By The ATA Chronicle
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Find out how implementing a flipped classroom methodology is proving to be a valuable component in a program designed to support bilingual employees who are Spanish heritage speakers on their journey toward becoming professionally certified health care interpreters.

As health care interpreting becomes more professionalized, thanks to the efforts of national and statewide professional interpreter organizations and associations and the introduction of national certification in 2010, heritage speakers1 entering the profession face a unique challenge. In the following, we would like to share the lessons learned from the efforts of a pioneering three-month interpreter training program at Barton Health, a community health system in South Lake Tahoe, California, where more than 80% of the bilingual employees participating in our program are Spanish heritage speakers. This initiative used the flipped classroom methodology to introduce students to the medical interpreting profession, improve Spanish fluency, and expand their bilingual medical terminology.

About Barton

If you’re fortunate enough to have visited South Lake Tahoe, we hope you had a grand time and were able to stay out of Barton Memorial Hospital. But if you were seen at Barton, we hope you received consistently exceptional care from our rural, yet robust health care system. Barton Memorial Hospital, a component of Barton Health, consists of 24-hour emergency care services, 63 patient beds, a skilled nursing facility with 48 resident beds, and many departments to serve the health and medical needs of our patients, residents, employees, visitors, volunteers, and the community.

Our Language Access Services Department was established in 2006 with approximately 10 untrained dual-role2 Spanish medical interpreters and two rickety laptops that rolled around the emergency department for video remote interpreting. We currently have 14 nationally certified Spanish dual-role medical interpreters, an additional 14 students waiting for the results of their Certification Commission for Healthcare Interpreters3 National Oral Test, and another 12 participating in the training for this year. Thirty-four sturdy video remote interpreting units are scattered throughout our health care system as well. If the 14 students pass the oral test, we’ll be able to provide an in-person or video Spanish interpreter for each of our 63 beds simultaneously.

Using the Flipped Classroom Model

If you’re new to this jargon, here’s a little primer. A flipped classroom is a teaching model that uses technology to flip the roles in a traditional classroom. It’s called a “flipped” classroom because the classroom paradigm looks totally different than the traditional classroom. Essentially, it means that students first gain exposure to the subject outside of class through a series of online materials, such as videos, audios, and reading assignments, that they can refer to as many times as necessary. Then the actual class time is used to do the harder work of assimilating that knowledge through problem-solving and discussion.

Asynchronous learning, as opposed to synchronous learning (which involves students learning together at the same time, whether online or in person), means the material is delivered online via web-based platforms, email, online forums, and message boards. Students work at their own pace and on their own time.

The online flipped classroom portion of our program during January, February, and March was strategically designed to take place over our worst weather/commuting months. (Lake Tahoe is uniquely located on the border of California and Nevada, with an average snowfall of 34 feet a year, which can make commuting a challenge.) Students were expected to dedicate five hours per week to studying and online classwork, for a total of 60 hours.

Interpreter Training Timeline

To keep up with national advances in our profession, as of January 1, 2019, Barton Health started requiring all in-person interpreters to be nationally certified. To accomplish this, we expanded our training program and evolved our 40-hour course into a year-long program. The program follows the timeline below:

  1. Take the American Council on the Teaching of Foreign Languages Oral Proficiency (OPIc) Exam.4 Students must obtain a minimal speaking proficiency level of Advanced-Mid for Limited Certification on the oral exam to enter our program. (Many times, heritage speakers score one level below at Advanced-Low on their first attempt. Some then re-test at their own expense and achieve an Advanced-Mid for Limited Certification on their second attempt.)5
  2. A three-month introductory flipped online class. This is where we really dug in and catered to our heritage speakers’ needs by working on increased fluency, advanced language vocabulary, and instilling linguistic and cultural pride.
  3. A 72-hour onsite medical interpreting course. During the three-month time period, we also include shadowing6 sessions (students watch a trainer interpret for four to eight hours).
  4. Preceptorships: students are observed interpreting and coached as needed (four to eight hours).
  5. Practice written and oral tests (one to two hours).
  6. Take the National Certification Exam (Certification Commission for Healthcare Interpreters).

