Recent updates regarding the unmet surgical need indicate that 5 billion of theworld’s 7 billion people lack access to safe and timely surgical care.1 One of the critically missing pieces is trained surgical staff, including surgeons, anesthesiologists, nurses, and biomedical engineers. The ecosystemof people and processes, as well as supplies and infrastructure, is necessary tobegin to remove thegaps in care.Yet, how to fill the human resource gap has remained a conundrum. The consortium approach to surgical education has many merits and has worked well in other, nonsurgical settingswhereconsortiaofuniversities support themedical training programs in a low-resource country. The limitation to this approach for surgery has been the small numbers of US surgeons available to teach, combined with the constraints of time andobligations to their homedepartments. This shortcoming has necessarily created a situation inwhich discontinuity is the normand training brigades, camps,workshops, ormissions attempt to fill at least someof the training needs.2 As described by Cook et al2 in this issue of JAMA Surgery, the Alliance for Global Clinical Training program with the Muhimbili University ofHealth andAllied Sciences,Dar es Salaam,Tanzania, servesasavaluable templateand learningsystemonwhich tobuild a full surgical platform.Lessons learned can be applied to similar academic consortia to support other training centers. This model will require financial support to becomesustainableonbothends.With thepassing inMay2015 of the new resolution at the World Health Assembly on Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage,3 coupled with the recent report from the DCP3 Essential Surgery Author Group4 and theWorld Bank and the Lancet Commission on Global Surgery 2030 report,1 critical momentum is developing to address the financial needs both of the visiting trainers and the surgical training centers they are entrusted to help support. An evidence-based approach to developing surgical capacity is emerging, and the political will to do so has been strengthenedby the realizationof thebenefits to theeconomy of societies. Without scale-up of surgical care, low-income and middle-income countries between 2015 and 2030 will lose an estimated $12.3 trillion (2010 US dollars purchasing parity).1 Yet, scaling up of surgical care cannot be done strictly through the efforts of volunteers, even in academic consortia. A new model must emerge that values training and includes clinical decision making and technical skill and systems integration in a tangible and sustainableway. This is the time for academic surgical programs to learnmore aboutwhat it takes to create and sustain a surgical ecosystem rather than to just train technical operations, both domestically and internationally.