Currently, ISTCs do not have a standard operational process. On a small scale, a surgical team from a HIC may partner with a team from a LMIC to teach surgical procedures that they want to learn through a short training course – for example, Dr. Mark Bernstein teaches the awake craniotomy in many low-resource settings around the world . This helps address very specific needs in a local setting, often the most pressing issues, and can be significantly valuable to patients in that locality. On a larger scale, there are a variety of models for ISTCs. The Foundation of International Education in Neurological Surgery (FIENS) is an organization dedicated to developing neurosurgical education worldwide [19, 20]. The Toronto Addis Ababa Academic Collaboration (TAAAC) is a full institutional collaboration that has led to the development of education programs in many different medical and surgical specialties at Addis Ababa University in Ethiopia through partnership with the University of Toronto . This larger scale model focuses on building the surgical capacity of major academic institutions in LMICs. However, by also focusing on training future trainers, ISTCs can build the capacity of those institutions to reach out to underserved rural areas of their countries . These larger collaborations often involve not only local stakeholders, such as surgeons, anesthesiologists, nurses, and hospital staff, but national stakeholders as well, including the Minister of Health, Minister of Finance, and others who can provide a more comprehensive perspective on the progress of these efforts.