{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:50:35Z","timestamp":1791226235973,"version":"4.1.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R18HS029362"],"award-info":[{"award-number":["R18HS029362"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["T32GM135118"],"award-info":[{"award-number":["T32GM135118"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["K12TR004908"],"award-info":[{"award-number":["K12TR004908"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J GEN INTERN MED"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Interpreters help millions of patients with a\u00a0non-English language preference (NELP) navigate the healthcare system. Artificial intelligence (AI) tools are rapidly improving and undergoing testing and implementation for interpretation purposes. However, little is understood about interpreters\u2019 roles beyond direct interpretation, such as how they may promote resilience, which supports patient safety. Understanding these additional roles is critical as AI tools expand in interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To understand how medical interpreters enhance resilience in the care of patients with NELP undergoing ambulatory diagnostic processes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We conducted focus groups with medical interpreters to examine their experiences assisting patients with\u00a0NELP in ambulatory visits for new or worsening symptoms. We focused on the\u00a0ambulatory setting due to the high risk of misdiagnosis as patients navigate language barriers and the health system across multiple encounters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Seventeen medical interpreters participated in three focus groups and result-checking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach<\/jats:title>\n                    <jats:p>Deductive analysis using Hollnagel\u2019s resilience potentials \u2014 potential to respond, monitor, learn, and anticipate \u2014 as the organizing framework for understanding the impact of interpreter behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven behaviors supporting resilience were identified. The potential to respond included (1) managing communication flow, (2) strengthening the patient\u2019s voice, (3) viewing their interpretation role broadly, and (4) engaging in pre-briefings. The potential to monitor involved monitoring (5) patient emotion and understanding, (6) team dynamics, and (7) the impact of technology. The potential to learn included (8) learning from their cultural background and (9) from their work experiences. The potential to anticipate was comprised of (10) predicting future threats to patient safety and (11) identifying potential system improvements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Interpreters engage in behaviors beyond strict interpretation which enhance resilience, but these behaviors are not yet supported by AI interpretation tools. Careful consideration of these resilience-enhancing behaviors will be necessary when implementing AI tools and their workflows to avoid safety gaps.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-026-10850-4","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:52:34Z","timestamp":1791222754000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Interpreters in Supporting Resilience and Implications for Artificial Intelligence"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4747-461X","authenticated-orcid":false,"given":"Aubrey","family":"Samost-Williams","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paige","family":"Wermuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Fern\u00e1ndez Castillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronnie","family":"Zipkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Hanley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunbo","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Newton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Salas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Tannenbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siri","family":"Wiig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigall K.","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"10850_CR1","doi-asserted-by":"publisher","unstructured":"Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60-67.\u00a0https:\/\/doi.org\/10.1093\/intqhc\/mzl069.","DOI":"10.1093\/intqhc\/mzl069"},{"key":"10850_CR2","doi-asserted-by":"publisher","unstructured":"de Moissac D, Bowen S. Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada. J Patient Exp. 2019;6(1):24-32. https:\/\/doi.org\/10.1177\/2374373518769008.","DOI":"10.1177\/2374373518769008"},{"key":"10850_CR3","doi-asserted-by":"publisher","unstructured":"Bell SK, Dong J, Ngo L, McGaffigan P, Thomas EJ, Bourgeois F. Diagnostic error experiences of patients and families with limited English-language health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based survey. BMJ Qual Saf. 2023;32(11):644-654. https:\/\/doi.org\/10.1136\/bmjqs-2021-013937.","DOI":"10.1136\/bmjqs-2021-013937"},{"key":"10850_CR4","doi-asserted-by":"publisher","unstructured":"Saadi A, Bin Abdul Baten R, Alegr\u00eda M, Himmelstein D, Woolhandler S. Disparate Use of Diagnostic Modalities for Patients With Limited English Proficiency and Neurologic Disorders. Neurol Clin Pract. 2025;15(2):e200417.\u00a0https:\/\/doi.org\/10.1212\/CPJ.0000000000200417.","DOI":"10.1212\/CPJ.0000000000200417"},{"key":"10850_CR5","doi-asserted-by":"publisher","unstructured":"Stokes SC, Jackson JE, Beres AL. Impact of Limited English Proficiency on Definitive Care in Pediatric Appendicitis. J Surg Res. 2021;267:284-292.\u00a0https:\/\/doi.org\/10.1016\/j.jss.2021.05.024.","DOI":"10.1016\/j.jss.2021.05.024"},{"key":"10850_CR6","doi-asserted-by":"publisher","unstructured":"Chu JN, Wong J, Bardach NS, et al. Association between language discordance and unplanned hospital readmissions or emergency department revisits: a systematic review and meta-analysis. BMJ Qual Saf. Published online December 30, 2023. https:\/\/doi.org\/10.1136\/bmjqs-2023-016295.","DOI":"10.1136\/bmjqs-2023-016295"},{"key":"10850_CR7","doi-asserted-by":"publisher","unstructured":"Wu MS, Rawal S. \u201cIt\u2019s the difference between life and death\u201d: The views of professional medical interpreters on their role in the delivery of safe care to patients with limited English proficiency. PLOS ONE. 2017;12(10):e0185659.\u00a0https:\/\/doi.org\/10.1371\/journal.pone.0185659.","DOI":"10.1371\/journal.pone.0185659"},{"key":"10850_CR8","doi-asserted-by":"publisher","unstructured":"Allen MP, Johnson RE, McClave EZ, Alvarado-Little W. Language, Interpretation, and Translation: A Clarification and Reference Checklist in Service of Health Literacy and Cultural Respect. NAM Perspect. Published online 2020: https:\/\/doi.org\/10.31478\/202002c.","DOI":"10.31478\/202002c"},{"key":"10850_CR9","doi-asserted-by":"publisher","unstructured":"Genovese A, Borna S, Gomez-Cabello CA, et al. Artificial intelligence in clinical settings: a systematic review of its role in language translation and interpretation. Ann Transl Med. 2024;12(6):117.\u00a0https:\/\/doi.org\/10.21037\/atm-24-162.","DOI":"10.21037\/atm-24-162"},{"key":"10850_CR10","doi-asserted-by":"publisher","unstructured":"Vieira LN, O\u2019Hagan M, O\u2019Sullivan C. Understanding the societal impacts of machine translation: a critical review of the literature on medical and legal use cases. Inf Commun Soc. 2021;24(11):1515-1532. https:\/\/doi.org\/10.1080\/1369118X.2020.1776370.","DOI":"10.1080\/1369118X.2020.1776370"},{"key":"10850_CR11","doi-asserted-by":"publisher","unstructured":"Khoong EC, Steinbrook E, Brown C, Fernandez A. Assessing the Use of Google Translate for Spanish and Chinese Translations of Emergency Department Discharge Instructions. JAMA Intern Med. 2019;179(4):580-582.\u00a0https:\/\/doi.org\/10.1001\/jamainternmed.2018.7653.","DOI":"10.1001\/jamainternmed.2018.7653"},{"key":"10850_CR12","doi-asserted-by":"publisher","unstructured":"Hudelson P, Chappuis F. Using Voice-to-Voice Machine Translation to Overcome Language Barriers in Clinical Communication: An Exploratory Study. J Gen Intern Med. 2024;39(7):1095-1102. https:\/\/doi.org\/10.1007\/s11606-024-08641-w.","DOI":"10.1007\/s11606-024-08641-w"},{"key":"10850_CR13","doi-asserted-by":"publisher","unstructured":"Lee W, Khoong EC, Zeng B, et al. Evaluation of Commercially Available Machine Interpretation Applications for Simple Clinical Communication. J Gen Intern Med. 2023;38(10):2333-2339.\u00a0https:\/\/doi.org\/10.1007\/s11606-023-08079-6.","DOI":"10.1007\/s11606-023-08079-6"},{"key":"10850_CR14","doi-asserted-by":"publisher","unstructured":"Loeffler CML, Muti HS, Kather JN, Truhn D. Bridging communication gaps: the role of voice-enabled AI in medicine. ESMO Real World Data Digit Oncol. 2025;8:100138.\u00a0https:\/\/doi.org\/10.1016\/j.esmorw.2025.100138.\u00a0","DOI":"10.1016\/j.esmorw.2025.100138"},{"key":"10850_CR15","unstructured":"Prevost R. Can Apple\u2019s AirPod Translation Get You Through Tokyo? We Tested It. N Y Times. December 26, 2025. Accessed January 29, 2026.\u00a0https:\/\/www.nytimes.com\/2025\/12\/26\/travel\/airpods-live-translation-japan.html."},{"key":"10850_CR16","unstructured":"Benjamin R. The Costs of Instant Translation. The Atlantic. November 10, 2025. Accessed January 29, 2026.