Resolving these tensions requires a collaborative, comprehensive, generation-spanning approach to global health education. A recent Lancet
commission on professional medical education noted that education has stagnated in the face of growing and shifting health challenges; faculty are “essential to investing in future health dividends by training the next generation of health professionals” 
. Indeed, faculty investment from all resource settings will be essential to lead rational and effective programs. Senior mentors from institutions in HI countries have expertise in the complex and high-tech care of diseases, advanced research methods, and innovative curriculum. However, these mentors do not provide the same breadth of experience as their developing country counterparts with respect to best practices in high disease burden, low-resource settings where these same technologies and medications are simply unavailable 
. Any global scale-up of education will require augmenting the bandwidth of leadership and experience of doctors trained in LMIC settings.
While academic mentorship and senior faculty are needed to lead this effort, investment must also overcome a “mid-level” leadership gap in LMIC academic centers. For both research and clinical medicine, this cadre of mid-level investigators and clinicians will create the visible and replicable pathway to international leadership for future students and junior trainees. The Network of African Health Science Academies states that a sustainable economic future for Africa lies in “strengthening the continent's scientific and technological capacity… [a goal that] can only be met if Africa educates and retains a critical mass of world-class scientists and technologists with the knowledge and expertise to address the continent's key scientific, technological and economic problems” 
. A tenable path for career development will help buttress retention of indigenous physicians and researchers.
Considerable discussion has revolved around the importance of partnerships to integrate global health training 
. For example, the Swiss Commission for Research Partnerships (KFPE) published guidelines over a decade ago to guide best practices for how to establish mutually beneficial relationships 
. However, these and other guidelines are not always heeded, and mobilizing complementary and equitable partnerships remains a challenge 
. Whose interests are served through academic and other global health programs? The benefits for visiting residents and researchers are documented, including improved clinical skills, publications, and greater understanding of the challenges of delivering care in LMIC settings 
. There is less attention, however, devoted to the effects on recipient countries. Visiting trainees, for example, could potentially consume real financial and human resources without a clear benefit to host institutions 
. Resources devoted to transportation, orientation, and acculturation need to be re-delivered to every incoming class of “rotators.”
Structured partnerships with devoted human resources and infrastructure foster integrative, supervised exchanges, which may help mitigate some of the intangible costs of volunteerism 
. The KFPE endorses the idea that not only the outcomes of research should be valued, but also the interaction between scientists and the public and how research impacts everyday life 
. Along these lines, a number of such partnerships have developed between academic medical centers in HI countries and centers in LMIC settings. Cambridge University and its affiliated teaching hospital, Addenbrooke's, have partnered with Princess Marina Teaching Hospital in Gaborone, Botswana. Responding to the needs outlined by the Botswana hospital and Ministry of Health, the partnership has established common goals for education, research, and capacity building 
Medical institutions in HI settings, whose strengths are advanced practice standards, complex disease management, and scientific innovation, are natural allies to help buttress medical education and build capacity in partner countries. Drawing on their academic strengths, most HI countries' programs target support for three missions: health care delivery, research, and training their staff shoulder-to-shoulder with partner-country health providers. This “twinning” of professionals side-by-side encourages mobilization to fill human resource needs while simultaneously investing in capacity-building efforts and sustainable partnerships. To be effective in this mission, they rely on bi-directional teaching and training where developing local programs must be a priority 
. For greater impact, programs need to be initiated and nurtured by both partner institutions rather than “inviting” in-country partners into plans that are already developed by the visiting partner. Success is measured two-fold: first by the quality of the experience for both the HI- and partner-country trainees, and second by the incremental improvement in in-country care, infrastructure, and/or research to which a trainee contributed.
While the detailed challenges of building effective research partnerships are beyond the scope of this discussion, they should not be minimized in the international setting. Important areas for mutual collaboration and outcomes include developing research priorities, technical capacity building, creating consensus across differing approaches to human subjects protection, establishing administrative and fiscal management structures, and maintaining reporting structures. Several organizations have dedicated themselves to just these challenges. Agencies such as the Wellcome Trust 
, WHO's Essence on Health Research 
, and the Council on Health Research for Development 
are paying increasing attention to building institutional and overall system capacity for research. The focus on strengthening research capacity is originating from LMIC settings as well. The Initiatives for Strengthening Health Research Capacity in Africa is one such example