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Designated Interpreters

A Model to Promote the Diversity and Inclusion of Deaf Professionals in Academic Medicine

Hall, Wyatte C., PhD; Elliott, Marlene; Cullen, John P., PhD

doi: 10.1097/ACM.0000000000002570
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Problem Deaf professionals who use American Sign Language (ASL) are a growing population in academic medicine. Reasonable accommodations for this group include providing an ASL interpreter. Many institutions contract with external agencies to provide ad hoc interpreters, but this model has hidden costs for deaf professionals and institutions.

Approach The University of Rochester School of Medicine and Dentistry (URSMD) uses the designated interpreter model in which interpreters are on staff and embedded with deaf professionals so they can learn both the work environment and the deaf professionals’ specialized science and medicine content. This model addresses many of the limitations of the external agency approach and better facilitates the inclusion of deaf professionals in the institution.

Outcomes This model has been in use at URSMD since 1990 but has seen exponential growth recently (increasing from 3 deaf professionals with designated interpreters in 2011 to a peak of 17 in 2016). Designated interpreters have worked in different research and clinical settings from dentistry and nursing to community and global health. This growth highlights the increasing number of deaf professionals in medicine and the need to train more designated interpreters.

Next Steps In response to this growing demand, URSMD is developing an ASL Interpreting in Medicine and Science program, a master’s degree–level program to train interpreters who are bilingual in ASL and English to be designated interpreters. The designated interpreter model is one step toward creating an environment that is fully inclusive of deaf professionals to the benefit of the whole institution.

W.C. Hall is research assistant professor, Departments of Obstetrics & Gynecology, Pediatrics, and Public Health Sciences, and Clinical & Translational Science Institute, University of Rochester Medical Center, Rochester, New York.

M. Elliott is American Sign Language interpreter, Clinical & Translational Science Institute, University of Rochester Medical Center, Rochester, New York.

J.P. Cullen is research associate professor and director of diversity and inclusion, Clinical & Translational Science Institute, University of Rochester Medical Center, and assistant director, Susan B. Anthony Center, University of Rochester, Rochester, New York.

An AM Rounds blog post on this article is available at academicmedicineblog.org.

Funding/Support: This work was funded in part by a grant from the National Institute for General Medical Sciences (K12 GM106997) and the University of Rochester Clinical and Translational Science Award (UL1 TR002001) from the National Center for Advancing Translational Sciences of the National Institutes of Health.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Disclaimer: The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence should be addressed to Wyatte C. Hall, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY 14624; e-mail: wyatte_hall@urmc.rochester.edu.

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Problem

The Americans with Disabilities Act (ADA) was passed in 1990. Twenty-eight years later, many deaf then-children-now-adults who benefited from the ADA are now pursuing medical and/or scientific careers. To support these individuals, the University of Rochester School of Medicine and Dentistry (URSMD) is working to become a “[deaf and hard of hearing] hub of innovation … that trains physicians and biomedical scientists.”1

While the number of deaf professionals in science and medicine continues to grow, many academic medical centers lack the knowledge and expertise to support the effective inclusion of this group in their institutions.2 Consequently, we recommend reexamining how reasonable accommodations are provided for deaf professionals to promote their educational and professional success, with the goal of building more diverse and inclusive academic medical centers and other professional environments.

Within the larger population of people with hearing loss, there is a smaller group of deaf individuals who use American Sign Language (ASL). They are unique relative to other ADA disability groups because English may not be their primary language. These deaf individuals are more akin to members of a sociolinguistic minority group who have a cultural identity that is strongly connected to their language. This unique intersection between disability and culture poses special challenges for deaf professionals as they launch their careers, and successfully including them in academic institutions requires ASL interpreters.

Institutions often will contract with external agencies to provide ad hoc interpreters for deaf faculty and trainees. This option is especially common in institutions that do not have a perceived critical mass of deaf professionals to justify a dedicated internal interpreter structure. Conceptually, this external agency approach appears logical and cost-effective. In our experience, however, it does have hidden costs in terms of time and productivity, misrepresentations, and social capital, among other things.

Deaf individuals can spend 2 to 10 hours per week arranging their own accommodations,3 hours that are lost from their education or work time. Deaf professionals also must repeatedly explain their work and give feedback to a rotating number of ad hoc interpreters, at a further cost to their learning and work time. Additionally, the risk of misrepresenting both the deaf professional and other individuals in a conversation significantly increases when interpreters do not have technical expertise, content knowledge, and institutional awareness.

We have observed that many hearing people are not consciously aware of how much knowledge they gain incidentally and how many professional relationships depend on indirect auditory communication. Deaf professionals struggle to acquire this social capital when interpreters are available only for specific structured events, such as meetings and presentations. Deaf professionals are, therefore, often excluded from much of the informal curriculum (e.g., institutional culture quirks, social reciprocity, and spontaneous learning) and from the professional networking that occurs in social areas (e.g., the water cooler). Institutions, then, are essentially excluding certain employees who could otherwise make valuable contributions in a more inclusive workplace.

