The interest of the surgical community in global health has dramatically increased during the past decade as indicated by the numerous surgically focused medical missions, a burgeoning number of surgical resident applicants and programs looking to participate in international collaborations, and an increased attention given to global health by national organizations such as the American College of Surgeons and the International College of Surgeons.1,2 The World Health Organization identified a severe imbalance of availability of surgical services worldwide, and participation in global health programs offers opportunities to bridge the surgical service gap.3–6 Recent reports highlight the valuable learning opportunities for both local and visiting physicians and the potential to provide medical care to indigent populations that might otherwise be without technical support. The impact of medical missions is objectively measured by disability-adjusted life-years for patients treated, number of cases performed by surgical teams, fixed and relative costs of services provided, and quality outcome.7 Subjective assessment includes the “feel good” reward to clinicians, the value of giving back, and the intercultural experiences that come with foreign travel and exchanges. Those who question the efficacy of global health programs point to the ill effects of “medical tourism,” a term referring pejoratively to the practice of health care providers travelling internationally to deliver health care. Medical tourism more commonly refers to patients traveling across international borders to receive health care. However, as global health care has gained popularity in America, so has the negative image of Western physicians, medical students, and college students working in the international arena with a perceived lack of continuity, cultural insensitivity, and failure to meet ethical standards in provision of care and research goals.8,9 The critics’ repeated theme is a need for collaborative partnership with other medical schools, universities, and health care systems. The Working Group on Ethics Guidelines for Global Health Training (with the ponderous acronym of WEIGHT) has emphasized the need for “comprehensive accounting for costs associated with programs; the goal of mutual and reciprocal benefit; the value of long-term partnerships for mitigating some adverse consequences of short term experiences; characteristics of suitable trainees ... preparation of trainees; trainee attitudes and behavior; trainee safety; and characteristics of programs that merit support by sponsors.”10 In the current climate of global health, a remarkably diverse range of experiences are available, depending on the country and region visited. All efforts are made to get things right the first time, but it is an evolving process. The University of California, San Francisco-East Bay Surgical Residency training program participates in several international efforts with a focus on surgical support and training experience. Four themes have emerged as “rules” for creating and sustaining successful international experiences; 1) attaining local buy-in, 2) effective mentorship, 3) developing institutional partnerships, and 4) program continuity. A description of efforts by participating residents to incorporate these key components and a discussion of the merits and lessons learned follows.