In 2010, The Continuing Medical and Dental Education Commission of CMDA approved a working group to investigate the experience of medical missionaries with a view to providing information to assist mission agencies in setting a current and sustainable medical mission strategy. The PRISM (Patterns and Responses in Intercultural Service in Medicine) survey is a research report that summarizes those findings. This talk will involve a discussion of the salient, challenging, and sometimes surprising findings of what our full-time, long-term cross-cultural colleagues are facing today.