ORIGINAL REPORTS Coalition for Global Clinical Surgical Education: The Alliance for Global Clinical Training Jahanara Graf, MD,* Mackenzie Cook, MD, †,‡ Samuel Schecter, MBBS, § Karen Deveney, MD, †,‡ Paul Hofmann, DrPH, ‡ Douglas Grey, MD, ‡ Larry Akoko, MD, ║ Ali Mwanga, MD, ║ Kitembo Salum, MD, ║ and William Schecter, MD ‡,¶ * Department of Surgery, University of California/East Bay, Oakland, California; † Department of Surgery, Oregon Health Science University, Portland, Oregon; ‡ The Alliance for Global Clinical Training, San Francisco, California; § Santa Rosa Department of Surgery, Kaiser Permanente Medical Center, Santa Rosa, California; ║ Muhimbili University of Health and Allied Sciences, Muhimbili National Hospital, Dar Es Salaam, Tanzania; and ¶ Department of Surgery, University of California, San Francisco, San Francisco, California OBJECTIVE: Assessment of the effect of the collaborative relationship between the high-income country (HIC) sur- gical educators of the Alliance for Global Clinical Training (Alliance) and the low-income country surgical educators at the Muhimbili University of Health and Allied Sciences/ Muhimbili National Hospital (MUHAS/MNH), Dar Es Salaam, Tanzania, on the clinical global surgery training of the HIC surgical residents participating in the program. DESIGN: A retrospective qualitative analysis of Alliance volunteer HIC faculty and residents' reports, volunteer case lists and the reports of Alliance academic contributions to MUHAS/MNH from 2012 to 2017. In addition, a survey was circulated in late 2016 to all the residents who participated in the program since its inception. RESULTS: Twelve HIC surgical educators provided rotating 1-month teaching coverage at MUHAS/MNH between academic years 2012 and 2017 for a total of 21 months. During the same time period 11 HIC residents accompa- nied the HIC faculty for 1-month rotations. HIC surgery residents joined the MUHAS/MNH Department of Sur- gery, made significant teaching contributions, performed a wide spectrum of “open procedures” including hand-sewn intestinal anastomoses. Most had had either no or limited previous exposure to hand-sewn anastomoses. All of the residents commented that this was a maturing and challeng- ing clinical rotation due to the complexity of the cases, the limited resources available and the ethical and emotional challenges of dealing with preventable complications and death in a resource constrained environment. CONCLUSIONS: The Alliance provides an effective clin- ical global surgery rotation at MUHAS/MNH for HIC Surgery Departments wishing to provide such an oppor- tunity for their residents and faculty. ( J Surg Ed ]:]]]-]]]. J C 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: global surgery, training, education COMPETENCIES: Medical Knowledge, Patient Care, Profes- sionalism, Interpersonal and Communication Skills, Practice- Based Learning and Improvement, System-Based Practice INTRODUCTION Two billion people lack access to surgical care worldwide. 1 Many live in low- and middle-income countries (LMIC). 2 When the 234 million surgical procedures performed annually in the world are analyzed, only 26% of them occur in health care systems with a yearly per capita spending of less than $100—systems that care for 70% of the world's population. 1 The result is a high rate of preventable death and disability. Tanzania is a stable democracy in eastern Africa with a population of approximately 47 million people and a mean life expectancy of approximately 54 years. The yearly per capita health care spending is 52 US dollars, meeting the World Health Organization definitions of a low-income country (LIC). There are approximately 180 trained sur- geons in all of Tanzania. 70% of the operations in Tanzania are performed by Medical Officers, nonphysicians who have 2 years of training. The Muhimbili University of Health and Allied Sciences (MUHAS) in Dar Es Salaam, Tanzania is the major Correspondence: Inquires to William P. Schecter, MD, 1155 Rhode Island Street, San Francisco, CA 94107; e-mail: wpschecter@gmail.com (W. Schecter) Journal of Surgical Education  & 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. 1931-7204/$30.00 http://dx.doi.org/10.1016/j.jsurg.2017.08.019 1