Objective

  This study aimed to identify the types, frequency, and clinical significance of altered interpreta-tion in clinical settings.

Methods

  Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese doctors, and hospital-provided interpreters were digitally recorded and transcribed. Segments of consecutively interpreted utterances were coded as “altered,” in which the interpreter changed the meaning of the source utterance, or “unaltered (accurate),” and the types and frequency of occurrence were analyzed. Altered interpretations were categorized as clinically negative or positive and classified into four categories: omission, addition, substitution, or voluntary intervention. Incidents resulting from alterations were investigated. Reliability was assessed by examining the correlation between random independently coded samples.

Results

  In total, 111 encounters were analyzed. The mean segments per encounter was 67.9 (range 14-186), and the mean frequency (standard deviation) of altered interpretations per 100 segments was 46.7 (14.3) for accurate interpretations; 46.1 (17.9) for negative or not significant alterations, including 27.2 (10.3) for omissions, 6.0 (5.0) for additions, 10.4 (6.9) for substitutions, and 2.5 (2.7) for voluntary interventions; 0.0 (0.2) for alterations potentially leading to an incident; and 26.2 (11.9) for positive alterations, including 1.8 (2.6) for positive omissions, 7.7 (4.7) for positive additions, 7.8 (6.3) for positive substitutions, and 8.8 (5.2) for positive voluntary interventions. The frequency of negative alterations was weakly negatively correlated with number of segments per minute (r＝−0.339).

Conclusion

  Trained healthcare interpreters with fewer clinically significant altered interpretations were effective. Professional medical providers should recognize the importance of positive alterations by healthcare interpreters and collaborate with them to provide safe medical care for foreign patients. To facilitate the provision of appropriate medical care to a growing foreign population with diverse cultural and linguistic needs, undergraduate medical education should teach aspiring medical professionals how to collaborate with healthcare interpreters and foreign patients.

Background and Objective

  The Projects of Global Growth of Medical Technologies, implemented by NCGM since 2015, have contributed to human resource development through on-site training in partner countries and training in Japan. However, since 2020, online training has become mainstream due to the travel restrictions by COVID-19 impact. As one of the projects, the NCGM and Bach Mai Hospital rehabilitation departments in Vietnam held an interactive online hands-on seminar in FY2022 for Vietnamese occupational therapists and others to provide technical guidance for making splint orthoses to rehabilitate patients with hand dysfunction. This paper aims to report on the preparation and implementation process of the seminar and its results.

Preparation and Implementation of the Seminar

  NCGM (the instructor) and Bach Mai Hospital (the site of the hands-on training) prepared the seminar through regular online meetings, fostering ownership and collaborative planning on the Vietnamese side, and discussed the program development, necessary materials, participant selection, and obtaining authorization from the Vietnamese Ministry of Health. To ensure the quality of the technical instruction, the seminar was connected via Zoom to both NCGM and Bach Mai Hospital, where the live video of the splinting technique was conducted, along with explanations and Q&A sessions. The post-training evaluation was carried out through a questionnaire with self-assessment of the participants about the knowledge and skills they obtained.

Outcome and Discussion

  As a result, 96% (27/28) of the participants answered that the seminar was “useful for clinical practice,” suggesting that the interactive online hands-on seminar regarding technical instruction in making splint orthosis was as good as or better than the face-to-face training. We found that the Vietnamese side took ownership from the preparatory stage by establishing a regular online meeting system; the quality of the training was assured by live video by both sides, which enabled detailed technical instruction; the training provider’s skills were improved by more detailed preparation; training was cost-effective compared to on-site training or training in Japan; and the materials used and the training videos can be used as teaching materials, which is expected local benefits and sustainability. These findings can be applied to face-to-face training to make the training more effective and extended as a useful method when similar activities are developed in other countries.

Introduction

  In-service training is an incentive to work and improve the quality of services of health human resources. In-service training for health human resources requires multi-sectoral efforts across relevant institutions, including the Ministry of Health (MOH), which is responsible for policy, and higher education institutions, teaching hospitals, etc.

  The only national medical university of Bhutan, KGUMSB has developed a nationwide distance in-service training system using ICT, which had been prepared during the COVID-19 pandemic. Prior studies have reported that there are benefits to the use of ICT for in-service training in low- and middle-income countries to compensate for resource shortages.

  In January 2023, a Memorandum of Understanding (MOU) was signed between the MOH and KGUMSB, etc. to cooperate and collaborate in the in-service training of health human resources across Bhutan.

  This paper provides an overview of Bhutanese health systems and introduces how to establish a nationwide in-service training system by connecting central and regional health institutions through distance education using ICT, in the case of Bhutan.

Methods

  Participant observation, online interviews with stakeholders from KGUMSB, MOH, JICA, and documentary researches were conducted till July 2023.

Results

  ICT environment and simulation training center at KGUMSB and two regional referral hospitals (teaching hospitals) developed. KGUMSB developed facilities and systems for distance education (digital education equipment, learning management system, etc.), training of trainers, and distance education content. In addition, the MOU for in-service training was signed between the MOH, KGUMSB, etc.

Conclusion

  Through the efforts of KGUMSB, a specialized institution for health human resource development in Bhutan, to develop a distance education system, the MOU was concluded with MOH, and a nationwide in-service training system for health human resources was formed. For this system to work, in low- and middle-income countries with limited resources, a collaboration between the MOH, medical university, and teaching hospitals is essential.