Ethics & Professional Responsibility
23%of exam
9 Ethics PrinciplesConfidentiality LimitsConflicts of InterestAccuracy Error TypesWhich Role LevelCode vs StandardsConduit vs AdvocateOASE Mnemonic
Managing the Interpreting Encounter
24%of exam
Interpreting ModesPre-Session ProtocolIntervention PhrasesSelf-Monitoring FitnessWhich Mode to UseConsecutive vs SimultaneousCHI Skill Weights
Healthcare Terminology
25%of exam
Key PrefixesKey SuffixesKey RootsDo-Not-Use AbbreviationsClinical ShorthandSpanish False CognatesDecode a Term-otomy vs -ostomyDomain Weights
U.S. Health Systems & Law
13%of exam
Language Access LawsU.S. PayersHIPAA & Patient RightsWhich Law AppliesQualified vs CertifiedTitle VI vs ADALaw Stack Mnemonic
Cultural Responsiveness
15%of exam
Quick Facts
- Credential
- CHI (CoreCHI + performance)
- CoreCHI Qs
- 100 (85 scored)
- CoreCHI Time
- 2 hours
- CoreCHI Pass
- 450 / 600 scaled
- CHI Languages
- Spanish, Arabic, Mandarin
- CHI Time
- 60 minutes
- Total Cost
- ~$533
- Recert Cycle
- 4 years, 32 CE hrs
OASE Accuracy Errors
Omission, Addition, Substitution, Editorializing break accuracy
O: leaves out contentA: inserts unspoken contentS: changes stated meaningE: adds interpreter opinion
Code of Ethics vs Standards
Code of Ethics
- States values
- Answers the why
- Broad principles
Standards of Practice
- Observable behaviors
- Answers the how
- Specific actions
Why vs how
Which Role Level to Use
- Default, no issue present→Conduit(First person, complete rendering)
- Term has no equivalent→Clarifier(Brief, transparent step-out)
- Cultural gap blocks understanding→Cultural broker(Flag transparently, third person)
- Health, safety, dignity at risk→Advocate(Least intrusive step first)
- Patient just dislikes plan→Stay conduit(Disagreement is not risk)
- Jumping straight to advocacy→Role violation(Must escalate stepwise)
NCIHC Code: 9 Ethics Principles
- Accuracy
- Render message complete, faithful
- Confidentiality
- Protect all encounter info
- Impartiality
- Stay neutral, no bias
- Respect autonomy
- Patient decides, not interpreter
- Cultural awareness
- Recognize cultural factors
- Role boundaries
- Stay within interpreter role
- Respect
- Treat all parties respectfully
- Professional development
- Pursue ongoing training
- Advocacy
- Only to prevent harm
Conduit vs Advocate
Conduit
- Default role
- Complete, accurate
- No opinions added
Advocate
- Rare, highest level
- Risk-triggered only
- Least intrusive first
Baseline vs last resort
Confidentiality Limits & Exceptions
- Patient consent
- Patient allows sharing
- Mandated reporting
- Abuse, communicable disease
- Court order
- Valid subpoena compels disclosure
- Treatment team
- Need-to-know care sharing
- Default rule
- Decline unless exception applies
Conflict of Interest Types
- Family relationship
- Relative or close friend
- Provider relationship
- Friend or business tie
- Financial interest
- Stake in outcome
- Moral objection
- Strong religious, political view
- Dual role
- Interpreter plus witness, advocate
Accuracy Error Types
- Omission
- Leaving content out
- Addition
- Inserting unspoken content
- Substitution
- Softening or exaggerating meaning
- Editorializing
- Adding interpreter's own opinion
CHI Skill Weights
Consecutive 70, Simultaneous 17, Sight 11, Written 2
Consecutive: 70% of scoreSimultaneous: 17% of scoreSight: 11% of scoreWritten: 2% of score
Consecutive vs Simultaneous
Consecutive
- Speaker pauses first
- 70% of CHI score
- Listen twice allowed
Simultaneous
- No pause, real time
- 17% of CHI score
- Played once only
Pause vs continuous
Which Interpreting Mode to Use
- Routine dialogue exchange→Consecutive(Default, 70% of CHI)
- Reading a consent form aloud→Sight translation(Written to spoken)
- Group class, one patient→Chuchotage(Whispered simultaneous)
- Rapid triage, time-limited→Simultaneous(No pause allowed)
- No visual info needed→OPI acceptable(Phone-only channel)
- Physical exam, visual cues matter→On-site or VRI(Not phone-only)
- Not fit-tested for N95→Remote modality(VRI or OPI instead)
Interpreting Modes & Terms
- Consecutive
- Speaker pauses, then render
- Simultaneous
- Render while speaker continues
- Sight translation
- Read document, speak aloud
