I have had several requests for Third Party Medical Reviews of translated content for various types of products. Usually the content being reviewed is for printed documentation. However, I recently had a request to conduct a third-party medical review for the content of website. In order to find the best way to proceed with this review, I did a bit of research. I thought this research and experience might help you if are planning for or are asked to conduct a third-party review in the future.

What is it?
For medical content, the purpose of a third-party review is to ensure that terminology and text are being used correctly in the context of the medical field. This is not an exercise to correct grammar, spelling, or other linguistic errors. These steps, including final QA, should have already been completed. The review should be conducted on the finished product that is ready for release.

Who should do it?
This depends on the product itself, and the needs of the customer requesting the review. Because this is a third-party review, it should not completed by any of the customer’s employees (developers, marketing team, doctors, or nurses). That type of review would be considered an in-country review. Nor should it be completed by any of the linguists (translation, edit, proof, testing) who worked on the project. Find a qualified medical linguist who has no connection to the original project. In my case, our Resource Manager had already assembled a pool of linguists who were certified medical linguists or had vast experience in the medical field. But if you do not have a resource pool to select from, check with organizations like the International Medical Interpreters Association (IMIA) to find linguists for your language.

How to do it?
Get a good understanding of the product that is being reviewed. How will it be used? Is it an operations guide for a medical device? Is it a health information system for the general public? Will it be used in a clinical setting? In the case of the website, I not only had to find linguists with a medical background, but non-English residents of the US.

Get a good definition of the target audience. Will the product be used only by medical personnel? Will non-medical people be using the product? If so, what grade-level should the translations be geared to? Will the users of the product be native speakers of the language? Will the users be US-based or in-country? All these elements will help the reviewers know if the terminology has been used correctly in the translations.

In the case of the website, the target audience was non-native residents of the US, who had little to no medical background, and were not educated beyond a high-school level. So we had to review the content from the medical perspective, but also from a layman’s perspective as well. For some languages, I was able to find linguists who were retired doctors who now resided in the US. For others, I used medical linguists for one pass, and US-based non-medical linguists (laymen’s perspective) for a second pass. The goal of the website was to help non-English speaking US residents find information about their medical care and about medicines they have been prescribed. People using it were likely to be be sick, facing surgery, or have a sick child. In that state, most people want reassurance and comfort, in addition to clear, simple information about their condition or the medicine they are taking. Therefore we asked the medical reviewers to make sure that the medical terminology used was the more common layman’s form, not the true medical form. (For example, "bruise" instead of "contusion".)

Also make sure you instruct the reviewers how to access the information (if it appears online), how to report their feedback (it’s a good idea to create a form for the reviewers to fill out), and give them a deadline. Ask them to provide back-translations for errors that they mark as severe.

What do you do if vast changes are suggested?
First of all, get a second opinion. Have multiple linguists, coming from various points of view, look at the portions in question. In my case, we found that one language was extremely problematic. We brought in other linguists with varying skill levels (a practicing doctor, a field medic, a student, a non-English speaking housewife, etc.) to give us input on the translation.

Second, make sure that the reasons for the changes are legitimate, and that you have examples. Highlight the questionable portions of text. Describe what the change should be, and why. Ensure that the changes are not stylistic. A third-party review is not the place for stylistic arguments.

Then, realize that you might need to be the bearer of bad news. In most third-party reviews, there are only a handful of changes suggested for each language. But in the case of the website, after several linguists reviewed the changes in the problem language, the consensus was that the terminology used would impede the end-user's ability to find basic (and correct) information. They also unanimously agreed that users of the website for that language would not gain the guidance, reassurance, and comfort that the system is designed to impart during times of medical need or uncertainty.

Use tact when reporting the feedback to the customer. Make sure you have documented evidence of the necessity for the changes. Reassure them that you have taken measures (like checking with multiple reviewers) to ensure that the changes are medically necessary, and not preferential.
Here are some examples from my recent project:
English: Your reproductive organs are located in your lower abdomen (belly).
Language back translation: Your reproductive organs are located in your stomach.
This is a misleading and incorrect use of medical terminology.
Another example:
EN: Birth defects
Language back translation: Defects caused by birth.
Birth defects are physical abnormalities that are present at birth, and they may or may not be caused by the birth process. Therefore this is another misleading and incorrect translation.

Conclusion
The third-party review process provides reassurance that a medical product is ready to be sold, used, and distributed in the target languages. But it also can reveal flaws that need to be readdressed prior to release, as in the case with the website. It provides a solid safety and sanity check for each language. With the problem language for the website project, once the final errors were addressed, the customer was able deploy their translated system with certainty that the target audience will get the maximum benefit from it. And most importantly, the customer knows that the system now provides safe, accurate, and usable information.