for Credentialing Excellence (ICE), the parent entity of NCCA, and adds a self-serving statement where they praise their own CMI certification. They emphasize their continued ICE membership adding this statement to their official website:

“…As a proud member of ICE, we stay informed on best practices in developing and administering quality certification [certificate] programs so that we may better serve you…” 

This could be a simple statement of facts, but unfortunately, it could also be misunderstood by some who may think that continued ICE membership affects their CMI program after January 1, 2018.

ICE clearly tells us what membership means:

“…An organization may join ICE at any time whether or not it has any programs accredited by the National Commission for Certifying Agencies (NCCA).  Membership in ICE does not mean that an organization or any of its credentialing programs have been accredited, approved, or otherwise endorsed by ICE…”

Membership in ICE does not mean that an organization or any of its credentialing programs have been accredited, approved, or otherwise endorsed by ICE. We can see this means more than no more accreditation. According to ICE itself, membership means no approval or any other endorsements.

As I write this post, my only goal is for NBCMI to published a written detailed explanation of the reasons they abandoned the NCCA accreditation, the potential consequences this decision can bring to certified medical interpreters, and why candidates scheduled to take the exam in 2018 were not informed of this important change so they could decide to either pursue the CMI certification or perhaps take the CHI exam instead. Spanish language CMI interpreters have a right to know why a certification exam after the NCCA accreditation ended has the same cost as the one offered when the accreditation was in place. How does a business decision to add more languages to the certification program benefit the Spanish language CMIs whose credentialing program lost NCCA accreditation? So far, NBCMI has limited its answer to a statement posted on their newsletter that repeats what they previously said about the validity of the exam and CMI certification, but the explanation of the reasons to discontinue the accreditation have not been disclosed. Dismissing social media as myths and misinformation does not answer the questions so many interpreters want answered.

Some changes have already been impacting those who hold a CMI certification: Some institutions stopped reimbursing the certification exam fee to certification candidates taking the exam in 2018. It has been reported that some clients are now preferring those interpreters holding a CHI certification over a CMI credential; and, a good possibility is that in the future, CMI credentials will be questioned and tested by attorneys who will cross-examine NBCMI certified medical interpreters in the presence of a jury during a medical malpractice trial.

NBCMI needs to explain why NCCA accreditation went from being something they were proud of a few years ago to something no longer needed:

“…The National Board of Certification for Medical Interpreters (NBCMI) is pleased to announce that its Certified Medical Interpreter (CMI) program has been accredited by the National Commission for Certifying Agencies (NCCA), thus joining an elite group of certifying bodies dedicated to public protection and excellence in certification… NCCA accreditation was one of the objectives the National Board set for itself at the very outset…” (NBCMI press release dated January 18, 2013 at Miami Beach Convention Center)

These are valid questions we hope NBCMI will officially address, and they are all legitimate reasons in a free market economy like the United States’ for any interpreter working on the healthcare sector to think very carefully about which one of the two certifications she or he should hold. Let’s hope that at the end of all the confusion and uncertainty the answer is either one of the certifications, but as of today, we do not know if that will be the case, even if both certifications were equally recognized, because one continues to have an accredited certification program and the other one does not. Many of our colleagues would like to know the reason for the changes that both, NBCMI and its parent organization IMIA experienced just now: a new president for NBCMI (we wish her well) and the resignation of IMIA’s president-elect before he officially took office. Interpreters want to know if these changes at this confusing times are related to the decision to end accreditation, or it is just a coincidence.

I now invite you to share your thoughts on this issue, and please, do not write personal attacks, and unless you are officially commenting on behalf of NBCMI, please abstain from sending surrogate comments defending the Board.

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§ 30 Responses to Should healthcare interpreters in the U.S. be concerned?

  • Hi Tony. I join you in your well wishes for the new NBCMI president. I’m certified through CCHI, and I train healthcare interpreters. I don’t represent either organization. I haven’t participated in this conversation in social media, but I certainly have watched it unfold. I was one of those interpreters who saw the video from the CHIA conference, and what struck me was leadership’s tactic of attacking other certification exams for interpreters and translators, claiming that if these exams are not accredited by the NCCA, then why was it a problem that the NBCMI is no longer accredited? There may be disagreements and room for debate surrounding the NBCMI’s messaging, their reasoning, and how they’ve handled the situation so far, but to me, going after the validity of certification exams of our colleagues working in other settings crosses a line. It only creates a further divide among interpreters working in different settings, and it doesn’t do anything to answer the questions that you’ve posed. I hope there will be a resolution, and some lessons learned.

    • Linda Joyce says:

      Thank you Liz. We need to keep our eyes on the medical interpreters and advancing the field, and collaboration and civil discussion should be the norm. Both certification programs are valid, and hopefully one day we can unite, like the ASL interpreter certification programs did.

