research is needed on whether increasing the number of bilingual residents, educating trainees on language services, or implementing medical Spanish courses as a supplement to (not a substitute for) interpreter use would improve care for LEP patients. 4,5 This study has limitations. The data were based on selfreport. However, a recent study found that clinicians' selfassessment correlated with their oral language assessment, particularly at the high and low ends. 6 Fifteen percent of applicants did not provide a self-identity and only 26 392 (49.8%) matched into an internship. The population actually entering internship may differ in their diversity or language proficiencies. Because of confidentiality, we do not know the relationship between applicant language proficiency and geographic matching of these skills to the local communities' language needs.

Patients with PRS require thorough airway and feeding evaluation. Those with additional syndromic diagnoses demonstrate higher rates of more invasive interventions. Patients with PRS must undergo individualized approaches with consideration of multiple factors for successful management.

Eccrine spiradenocarcinoma is an aggressive tumor with a poor prognosis. Primary treatment should include wide local excision with or without regional lymphadenectomy. Isolated successful treatments have been documented with adjuvant hormonal manipulation, chemotherapy, and radiation therapy.