Lack of organization and a systematized process for involvement in ISTCs is a major barrier to their success. This section describes suggestions/models that can be implemented to better organize ISTCs, based on participants’ interviews. Figures 1, 2, 3, 4 and 5 summarize and consolidate the points below in a framework for a unified approach to ISTCs and sustainable global surgery efforts.Fig. 1Centralized Website for Consolidating Information on ISTCs and Sustainable Global Surgery Efforts. A website for ISTCs and sustainable global surgery efforts should be universally accessible, have international coverage, and potentially be facilitated by professional bodies. The website could include names and identifying information of those involved, surgical specialty focus, where the group is from, where they are engaging in work (or what type of work is needed), a description of the global surgery work, learning points to share with others, and the current needs for sustaining the work. Other information could be included as well. This website could allow relevant stakeholders to look at current efforts, contact those involved and learn more, engage in new work based on needs, and/or initiate collaborations based on similarities of surgical specialty, regions, etc. Fig. 2Expansion and Consolidation of ISTCs with Consistent Action and Reflection. This figure integrates the framework of action and reflection with that of expansion and consolidation. Action includes the expansion phase, which leads to more ISTCs, and the consolidation phase, which strengthens partnerships and focuses on long-term outcomes. Reflection includes meetings and conferences from the local to the national levels in order to assess the successes and failures of interventions Fig. 3A Scholarly Approach to Global Surgery Efforts. A scholarly approach to global surgery work can further formalize efforts. Integral to this is increasing academic recognition of global surgery, increasing research on needs and outcomes, an interdisciplinary approach that engages multiple relevant fields (all of which are not listed), and consistent program evaluation Fig. 4The Role of Technology in Facilitating Continued Long-Distance Partnerships. Sharing cases, having joint teaching rounds, sharing textbooks/journal articles, developing curricula, and engaging in telesimulation are all ways in which technology can be used to further advance ISTCs and global surgery efforts, although there are many other possibilities. Use of technology can encourage collaboration, lead to continuous learning and partnerships, and increase global connections and networks Fig. 5Roles of a Single Multi-Level Global Surgery Administrative Structure. Local, national, and international boards working in conjunction as a single multi-level administrative structure can unify ISTCs and other sustainable global surgery efforts. Working at a grassroots level, local global surgery boards can directly monitor and engage in local global surgery efforts, assess local needs, and share these needs with the relevant national global surgery board. These national boards can then monitor local efforts and guide resources and funding to underserved areas, while consolidating requests to share with the international board. The international board tracks global surgery efforts, receives requests/needs from the national level, consolidates data/research, tracks funding, and disseminates data and knowledge of successes/failures down to national boards, who can then share this global information to those working on the local level