      • EMartinez says:

        “As I write this post, my only goal is for NBCMI to publish a written detailed explanation of the reasons they abandoned the NCCA accreditation, the potential consequences this decision can bring to certified medical interpreters, and why candidates scheduled to take the exam in 2018 were not informed of this important change so they could decide to either pursue the CMI certification or perhaps take the CHI exam instead. ”

        “NBCMI has limited its answer to a statement posted on their newsletter that repeats what they previously said about the validity of the exam and CMI certification, but the explanation of the reasons to discontinue the accreditation have not been disclosed. Dismissing social media as myths and misinformation does not answer the questions so many interpreters want answered.”

        quotes from the article

  • Linda Joyce says:

    The National Board exams are validated by a third party. Certification exams do not have to be accredited, for example the ATA exams are not accredited, but certification exams must be validated.

    ALL of the National Board exams, in all six languages, are validated.
    The reports on the validation process by a third party, PSI, are on the National Board website under About Us and then Reports: https://nbcmi.memberclicks.net/reports-and-publications/

    They include the “Development and Validation of Oral and Written Examinations for Medical Interpreter Certification: Spanish” and “Development and Validation of Oral Examinations for Medical Interpreter Certification: Mandarin, Russian, Cantonese, Korean, and Vietnamese.”

    • Thanks for the link, Linda. This report is from 2010. I think that as per NCCA regulation, the National Board needs to submit quarterly reports regarding the statistical values of each test item. It is mandated by their policy manual.

      Additionally, I believe PSI only looked at statistical data in 2010, but the NCCA also looks at other markers of the testing entity such as governance, etc. They accredit the program, not just the tests.

      • Dr. Souza says:

        The National Board had to submit Annual reports, not quarterly reports, and I know personally they have done so up until this point Carlos. PSI has looked at statistical data periodically and not only in 2010. Your text implies that it is quarterly and that it hasn’t done so, which is false.

  • Thank you Tony. Thank you for presenting this issue under your blog platform in such a well informed and professional way. I am worried like many. I recently renewed my CMI credentials and like all who do, rely on the board’s integrity and professionalism. It is required by my current employer and was by my previous one too. Many of us know that both certifications are needed in our profession. I just wish the ongoing differences between the two would vanish. The NBCMI did publish a note on this debunking myths:
    http://www.certifiedmedicalinterpreters.org/newsletter?ver=201804#section-1
    Maybe a third global entity managing global certification might do better, no feuds, maybe the ATA? I hope this issue gets resolved soon. Gracias.

    • EMartinez says:

      @LizetteGOtranslations

      “NBCMI has limited its answer to a statement posted on their newsletter that repeats what they previously said about the validity of the exam and CMI certification, but the explanation of the reasons to discontinue the accreditation have not been disclosed. Dismissing social media as myths and misinformation does not answer the questions so many interpreters want answered.”

      quote from the article in regards to the NBCMI newsletter on debuking myths

    • Dr. Souza says:

      Lizette, accreditation was required? I’ve never heard of an employer requiring accreditation. We asked the ATA to join the coalition back in the day, but it was not feasible. One entity has to own the process, and that is why we ended up with two, because IMIA was created to do this and NCIHC emerged later with the same purpose, and both are leading organizations in the field. I’m a CMI and I am not worried.

      • You might be correct, Izabel, but I am not sure it is yearly. It would help if we had officers of the National Board come and answer this one. I know you know about accreditation because you are one of the co-founders of the National Board, but let them answer.

        One issue that also could have caused the National Board not to be compliant with NCCA standards is their autonomy. When the news broke on social media, it prompted an unscheduled session at the CHIA conference to address interpreters. Mohammed Anwar showed up and spoke on behalf of the National Board, but he is not part of them, he was the IMIA President-Elect.

        To my opinion, the session could have gone better without his input. He came out very defensive and implying that Carlos Pava shouldn’t be asking questions because he is not a CMI. Mohammad is not a CMI, either, nor is he on the National Board, so he had no right to be there and speak, either.

  • EMartinez says:

    There is NO need for two competing certifying bodies in our profession. All of this is just causing a divide. Is sad to see both certifying bodies taking subliminal shots at each other, as if they were corporate products marketing their brand for more customer acquisitions.

    As health care interpreters, we should push for a merge/unification of both certifying bodies, just like ASL interpreters did.

    • EMartinez, I agree with you. One is enough. It costs $300 to recertify. CCHI is offering CMIs a discount to get certified through them. Pay only $300 for both written and oral exams. Offer is good only this year. Play it safe! Get certified through CCHI.

    • SGomez says:

      EMartinez, I agree. We should have ONE certifying body. Merging makes the most sense, just like ASL.

