Harmonization of Cultural Differences in Translating the Promoting Excellence and Reflective Learning in Simulation (PEARLS) Debriefing Tool for Japan

Date
2022-02
Authors
Sato, Eri
Eto, Yuka
Nakahira, Atsushi
Ouchi, Gen
Lee-Jayaram, Janet
Berg, Benjamin W.
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Abstract
Introduction: Cultural consideration in debriefing is required, yet there is a lack of consensus on how to incorporate cultural elements in a translation process. SimTiki researchers developed a Japanese version of the published PEARLS debriefing tool. Objective: Linguistic, conceptual, and cultural considerations were incorporated in a process conducted by American and Japanese simulation-based education (SBE) Certified Healthcare Simulation Educator® (CHSE®) or Certified Healthcare Simulation Operations Specialist® (CHSOS®) experts. This report aims to describe the process to identify, reconcile and harmonize discrepancies that emerged during the translation. Methods: Step 1: The translation method aligned with PEARLS English language author suggestions and followed other translation guidelines including use of a team approach. Step 2: Forward translations were created by two Japanese native-speaking simulation education fellows, synthesized by consensus, and reviewed and revised in a meeting with other team members. Step 3: Two back-translations (BT) were completed; by a non- SBE expert bilingual physician, and by DeepL®, a neural machine translator. Two American SBE experts with CHSE assessed each BT phrase individually and discrepancies that emerged were reviewed and reconciled with forward translators. Step 4: To ensure conceptual equivalency and cultural validation, three Japanese SBE experts with CHSE or CHSOS independently rated the reconciled translation and convened for a focus group. Step 5: Team review, adjudication, and revision resulted in a final harmonized translation. Results: A total of 59 translated phrases were assessed as acceptable or unacceptable and harmonized using the 5-step process. As an example of the process, an original PEARLS phrase, “How are you feeling?”, was translated into “感想を教えてもらえますか?” and was back-translated to “Tell me what you thought about it” by the physician and “Can you tell me what you think?” by DeepL. American experts assessed both BT’s as “unacceptable”. Discrepancies were discussed in the experts’ review meeting. The raters judged “thoughts” had a different meaning than “feelings”. Japanese experts advised that the translation “感想” has a nuance of both “feeling and thought”. This issue was related to linguistics and the Japanese translation was not changed; all three Japanese SBE experts assessed it as “acceptable”. However, the Japanese experts stated that Japanese people are not accustomed to verbalizing and sharing feelings publicly and that expressing one's feelings in public is sometimes perceived negatively. Referring to these cultural insights, the translation was revised to "どんな感じですか?" and was re-translated by DeepL to "How's it going? "; another alternative was the same expression as the original PEARLS terminology; "How are you feeling?". American experts assessed the final DeepL BT as acceptable. This Harmonized translation has a broader connotation than the original and is generalizable in the Japanese context. Limitations: Only short phrases were translated. Lack of established guidelines or standards for conducting a back-translation assessment precluded comparison to a “gold standard” for educational cultural adaptation or validity. A professional translator was not involved in the process. Discussion: The 5-step Translation process effectively guided detection and adjudication of discrepancies to create a harmonized translation. The next steps are to establish measures of educational effectiveness of translated material.
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