title: Perceived barriers to success for resident physicians interested in immigrant and refugee health.
abstract: BACKGROUND
  Cross-cultural care is recognized by the ACGME as an important aspect of US residency training. Resident physicians' preparedness to deliver cross-cultural care has been well studied, while preparedness to provide care specifically to immigrant and refugee populations has not been.
  
  
  METHODS
  We administered a survey in October 2013 to 199 residents in Internal Medicine, Pediatrics, and Medicine/Pediatrics at the University of Minnesota, assessing perceived knowledge, attitudes, and experience with immigrant and refugee patients.
  
  
  RESULTS
  Eighty-three of 199 residents enrolled in Internal Medicine, Pediatrics and Medicine/Pediatrics programs at the University of Minnesota completed the survey (42 %). Most (n = 68, 82 %) enjoyed caring for immigrants and refugees. 54 (65 %) planned to care for this population after residency, though 45 (54 %) were not comfortable with their knowledge regarding immigrant and refugee health. Specific challenges were language (n = 81, 98 %), cultural barriers (n = 76, 92 %), time constraints (n = 60, 72 %), and limited knowledge of tropical medicine (n = 57, 69 %). 67 (82 %) wanted more training in refugee and immigrant health.
  
  
  CONCLUSIONS
  The majority of residents enjoyed caring for immigrant and refugee patients and planned to continue after residency. Despite favorable attitudes, residents identified many barriers to providing good care. Some involved cultural and language barriers, while others were structural. Finally, most respondents felt they needed more education, did not feel comfortable with their knowledge, and wanted more training during residency. These data suggest that residency programs consider increasing training in these specific areas of concern.
authors.affiliation: Department of Infectious Disease, University of Minnesota, 800 North 3rd St. Apt 520, Minneapolis, MN, 55401, USA. alper054@umn.edu.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Alpern
authors.affiliation: University of Minnesota, Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, Minneapolis, MN, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Davey
authors.affiliation: Department of Medicine, University of Minnesota, Center for Bioethics, Minneapolis, MN, USA.
authors.forename: John
authors.initials: J
authors.lastname: Song
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003144:Communication Barriers; D018864:Cultural Diversity; D065246:Culturally Competent Care / Q000458:organization & administration*; D003695:Delivery of Health Care; D004503:Education, Medical, Graduate; D054242:Emigrants and Immigrants; D005260:Female; D005380:Financing, Government; D054624:Health Status Disparities; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008297:Male; D010820:Physicians / Q000523:psychology*; D012036:Refugees; D013038:Specialization; D014146:Training Support; D014481:United States; D035862:Vulnerable Populations