Additionally, people with a shared context—the university, the department, individual relationships, various personalities—will speak in ways that implicitly refer to shared institutional knowledge and will make oblique references to shared experiences and knowledge. An interpreter who was not present in the shared context may have difficulty making sense of these references and unknowingly obscure their intended meaning, further reducing deaf professionals’ opportunities to learn and participate in the conversation.

The interpreting process is highly imperfect, and it can produce “forced errors” because of the natural cognitive limitations of simultaneous language processing. Interpreters also can make “unforced errors” if they do not have the correct vocabulary and/or contextual and content knowledge to produce an accurate interpretation. Usually, these errors are attributed to the deaf person rather than the interpreter because a frequent underlying assumption is that the interpreting process is mistake free.4 When working simultaneously in ASL and spoken English, interpreters are processing two languages while also attempting to predict what is going to be communicated before it actually has been, to keep up with the pace of conversation. This necessity for prediction means that interpreters without contextual knowledge are at a much higher risk of producing inaccuracies. For deaf professionals, there is the added challenge of finding interpreters with appropriate technical knowledge in their field to be able to represent complex, field-specific information.

In our experience, when assessing the need for interpreters, administrators may be more likely to underestimate the needs of deaf professionals and the advantages to the institution of providing timely, consistent, and appropriately skilled interpreters to promote a culture of inclusion for all employees. Administrators who have fiduciary responsibilities can prefer ad hoc interpreters because they believe their services come at a lower cost. Such decisions, however, may limit the inclusion of deaf professionals and come at unexpected costs to the institution.

To address this issue and overcome the limitations of the ad hoc, external agency approach, URSMD implemented the designated interpreter model to provide consistent accommodations for deaf professionals.

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Approach

Designated interpreters are collaborative partners on staff who work at the direction of a deaf professional. They not only interpret formal and informal contexts but also become knowledgeable about the deaf professional’s work.5,6

Most important, designated interpreters more accurately predict appropriate language and interaction structures depending on who is in the room (e.g., colleague versus supervisor) because they are familiar with individuals and their relationships, which allows interactions to happen more in “real time” than typical interpreting processes. Designated interpreters also can work more efficiently because they do not have to constantly manage the language and culture differences for both the deaf professionals and their hearing colleagues. Indeed, we know from our hearing colleagues that they have more seamless interactions with their deaf colleagues when they are working with a designated interpreter, allowing for the deaf professional’s expertise and perspective to enhance the project or work. Additionally, deaf and hearing colleagues can have immediate access to one another for impromptu conversations without having to request and wait for an interpreter to be available. The myriad of last-minute demands in an academic environment—grant proposals, team projects, and meetings, among others—become a nonissue when a designated interpreter is present.

The URSMD designated interpreter model evolved naturally because of the specialized nature of working in academic medicine, which requires close professional relationships and limits the number of interpreters with the necessary interpreting skills and advanced content knowledge. Because less time and fewer people were needed to coordinate accommodations overall (particularly in reacting to last-minute scheduling needs), thus increasing overall productivity, many at URSMD came to recognize that the designated interpreter model was more efficient for both deaf professionals and the institution. Indeed, deaf professionals with designated interpreters seem to be more productive and successful.

Effective designated interpreter systems have four important components: (1) a pool of qualified designated interpreters; (2) buy-in at all administrative levels; (3) an identified funding mechanism; and most important, (4) a point person who serves several critical functions in being able to solve any technical issues, perform regular outreach/education within the institution, and advocate for the needs of deaf professionals, if necessary.

When this point person is informed of an impending deaf professional hire, she or he should set up a meet-and-greet for the deaf professional and the available designated interpreters. Over a period of weeks, the deaf professional can “try out” interpreters until finding one or more who are a good fit, as determined by the deaf professional’s assessment of the interpreters’ content knowledge, ability to learn specialized terminology, interactions with others, and skill in matching language styles. Once a designated interpreter is selected, she or he can take over any logistics tasks like scheduling and coordinating with the point person as needed, allowing the deaf professional to focus entirely on professional work.

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Outcomes

Designated interpreters have worked successfully on a case-by-case basis in a range of diverse educational, research, and clinical settings in more than 15 departments at URSMD since the model was introduced in 1990. Initially, faculty and trainees had to request a designated interpreter rather than an ad hoc interpreter. Since 2012, however, with the growing influx of deaf professionals (e.g., medical students, other trainees, graduate students) in a variety of biomedical and behavioral science fields (at least 13 graduate-level students and trainees since 2012), the use of designated interpreters has become the primary interpreting approach. The number of deaf professionals with designated interpreters has increased from 3 in 2011 to a peak of 17 in 2016 (see Figure 1). In addition, the designated interpreter model has been instrumental in the development of “a deaf and hard of hearing hub of innovation” with the goal of fostering a diverse and inclusive culture at URSMD.