\u00a0https:\/\/www.theatlantic.com\/books\/2025\/11\/what-translation-airpods-are-taking-away-from-us\/684865\/."},{"key":"10850_CR17","doi-asserted-by":"crossref","unstructured":"Ra\u00eddo VE. Chapter 7: Artificial Intelligence in Healthcare Translation: A Contemporary Systematic Review. In: The Social Impact of Automating Translation. Routledge; 2024.","DOI":"10.4324\/9781003465522-7"},{"key":"10850_CR18","doi-asserted-by":"publisher","unstructured":"Sleptsova M, Hofer G, Morina N, Langewitz W. The role of the health care interpreter in a clinical setting--a narrative review. J Community Health Nurs. 2014;31(3):167-184.\u00a0https:\/\/doi.org\/10.1080\/07370016.2014.926682.","DOI":"10.1080\/07370016.2014.926682"},{"key":"10850_CR19","unstructured":"Beltran Avery MP. The Role of the Health Care Interpreter: An Evolving Dialogue. 2001. Accessed July 29, 2026.\u00a0https:\/\/www.nichc.org\/assets\/documents\/publications\/NCIHC%20Working%20Paper%20-%20Role%20of%20the%20Health%20Care%20Interpreter.pdf."},{"key":"10850_CR20","doi-asserted-by":"crossref","unstructured":"Hollnagel E, Braithwaite J, Wears RL, eds. Resilient Health Care. Ashgate; 2015. Accessed June 2, 2025. https:\/\/erikhollnagel.com\/books\/resilient-health-care.html.","DOI":"10.1201\/9781315366838"},{"key":"10850_CR21","doi-asserted-by":"publisher","unstructured":"Wiig S, Aase K, Billett S, et al. Defining the boundaries and operational concepts of resilience in the resilience in healthcare research program. BMC Health Serv Res. 2020;20(1):330.\u00a0https:\/\/doi.org\/10.1186\/s12913-020-05224-3.","DOI":"10.1186\/s12913-020-05224-3"},{"key":"10850_CR22","doi-asserted-by":"publisher","unstructured":"Berger\u00f8d IJ, Braut GS, Wiig S. Resilience From a Stakeholder Perspective: The Role of Next of Kin in Cancer Care. J Patient Saf. 2020;16(3):e205-e210.\u00a0https:\/\/doi.org\/10.1097\/PTS.0000000000000532.","DOI":"10.1097\/PTS.0000000000000532"},{"key":"10850_CR23","doi-asserted-by":"publisher","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care J Int Soc Qual Health Care. 2007;19(6):349-357.\u00a0https:\/\/doi.org\/10.1093\/intqhc\/mzm042.","DOI":"10.1093\/intqhc\/mzm042"},{"key":"10850_CR24","unstructured":"Ruschke K, Bidar-Sielaff S, Beltran Avery MP, Downing B, Green CE, Haffner L. National Standards of Practice for Interpreters in Health Care. Published online 2005. Accessed March 5, 2026.\u00a0https:\/\/www.ncihc.org\/assets\/media\/ncihc%20national%20standards%20of%20practice.pdf."},{"key":"10850_CR25","doi-asserted-by":"publisher","unstructured":"Ong AY, Merle DA, Pollreisz A, et al. Flight rules for clinical AI: lessons from aviation for human-AI collaboration in medicine. Npj Digit Med. 2026;9(1):201.\u00a0https:\/\/doi.org\/10.1038\/s41746-026-02410-1.","DOI":"10.1038\/s41746-026-02410-1"},{"key":"10850_CR26","doi-asserted-by":"publisher","unstructured":"Abdulnour REE, Akbarialiabad H, Haghighi A, Leachman SA. Crew Resource Management \u2014 Navigating AI\u2019s Automation Paradox. N Engl J Med. 0(0).\u00a0https:\/\/doi.org\/10.1056\/NEJMp2600938.","DOI":"10.1056\/NEJMp2600938"},{"key":"10850_CR27","doi-asserted-by":"publisher","unstructured":"Li I, Kagimoto H, Iwasawa Y, Matsuo Y, Goh E. When medical AI fails outside English. BMJ Digit Health AI. 2026;2(1).\u00a0https:\/\/doi.org\/10.1136\/bmjdh-2026-000038.","DOI":"10.1136\/bmjdh-2026-000038"}],"container-title":["Journal of General Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-026-10850-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11606-026-10850-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-026-10850-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:52:37Z","timestamp":1791222757000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11606-026-10850-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":27,"alternative-id":["10850"],"URL":"https:\/\/doi.org\/10.1007\/s11606-026-10850-4","relation":{},"ISSN":["0884-8734","1525-1497"],"issn-type":[{"value":"0884-8734","type":"print"},{"value":"1525-1497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"assertion":[{"value":"17 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Clinical Trial Number","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by our institutional IRB (#MS-22-0822). Participants provided verbal informed consent.","order":2,"name":"Ethics","label":"Human Ethics and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Aside from the grant funding above, the authors report no conflicts of interest.","order":3,"name":"Ethics","label":"Conflict of Interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}