healthcare-communications.imedpub.com/Healthcare professionals increasingly report interest in global health and participation in international healthcare delivery. Growth opportunities exist for trainees to improve knowledge, skills and attitudes through international experiences. Professional development via international medicine may have lasting effects on patient care and practice patterns following training. In 2010, the first resident took part in an international, exchange elective between The George Washington University’s Department of Anesthesiology in Washington, DC and La Universidad de San Francisco’s Department of Anesthesiology in Quito, Ecuador. This resident elective rotation resulted from a strategic partnership, initiated in 2008, between two training institutions with an established track record of medical student educational exchange programs. The goal of any resident elective rotation should be to enhance an educational experience, to improve upon a perceived training deficiency, or to create a unique offering that takes advantage of local assets and connections. International electives, if properly conceived, can accomplish all three goals. This guide for program leadership addresses the rationale and challenges, from concept to Accreditation Council for Graduate Medical Education approval, of creating an international clinical rotation for residents.