In reply to Drain and Rhatigan.

We appreciate the insightful comments from Drs. Drain and Rhatigan regarding our article. Their observation that our findings may overestimate residents’ proficiency with interpreters reemphasizes our study’s central conclusion: that the low rate of education and evaluation on interpreter use, even among residency programs where exposure to individuals with limited English proficiency (LEP) is relatively high, suggests that broad action in this area is needed. We believe that as the population with LEP increases and the striking demand for global health experiences grows,[1] the need to uniformly train physicians in interpreter use is substantiated regardless of a program’s local population demographics. Supporting this call for action is our finding that educational sessions on interpreter use during residency are associated with increased resident self-efficacy in this domain. Equally important is a finding reported by Hernandez et al[2] that self-efficacy in the overall care of families with LEP is associated with increased resident satisfaction in the care of such families.

We agree with Drain and Rhatigan that training in global health is important and add that interpreter training relates to both the care of individuals with LEP in the United States and to experiences with international populations. Given that training in cross-cultural care is now a residency program expectation,[3] we propose that training in the areas of global health and caring for individuals with LEP may have a greater impact when combined in scope. They also may be better accepted and more effective when introduced earlier in training, such as throughout the medical school curriculum.