- Written translation
- Text rendered into writing
- Chuchotage
- Whispered simultaneous, one listener
- Décalage
- Lag behind speaker
- VRI
- Video remote interpreting
- OPI
- Over-the-phone interpreting
Pre-Session & Introduction
- Pre-session
- Brief provider before encounter
- Introduction
- Name, role, confidentiality stated
- Triangle
- Provider-patient face each other
- Ground rules
- Pauses, terms, side talk
- First person
- Speak as the party
- Speak to patient
- Ask provider address patient directly
Announced Intervention Cues
- Clarification cue
- The interpreter needs clarification
- Self-correction cue
- Interpreter corrects prior statement
- Cultural note cue
- Interpreter adds cultural note
- Repetition request
- Could you repeat that
- Side conversation
- Flag or interpret aside
Self-Monitoring Fitness Factors
- Linguistic
- Know this dialect, variant
- Cultural
- Understand cultural context needed
- Personal
- No conflict with parties
- Subject-matter
- Know specialty terminology
- Modality
- Delivery method fits encounter
CoreCHI Domain Weights
Terminology 25, Encounter 24, Ethics 23, Culture 15, Systems 13
Terminology: 25%Encounter: 24%Ethics: 23%Cultural: 15%Systems: 13%
-otomy vs -ostomy
-otomy
- Incision, cutting into
- Temporary access
-ostomy
- Creates new opening
- Often permanent
Cut vs create opening
How to Decode a Term
- See unfamiliar medical term→ID the suffix first(Names the category)
- Suffix identified→ID the prefix next(Location, timing, degree)
- Prefix identified→ID the root(s)(Body part or system)
- All parts identified→Assemble the meaning(Suffix category stated last)
Key Prefixes
- hyper-
- Excessive, above normal
- hypo-
- Deficient, below normal
- brady-
- Slow
- tachy-
- Fast
- dys-
- Difficult, painful, abnormal
- a-, an-
- Without, absence of
- pre-
- Before
- post-
- After
- sub-
- Under, below
- inter-
- Between
- intra-
- Within
- poly-
- Many
Key Suffixes
- -itis
- Inflammation
- -ectomy
- Surgical removal
- -otomy
- Incision, cutting into
- -ostomy
- Creates new opening
- -osis
- Abnormal condition
- -pathy
- Disease
- -megaly
- Enlargement
- -emia
- Blood condition
- -algia
- Pain
- -scopy
- Visual examination
- -plasty
- Surgical repair
- -rrhage
- Excessive bleeding
Key Roots & Combining Forms
- cardi/o
- Heart
- hepat/o
- Liver
- nephr/o
- Kidney
- gastr/o
- Stomach
- pneum/o
- Lung (Greek)
- pulmon/o
- Lung (Latin)
- oste/o
- Bone
- derm/o
- Skin
- hemat/o
- Blood
- neur/o
- Nerve
Do-Not-Use Abbreviations
- U
- Misread as 0 or 4Danger
- IU
- Misread as IV, 10Danger
- QD
- Misread as QIDDanger
- QOD
- Misread as QD, QIDDanger
- Trailing zero
- 5.0 read as 50Danger
- No leading zero
- .5 read as 5Danger
- MS, MSO4, MgSO4
- Morphine vs magnesium confusionDanger
Common Clinical Shorthand
- BP
- Blood pressure
- HR
- Heart rate
- RR
- Respiratory rate
- WNL
- Within normal limits
- NPO
- Nothing by mouth
- PRN
- As needed
- STAT
- Immediately
- IV
- Intravenous
- IM
- Intramuscular
- CBC
- Complete blood count
- DNR
- Do not resuscitate
- Hx / Dx
- History / diagnosis
- Tx / Rx
- Treatment / prescription
Spanish False Cognates
- Embarazada
- Means pregnant, not embarrassed
- Constipado/a
- Means has a cold
- Intoxicado/a
- Means poisoned, not drunk
- Éxito
- Means success, not exit
- Asistir
- Means to attend
- Sano/a
- Means healthy, not sane
Language Access Law Stack
Title VI, then EO 13166, then Section 1557, then ADA
Title VI: 1964 baseEO 13166: 2000 dutySection 1557: 2010 health lawADA: disability track
Qualified vs Certified
Qualified interpreter
- Meets Section 1557 threshold
- Demonstrated skill needed
Certified interpreter
- Passed CoreCHI plus CHI
- Documented, testable proof
Legal floor vs credential
Which Language Law Applies
- LEP, national-origin discrimination→Title VI(1964, funding recipients)
- Federal agency access duty→EO 13166(2000, compels action)
- Health entity, free interpreter duty→ACA Section 1557(2010, health-specific)
- Deaf or hard-of-hearing patient→ADA(Disability, not LEP)
- Minor pressed into interpreting→Section 1557 violation(Emergency exception only)
Language Access Laws
- Title VI
- 1964, national-origin nondiscrimination
- EO 13166
- 2000, meaningful-access duty