Objectives

We chose a flipped asynchronous learning environment because we felt it lent itself best to our somewhat isolated geographical location (including challenging winter driving conditions for both trainers and students) and scheduling issues for full-time employees who are juggling work, parenting, and other responsibilities.

This format worked very well for both the instructor (Julie), who didn’t have to brave the four-hour drive on icy roads every week during the winter, and for Barton Health, as it meant no disruption of our student employees’ work schedules, no need for coverage during work time, and no classroom space required.

We initially chose the Schoology online learning platform for our online training because Julie had previous experience with it as a student. Our objectives for the three-month course were for the students to:

  1. Become familiar with Schoology and learn to access instructional material (documents, video links, etc.), homework assignments, and upload completed homework assignments.
  2. Become familiar with the advantages, challenges, and solutions associated with studying on an online learning platform.
  3. Learn to use Audible as a tool for improving Spanish-language fluency.
  4. Use Audible, YouTube Videos, and podcasts to learn and practice the technique of shadowing.
  5. Use the above material to harvest medical terminology.
  6. Learn to use online and paper resources to research and expand bilingual medical terminology.

Course Elements

Each class included a variety of activities: group discussions, assignments, YouTube videos, readings, and exercises. Once students were familiar with the online platform and had installed Audible on their mobile devices, we introduced them to the practice of shadowing with an audio book that was full of medical terminology and jargon: Cerebro de Pan (Grain Brain) by David Perlmutter. As the weeks went on, we built on students’ initial shadowing practice by introducing some material on reflective learning. We then progressed to having students record themselves shadowing, reflecting on their progress, and finally submitting their recordings to the instructor.

Once the students were at ease with using Audible to practice shadowing, we added YouTube videos and podcasts in Spanish and assigned more terminology exercises from this material, which also provided rich opportunities for group discussions. One especially impactful YouTube video was a TEDTalk by Mexican actress Karla Souza, who eloquently described her struggles in the film industry and how she overcame adversity. In an ensuing assigned group discussion, students were asked to reflect on what life lessons Karla had learned, what inspired them about her talk, and what lessons they would apply to their own journey as professional interpreters.

This and similar activities led to indepth discussions, gave students the opportunity to express themselves in Spanish in writing (which many of them were not accustomed to doing), and build community by learning about each other’s experiences and reacting to everyone’s comments. As one participant wrote: “The discussions did help a lot, like to break the ice and get to know each other, and then when we were in class, it was like we already knew each other.”

Another key element of the classes was using the material (the Audible book, podcasts, and YouTube videos—all in Spanish) to harvest new medical terminology and begin building students’ skills related to researching and evaluating bilingual terminology resources.

One very heartwarming and slightly unanticipated outcome of the online course, which was expressed by many students, was an increased sense of pride in their bilingual abilities and cultural heritage, and a newfound determination to use these abilities to serve the members of their community who rely on interpreters to meet their health care needs.

Figure 1: Student Feedback from Anonymous Online Survey

Lessons Learned

This was also a rich learning lesson for both of us as trainers. The following are some of the changes we’ve implemented in our 2020 program based on what we learned from the 2019 class:

Get an early handle on the tendency to procrastinate. In our 2019 classes, we realized that many students were waiting until the wee hours of the night before assignments were due to complete their work, so we created a module and assignments focused on procrastination and time management into the curriculum about halfway through the course. This time, we simply moved these modules and assignments to the first two weeks, with good results!

Avoid technical glitches and slow starts. Instead of simply diving in online like we did in 2019, we added an onboarding one-hour synchronous class. This avoided some of the technical glitches and the slow start we experienced the first time as students learned to navigate the online learning platform. During our first class of the year, one of us (Tracy) was present onsite in the classroom while the other (Julie) participated via Zoom. We reviewed the online platform and some basic objectives for the class, gave students the opportunity of logging in to the platform with either their own or laptops loaned from Barton, and provided the opportunity for students to meet each other face to face.

