Program evaluation should be a systematic part of ISTCs, and recommendations from both local and visiting teams should be taken into account during this evaluation. Reports should outline what the needs and goals were, whether those needs were addressed, how the goals were met, what was successful, what was unsuccessful, and what the follow-up plans are. To facilitate collaboration, these reports should be publicly shared so that others can learn from the findings. These types of evaluations can help prevent duplication of unsuccessful models and can instead promote improvement and effectiveness. Additionally, establishing an equal and bidirectional partnership is important to achieving success, which is why evaluation from both sides of the partnership is essential . Program evaluation in a bidirectional manner is already being done by some who are involved in ISTCs, but it should continue and become a more regular part of global surgery work such that these efforts can further improve. See Fig. 3.