Medical missions, surgical education, and capacity building.

Campbell and colleagues provide additional evidence hat a highly structured short-term experience in a resourceimited environment enhances training of North Amerian surgical residents. In this case, residents worked ith Operation Smile, which has provided high-volume umanitarian surgical care in many low-income counries for 25 years. Trainees from high-income countries ave also reflected that similar experiences provide a nique way of meeting required competencies. As ampbell and colleagues state, surgical trainees of this eneration have an increasing interest in global experinces, and more training programs are providing these pportunities. As these programs proliferate, we want to challenge the urgical community to move beyond the needs of North merican trainees to consider the educational needs of stuents, residents, faculty, and health personnel in host instiutions and hospitals. Local specialist surgeons and aneshesiologists are often few, overstretched, and battle xtreme resource limitations on a daily basis. The priority nd feasibility of meeting needs varies in every context, but top priority stated by partners is the development of local apacity. This can include bedside and intraoperative teaching with short or long-term visiting faculty, skillsbased workshops, sharing of educational materials, or collaborative research training and projects. Local feedback is essential to evaluate any program sending North American trainees to a limited-resource environment. We must inquire if the experiences of our trainees detract from those of local clinicians rather than complement them. Reciprocity in such arrangements might not be exact; for example, it is not possible for overseas trainees to practice hands-on in the United States. However, local training needs can be met in other ways, ideally in the home environment, but some programs also incorporate well-structured short-term international experiences for trainees and faculty overseas.