Research the pros and cons of your online learning platform. After having to rely on email submissions for audio assignments and struggling with a clunky gradebook system, this year we switched to the Canvas Free for Teachers online platform instead of Schoology due to the ease of uploading audio clips and a more user-friendly gradebook (both for the instructor and students).

Make the most out of observation and preceptorship assignments. To increase accountability for the observation and the preceptorship assignments, we added an additional module and assignments, including observation guidelines, an observation quiz, a group discussion, and new vocabulary assignments.

Results

At the conclusion of the class, an anonymous online survey was administered by Redwood Consulting Collective, an outside evaluation firm. Highlights of the results can be seen in Figure 1:

This is our second year using a flipped classroom methodology to introduce bilingual employees to the profession of medical interpreting, improve their Spanish fluency, and expand their bilingual medical terminology. We can safely say that it’s proving to be a critical and valuable component of our comprehensive one-year program to support heritage speakers on their journey toward becoming professionally certified health care interpreters. In the words of several of our students:

“I feel honored to be part of this program. I thought that I spoke Spanish properly, but after this program I know that there is always something to learn.”

“There are so many ways of studying and learning, and I feel this is one of the best experiences I could have had.”

“You learn better study skills, like self-reflection to better yourself with interpreting. I didn’t realize this was a whole other career, which is really awesome. So, at the end of it, it’s actually well worth the sacrifice.”

Notes
  1. If you’re unfamiliar with the term “heritage speaker,” here’s a definition from Language Line International: “A heritage speaker refers to a person who has learned a language informally by being exposed to it at home, as opposed to having learned it formally in a school setting. It may be their native tongue—the language they identify as being their primary language—but more often than not, their heritage language becomes secondary to English, the language in which they receive their formal education, and is used the most in their daily life outside the home.”
  2. Dual-role interpreters are generally ad hoc interpreters who are hired in an administrative or clinical position as their primary role, but use their bilingual language skills to serve as interpreters in a secondary role. For more information, download: Wilson-Stronks, Amy, and Erica Galvez, E. Hospitals, Language, and Culture: A Snapshot of the Nation—Exploring Cultural and Linguistic Services in the Nation’s Hospitals (The Joint Commission, 2007), http://bit.ly/Wilson-Stronks-Galvez.
  3. For more information on the Certification Commission for Healthcare Interpreters, see http://cchicertification.org/certifications.
  4. The OPIc is an online test that provides valid and reliable oral proficiency testing on a large scale. (See: http://bit.ly/ACTFL-OPIc)
  5. Information on tester and rater certifications awarded by the American Council on the Teaching of Foreign Languages can be found at http://bit.ly/ACTFL-certifications.
  6. Shadowing is a technique used for learning new languages and improving fluency that involves listening to a source audio while repeating what is said in the same language with a slight delay (décalage) as in simultaneous interpreting, but without the language conversion.

Julie Burns, CT is a veteran interpreter trainer, certified health care interpreter (Certification Commission for Healthcare Interpreters), worker’s compensation certified Spanish interpreter, and an ATA-certified Spanish>English translator. She has an M.Ed. in adult education. She is a former director of the Bridging the Gap Interpreter Training program, and has trained thousands of interpreters. She has served as a board member of the National Council on Interpreting in Health Care, International Medical Interpreters Association, and California Healthcare Interpreting Association. She has over 20 years of experience in health care interpreting and translation, as well as extensive experience in health care education and training in the U.S. and Latin America. In 2018, she was conferred the National Council on Interpreting in Health Care’s Language Access Champion award. Contact: julieburns1217@gmail.com.

Tracy Young is a certified medical interpreter, medical interpreter trainer, and long-time advocate for the profession. She is the coordinator of the Language Access Services Department at Barton Health in South Lake Tahoe, California. She has an MA in Spanish from the University of Nevada, Reno, and is the founding president of the Nevada Interpreters and Translators Association. In 2015, she was awarded the Language Access Champion Award from the National Council on Interpreting in Health Care. In 2019, she was named California Healthcare Interpreting Association’s Trainer of the Year. She continues to find innovative ways to make language access a reality at Barton Health and beyond. Contact: tyoung@bartonhealth.org.

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