When Aileen Prabhakaran took a job in Iowa, the young doctor from India expected a land of icy winters, cultivated fields and quiet living. One thing the 31-year-old, whose entire schooling was in English, didn't expect: a communication barrier. Then last year, she enrolled in a cultural-competency course at the hospital where she is a resident in family medicine. "It enabled me to understand Iowa and Iowans better," she says. The 90-minute sessions are taught by two social scientists once a month and are required of all foreign medical residents at the hospital, Mercy Medical Center here in Mason City. About 30 physicians recently attended "Topics for Small Talk With Iowans." In another session, "An Intro to Working Effectively With White Europeans" in Iowa, the professors dissected "the Iowa character." About a quarter of all medical doctors in the U.S. are foreign-born, with the percentage often higher in rural areas. In Iowa, where 63% of the counties have a shortage of physicians, according to the federal government, foreign doctors provide the backbone for many communities.