    • Dr. Souza says:

      I couldn’t agree more, but how do we go about doing that? Pitting one against the other does the opposite. Let’s work together and press for unification of entities. No jobs have been lost, accreditation does not involve the content or validity the exams (that is done by psychometricians, not NCCA), nobody requires accreditation.

      • SGomez says:

        Excellent point Dr Souza!

      • Julio Jimenez says:

        Honestly, I don’t think this will happen. What could happen is that NBCMI-certified interpreters move to get certified by CCHI. If enough interpreters do this (even if they feel forced to do it), then this could be the opportunity to have only one relevant body for all interpreters. This would solve the problem of the divisions. Frankly NBCMI has left CCHI with the upper hand.

      • EMartinez says:

        I believe NBCMI will become obsolete, once they lose the majority of their CMIs for CCHI. Even if NBCMI remains perfectly valid, the “perceived” notion will continue to tarnish NBCMI’s credibility by many. Really bad move by NBCMI.

        NBCMI should address the optimal questions posed by Mr. Rosado on this blog.

  • To read the NCCA standards, please go to this website: http://knappinternational.com/assets/uploads/pages/NCCA%20standards(1).pdf

    To read their policy manual, go to this website: file:///C:/Users/CaGarcia/Downloads/NCCA%20policies%206.16.16.pdf

  • Kamara Licea says:

    I’m a CMI and a CHI and not affected by this decision in that I haven’t lost a job because of not being certified. I would actually be relieved if there is only one certification, like CA court. It’s a hassle to recertify with both. I feel the pain of those who have lost a job because of this. I’m not even sure who cares about certification other than DWC. When I was freelancing, they were the ones who cared about certification. Those who have been told that they can’t be used because of the CMI status should contact DWC because the CMI is still valid. (I saw a different post about this, I’ll see if I can find it again.) Who else even requires certification?

    I think that the biggest issue is not with NBCMI but with a general lack of awareness and respect for healthcare interpreters. Interpreters can be proud of their credential, but until others in healthcare (I.e. those who hire interpreters) recognize that it’s a specialized skill and know what getting a credential means then whether or not an agency test is accredited should be the least of our worries.

    Meanwhile, if you’re a CMI, start on your CHI certification.

    • Dr. Souza says:

      Do you know of someone who has lost their job because of NBCMI losing their accreditation? I believe that did not happen, but if it is true, please tell me who as we can bring this information to NBCMI to reconsider.

  • Yaisel says:

    Thank you very much for addressing this concern. As a candidate getting ready to take the last exam to become a CHI interpreter, I have been through the hard work it takes to become certified. I feel fortunate that I chose CCHI and not NBCMI. However, I can’t help but sympathize with the CMI interpreters. I strongly agree that NBCMI owes these interpreters not only an explanation but an apology for how they have been disregarded.

    • Dr. Souza says:

      I’m a CMI and I don’t feel disregarded or disrespected. I have no issue with their decision other than now it has become a big deal so they should reconsider. Their process hasn’t changed.

  • Dana says:

    Dear Tony & colleagues,

    I would like your opinion and guidance for Medical interpreters considering the certification exams offered by NBCMI for languages other than Spanish (Mandarin, Cantonese, Vietnamese, Russian…). Do you think that nothing changes for them since their exams were not accredited by the NCCA even before this debacle?
    Consequently, would you advise a MANDARIN medical interpreter looking to get nationally certified to look at both credentials CMI (offered by the National Biard and CHI (offered by CCHI) as being the same and equally valid? Or would you advise him/her to pursue only the CHI credential given all that transpired?
    Thank you!

    • Dear Dana, thank you for your comment and question. I believe I already posted all information needed to understand the current situation. I do not plan to add anything else. I have a personal opinion, but I do not think it is appropriate to share it here. If you want to discuss it in private, please send me a personal email at: info@rpstranslations.com

    • Dr. Souza says:

      Dana, our field is still very young and we tend to be patriarchal with our interpreters. They are professionals who can review the information of both certifying entities themselves and make a decision.

      Luring them to one or the other is what has perpetuated the disunity in the field that is so detrimental to our profession. I would suggest they read all the information about the exams to make a decision. For example, the written exam of CCHI has 25% medical terminology while NBCMI has 75%. NBCMI doesn’t test for simultaneous or translation. CCHI doesn’t test in some languages that NBCMI does and vice versa. Perhaps these factors will weigh in on the interpreters decision and these are very personal decisions that need to be respected. Accreditation is not required by any entity, as has been previously implied, not in this article, but in other social media. Read the link from the NB on this above. Get the first hand story and information.

  • mark says:

    Recent article reports of some CMIs forced to get CHI in order to keep employment at hospitals, and some agency recruiters explicitly saying they don’t accept NBCMI credential. Furthermore, trainers and agencies who offer CE courses are not offering credits for CMIs because of economic burdens imposed by IMIA.

    https://spanishdavid.com

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