Figure 1

Figure 1

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Next Steps

The URSMD designated interpreter model has grown in recent years, which is an indication of both the increasing number of deaf professionals in science and medicine and the model’s efficacy in promoting an inclusive culture for these professionals in academic medical centers. While URSMD continues to navigate the challenges of creating an infrastructure to support overall interpreter-related operations and the designated interpreter model specifically (e.g., a possible “centralized reasonable accommodation fund”7), the primary challenge has been finding enough interpreters who are qualified to work at the advanced level of deaf professionals.

Central to the designated interpreter role is being fluent in both ASL and English, a willingness and ability to learn advanced scientific content, and the ability to follow the lead of deaf professionals in all aspects of their work. We believe that the best approach to ensuring the availability of interpreters with these skills is to “grow” and train designated interpreters in this specialized work from the beginning of their education. The University of Rochester already has a bachelor’s degree–level ASL program, so it is uniquely poised to train its ASL graduates to meet the increasing demand for designated interpreters. To that end, URSMD is in the initial stages of creating a master’s degree program—the American Sign Language Interpreting in Medicine and Science (AIMS) program—for fluent ASL–English language interpreters to work in medicine and science, both at URSMD and nationwide. In contrast to many other interpreter training programs,8 students are expected to enter the AIMS program already fluent in ASL and English, thus allowing them to focus on the skills needed to be a designated interpreter, rather than those needed to learn a second language (see Table 1 for a comparison of traditional interpreter training programs and the AIMS program).

Table 1

Table 1

The principle behind the designated interpreter model is that, legal mandate aside,9 the inclusion of deaf professionals is not only preferable but also beneficial to everyone. Collaborations, information sharing, learning, and other benefits of an academic environment will become more bidirectional as hearing colleagues are able to learn from their deaf colleagues and as deaf professionals can be seamlessly included on teams and projects.

Beyond deaf professionals, the designated interpreter model has the potential to benefit academic medical centers as a whole by allowing hearing faculty and staff to work with deaf colleagues in a natural way, interact with a population with whom they would not usually get to interact, and be exposed to different perspectives on their overall work. In this way, institutions can strive toward cultivating an inclusive culture made up of all kinds of diverse individuals.

The infrastructure supporting deaf professionals often affects how this group is viewed—as a recurring problem to be solved or as an opportunity for realizing the enriching benefits of diversity. We recommend that institutions go beyond minimally satisfying the legal mandate of providing reasonable accommodations and strive for creating an environment that is fully inclusive of deaf professionals. The designated interpreter model is one step in this direction.

Acknowledgments: The authors wish to thank Dr. Stephen Dewhurst, vice dean for research, for his support and leadership in establishing the American Sign Language Interpreting in Medicine and Science program; Elizabeth Butcher, manager of interpreter services, for her persistence in “greasing the wheels” for the University of Rochester School of Medicine and Dentistry designated interpreter program; and Dr. Jon Henner for being a source of inspiration to write this report.

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References

1. Buckley G, Smith S, DeCaro J, Barnett S, Dewhurst S. Building community for deaf scientists. Science. 2017;355:255.
2. Zazove P, Case B, Moreland C, et al. U.S. medical schools’ compliance with the Americans with Disabilities Act: Findings from a national study. Acad Med. 2016;91:979–986.
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4. Feyne S. Interpreting Identity: The Impact of Sign Language Interpreters on the Construction of the Situated Identity of Deaf Professionals [MA thesis]. 2014.New York, NY: Hunter College.
5. Hauser PC, Finch KL, Hauser AB. Deaf Professionals and Designated Interpreters. 2008.Washington, DC: Gallaudet University Press.
6. Swabey L, Agan TSK, Moreland CJ, Olson AM. Understanding the work of designated healthcare interpreters. Int J Interpret Educ. 2016;8:40–56.
7. Minnesota Management & Budget; Commission of Deaf, DeafBlind & Hard of Hearing Minnesotans. Centralized reasonable accommodation fund study 2015. https://www.leg.state.mn.us/docs/2015/mandated/150351.pdf. Published 2015. Accessed November 29, 2018.
8. Hall WC, Holcomb TK, Elliott M. Using popular education with the oppressor class: Suggestions for sign language interpreter education. Crit Educ. October 13, 2016;7(13). http://ojs.library.ubc.ca/index.php/criticaled/article/view/186129. Accessed December 26, 2018.
9. Blake CC. Searls v. Johns Hopkins Hospital. United States District Court, D. Maryland. 2016. Civil no. CCB-14–2983.
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