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BackgroundIndicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally.Methods and findingsThe Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees.ConclusionsTo track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.

The COVID-19 pandemic caused a global disruption to higher education, especially in engineering education, where many teaching and learning activities are difficult or impossible to conduct online. This study examines the changes in the students' experiences of this disruption using a 26-item process-oriented course experience questionnaire (CEQ) that was already in use in the Faculty of Engineering at Lund University (LTH), rather than a newly created pandemic questionnaire. This allowed results from spring 2020 to be compared with corresponding data for 2017-2019. Overall, the students expressed lower satisfaction with their courses, indicated they received less feedback and fewer valuable comments, and found it harder to understand the expectations and standards of work. On the positive side, students reported that assessment was less about facts and more about in-depth understanding. By gender, male students were overall more negative to the experience of online learning, whereas female students appeared better able to benefit from the shift to online learning. Our results show the great advantage of using a robust course evaluation system that focuses on students' learning experience rather than satisfaction, and suggest a way of being prepared to systematically study the effects of possible future disruptions to higher education.

A letter to the editor is presented in response to an article on measuring outcomes of hospital care by Matthew Austin in the March 2015 issue.