- ACA Section 1557
- 2010, health-specific nondiscrimination
- ADA
- Disability-based communication access
- PSDA
- Advance directive right, 1990
Title VI vs ADA
Title VI / Section 1557
- National-origin basis
- LEP language access
ADA
- Disability basis
- Deaf, hard-of-hearing access
Language track vs disability track
U.S. Payers & Safety Net
- Medicare
- Federal, age 65+
- Medicaid
- Joint federal-state, low-income
- CHIP
- Covers children above Medicaid line
- Employer-sponsored
- Largest working-age coverage source
- ACA Marketplace
- Subsidized individual plans
- EMTALA
- ED must screen, stabilize all
- FQHC
- Sliding-fee community health center
HIPAA & Patient Rights
- PHI
- Protected health information
- Minimum necessary
- Access only what's needed
- Business associate
- Contracted agency, signs BAA
- Workforce member
- Directly employed interpreter
- Access right
- Inspect, copy own records
- Amendment right
- Request correction to record
LEARN Model
Listen, Explain, Acknowledge, Recommend, Negotiate across beliefs
L: listen to patientE: explain biomedical viewA: acknowledge differencesR: recommend a planN: negotiate agreement
Cultural Humility vs Competence
Cultural humility
- Lifelong self-reflection
- CCHI's current framing
Cultural competence
- Checklist of facts
- Treated as mastered
Ongoing vs finished
When to Add a Cultural Note
- Silence read as noncompliance→Flag cultural note(Transparent, third person)
- Family wants group decision→Flag cultural note(Norm, not violation)
- Patient wants same-gender staff→Relay the request(Facilitate, do not judge)
- Urge to share own opinion→Do not volunteer it(Stay neutral)
- Interpreter disagrees with belief→Interpret faithfully anyway(Not interpreter's call)
Cultural Concepts & Frameworks
- Cultural humility
- Lifelong self-reflection process
- Cultural competence
- Older, checklist-of-facts framing
- Acculturation
- Adopting host-culture norms
- Intracultural variation
- Difference within one group
- High-context
- Meaning carried by relationship
- Low-context
- Meaning carried by words
- Explanatory model
- Patient's own illness understanding
- LEARN model
- Negotiating explanatory-model differences
High-Context vs Low-Context
High-context
- Relationship, tone, indirectness
- Silence may mean no
Low-context
- Explicit, direct words
- U.S. biomedical default
Implicit vs explicit meaning
Folk & Traditional Practices
- Curanderismo
- Latin American folk healing
- Coining, cupping
- Traditional Chinese medicine practices
- Ayurveda
- South Asian traditional medicine
- Hot-cold theory
- Humoral illness balance belief
- Susto
- Soul fright, idiom of distress
- Mal de ojo
- Evil eye belief
- Nervios
- Nerves-related distress idiom
Common Traps
Sight vs certified translation
Sight is spoken, on-the-spot ≠ Certified is a written record
Impartial vs indifferent
Impartial means neutral content ≠ Interpreter still stays engaged, warm
Qualified vs certified interpreter
Qualified meets Section 1557 floor ≠ Certified passed formal CCHI exam
Bradycardia vs tachycardia
Brady means abnormally slow heart ≠ Tachy means abnormally fast heart
Hyperglycemia vs hypoglycemia
Hyper means high blood sugar ≠ Hypo means low blood sugar
Cultural pattern vs stereotype
Pattern is a hypothesis to confirm ≠ Stereotype is assumed, applied blindly
Constipado vs constipated
Constipado means has a cold ≠ True constipated is estreñido/a
-otomy vs -ostomy
-otomy is a temporary incision ≠ -ostomy creates a lasting opening
Last Minute
- 1.CoreCHI: 100 questions, 85 scored
- 2.CoreCHI passes at 450 of 600
- 3.Terminology is the largest domain, 25%
- 4.CHI performance: consecutive weighted 70%
- 5.CHI languages: Spanish, Arabic, Mandarin only
- 6.Full CHI credential costs about $533
- 7.Role order: conduit, clarifier, broker, advocate
- 8.Default to first person always
- 9.Confidentiality has four legal exceptions
- 10.LEP access law: Title VI, 1964
- 11.ADA covers disability access, not LEP
- 12.Recert cycle runs every 4 years
- 13.Recert needs 32 CE hours total
- 14.Sight translation is not certified translation
- 15.Certified requires passing CoreCHI plus CHI
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