"Preparing International Medical Graduates (IMGs) for Psychiatry Residency: A Multi-Site Needs Assessment" (1) addresses the needs of IMGs entering psychiatry residency training in Canada. On the basis of a survey of five psychiatric residency training programs, the authors report that respondents ranked (in order of importance) understanding the Canadian healthcare system, learning medical documentation, practicing evidence-based medicine, and providing mental health care among the greatest challenges they face in successfully adapting to postgraduate medical training. Language barriers and social isolation were particularly difficult for those residents who did not speak English as their first language. Furthermore, residents who had lived in Canada for 12 months or less reported greater perceived knowledge gaps in psychotherapy. This commentary will focus on acculturation issues that underlie the survey's findings, including language difficulties causing social isolation that may affect the psychotherapeutic competence of IMGs.