International medical graduates (IMGs) account for more than 30% of the first-year positions filled in US psychiatric residencies (Nation Residency Match Program, 2007). At the time of writing, the first author was 4 months away from finishing his residency at the University of Connecticut (UCONN) when the opportunity arose to turn the tables and use his fluency in French to complete a month-long elective in France. During this period, he spent time as an observer in the psychiatric service of a Parisian hospital, l'Hôtel-Dieu. The realisation of this elective was helped by the fourth author, who knew various members of World Psychiatric Association. This paper presents some comparative observations of the clinical milieus at UCONN and the Hôtel-Dieu.