Background

Emergency medicine (EM) is one of the youngest medical specialties in the world and is rapidly growing all around the globe. Emerging in the late 1960s in USA and UK, EM is now a recognized medical specialty in more than 50 countries worldwide. EM is a mature, fully established medical specialty in only a handful of nations—USA, UK, Canada, Australia/New Zealand, Hong Kong, and Singapore. It is in the early or middle stages of development in about 45 countries, and many other countries have little or no EM or acute care systems development at all [1–4]. In the vast majority of the countries in the world, EM is not yet fully developed in the aspects listed in the following:

• EM as a profession and specialty, with governmental recognition, board certification, national professional societies, and specialty journals;
  
• EM residency programs and educational programs for physicians, medical students, nurses, and other health care professionals;
  
• trauma system development;
  
• emergency medical services (EMS) and prehospital services development;
  
• administrative and management expertise in EM operations and development;
  
• economic and financing aspects of EM and acute care services;
  
• health legislation, policy, and public health agenda for EM and acute care [1–6].

Countries with EM systems under development look to nations with more fully developed EM systems, professional societies, and emergency physicians for expertise, education, advice, and collaboration. Over the past 20 years, emergency physicians from EM systems at all developmental stages have looked beyond their borders to learn how EM is practiced in other parts of the world and have become increasingly involved with their international colleagues. The emerging field of international emergency medicine (IEM) is concerned with the development of EM and acute care systems in countries and regions where such development is needed and with encouraging educational, research, and informational exchanges between EM systems around the world [7, 8]. The enormous and growing international community of emergency physicians has a tremendous amount of expertise and advice to share and is increasing its cooperation and collaboration through IEM activities, projects, and conferences.

Many emergency physicians have begun lecturing and teaching in settings outside their countries and outside the EM systems in which they were trained and have gained experience. This chapter addresses important considerations for teaching international audience, including common pitfalls and mistakes.

Technical Considerations for Teaching International Audience

Table 18.1 lists some common errors that are made in the presentation of written and verbal medical material and suggests strategies that can avoid confusion and miscommunication.

Table 18.1 Extracts from a hypothetical clinical case presentation that would have to be modified before delivering in spoken and/or written format to an international audience.

Points to be considered: (i) spell out abbreviations; (ii) use generic or chemical names for pharmaceuticals; (iii) be careful with laboratory abbreviations, the names of panels, and local conventions of documentation—always indicate abnormal laboratory results; and (iv) some terms are nearly universal (e.g., ECG/EKG, BP); it is not necessary to write out every term.

Interpreter and Translator Considerations

In many international conferences and educational courses interpreters (for oral speech) or translation services (for written text) are used, who or that translate either simultaneously or sequentially. It is important to find out whether these services will be needed, if they will be available, and which kind will most likely be used.

For simultaneous translation, an interpreter listens to your words (perhaps sitting in sound booths), reads your slides and/or written materials, and then translates the lecture simultaneously to the audience via wireless headphones or other devices. The success or failure of this practice depends on the fluency of the interpreter (including his or her familiarity with medical terminology) and the ability of the lecturer to deliver understandable, cogent material. It can feel as though you are lecturing to the interpreter, who then lectures to the audience on your behalf. The use of idioms or unclear language can reduce the translator’s ability to interpret your message. Translators who become overwhelmed or confused tend to default to translating the words on the slides instead of the speaker’s words; for this reason, it is better in certain situations to write your spoken words on the slides and actually read your slides (something you would rarely do when lecturing to an audience of native speakers of your language). This technique enables the translator to translate your words verbatim and allows the audience to read the slide text along with the translator, if they are able to do so. This strategy can deliver and reinforce your message more effectively. It also allows the slides to be used as written and printed teaching and studying materials because they contain a more complete version of your material than your usual slides. In addition, when a simultaneous translator is reading the slides verbatim, it is necessary for you to pause for a few moments when you finish reading the text on your slide to allow the translator to “catch up” before you advance to the next slide—the translator is usually one or two sentences behind you and reads and translates less than your full text.

Sequential translation also involves a translator/interpreter but without simultaneous translation or wireless headphones. In this technique, the lecturer speaks a sentence or two and then pauses while the interpreter translates the information. The lecturer and translator trade sentences for the entirety of the lecture. This technique brings with it all the considerations and problems of simultaneous translation but introduces a few new ones: (i) the lecturer needs to speak slowly, in only a few sentences at a time, so that information is not lost, mistranslated, or forgotten by the translator and (ii) the audience is frequently several moments behind the speaker and the translator in terms of comprehension and understanding, causing a delay in their reactions, laughter, and responses to questions.

Translation services can double or triple the time it normally takes to deliver your lecture. Furthermore, the frequent pauses and trade-off between lecturer and translator can disturb the natural conversational rhythm of the talk, requiring additional time and possibly reducing the effectiveness of your presentation. This means that you cannot expect to deliver a 60-min lecture in the same time slot. Therefore, you must either shorten your talk or request more time for speaking.

Regardless of whether translators or interpreters are used, you should always allow more time for speaking or delivering your usual lecture when teaching to an international audience, given the unknowns in interpretation, fluency, and understanding. Do not forget that the use of translators and interpreters relies on the proper functioning of wireless or other broadcast technology, so having backup lectures and materials can be useful.

Solution: Always inquire whether translators or interpreters will be necessary and available and ask about the type of translation that will be used. Make corresponding allowances in time, content, and style.

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