The benefits of global missions are numerous and students and residents can provide valuable assistance on such trips. Certainly, those who speak the language of the host country are at an obvious advantage and often serve as translators for those who do not. The education students and residents receive is immeasurable. They learn alternative models of health care delivery, how to manage health care with fewer resources, the effects of local culture on health care, and the management of disease entities they might not see back home, among other advantages. In the absence of sophisticated primary care and routine imaging studies, students and residents must rely more on their ability to perform thorough patient histories and complete physical examinations than they might at home where patients may have extensive medical charts documenting their entire medical history, including monthly clinic visits and numerous diagnostic studies.

Mission trips also foster problem solving (the “MacGyver effect”). Where resources might be abundant back home, they are often scarce abroad. When machines break, there might not be a technician on call to repair them or a backup machine ready to substitute. In such circumstances, ingenuity and decision making become valuable traits. Is the problem something that can be overcome with the available resources or do hard decisions have to be made about making alternate plans? These experiences have been shown to improve skills and confidence among students and residents, as well as increase their sensitivity to health care costs, awareness of reliability on technology, and need to improve communication across different cultures [1].

There are also benefits to the Departments that support and offer an international experience. Many students and residents have an interest in such programs and electively seek out and rank higher those programs that offer rotations or trips to foreign countries. The Department also creates a wider exposure for itself if their attendings, residents, and students carry with them the name of their institution as they travel abroad. Relationships with colleagues in foreign countries and at foreign medical schools are established and reinforced by future trips.

There are numerous examples where ongoing relationships outside of the single mission trip have developed between mentor programs in North America and a local university or hospital. As an example in Rwanda, a mutually beneficial relationship has been established between the Canadian Anesthesiologists International Education Foundation, the American Society of Anesthesiologists, and the National University of Rwanda. Volunteer faculty, often with residents from Canadian programs, travel to Rwanda to lecture and demonstrate in the local residency-training program. Similarly, Rwandan residents travel to Universities in Canada to enhance their training [2].

From these relationships, joint research projects and publications should be fostered. In many instances, academic endeavors by foreign clinicians are rare on account of limited resources but are certainly desired. Efforts should be made to include foreign colleagues on papers and presentations that relate to those conditions addressed on the trip.

There are numerous challenges to developing a global health initiative and the amount borne by students and residents will relate to their level of involvement. Some students may not have ventured far from home for either college or medical school and may find it difficult to adjust to a different culture, as they will interact with people of different opinions, who speak different languages, and eat foods with different ingredients and flavors.

For some, the sheer numbers of patients that require care may be daunting. Students and residents who see a small handful of patients in clinics at home may be surprised to find large numbers of patients of all ages needing care. Such experiences may elicit feelings that the care provided on any one short trip is insignificant to the population on a global scale. Similarly, any one mission is limited by time and hard decisions often have to be made about which patients receive care and which do not. These decisions should probably not fall on students and residents who are the more junior members of a team, but are better left to attendings and local clinicians.

At home, team members have the luxury of any and all supplies they require and the opportunity to try out and use the latest equipment. Abroad, a lack of basic tools is usually the norm and team members have to bring what they feel they need to safely care for the patients or make do with what the host institutions provide. Thus scouting a location for a trip is critical and team members have to be flexible and resourceful in their decisions.

Some students may also be concerned with their own personal welfare, such as the safety of the housing and the cleanliness of the food and water supply. Again, housing arrangements should be scouted well in advance of the trip with a backup plan in hand. Smart food decisions should be made while abroad, including avoiding ice and freshly washed vegetables and drinking only bottled water in areas where gastrointestinal distress is common in those not used to the drinking water.

Students and residents may also have concerns about the costs involved in a mission trip. They should be aware of what is required of them up front so that there are no surprises during or after the trip. Some schools and organizations cover student and resident expenses, which alleviates this burden; others cover some or none of the costs. Funds may be available for travel alone while the students or residents cover housing and meals. However, meals and incidentals over the duration of a trip may prove costly.

The ultimate success of any medical mission lies in the completeness of the plan. Preparation should probably begin one or more years in advance of the actual mission. Medical students and/or residents with proper guidance and direction from more senior physicians should actually participate in the planning. Such actions serve as a valuable learning experience for international health care delivery. The plan should include the local problems to be addressed, the country and city, the medical facility, the length of the trip, team members, housing, transportation, and other critical information discussed herein.