From training to practice: a qualitative study of GPs’ shared decision-making experiences

This is the author accepted manuscript. The final version is available on open access from the Royal College of General Practitioners via the DOI in this recordBackground: Although shared decision-making (SDM) is key to delivering patient-centred care, there are barriers to general practitioners (GPs) implementing SDM in practice. SDM training is undergoing development by organisations, including the Royal College of General Practitioners. However, GPs’ perceptions of the delivery of SDM training in general practice remain largely unexplored. Aim: To explore GPs’ perceptions of teaching methods in SDM training. Design and Setting: A qualitative study of GPs with teaching roles at the University of Exeter Medical School was conducted. Method: Purposive sampling recruited 14 GPs. Semi-structured interviews explored their SDM educational experiences. Data were analysed using thematic framework analysis. Results: Three themes were identified. The GPs described role-play, receiving feedback, and on-the-job learning as modes of delivering SDM training that positively informed their SDM in clinical practice. Learning from knowledgeable individuals and using realistic patient cases were perceived as beneficial components of SDM learning, though most learning occurred implicitly through reflections on their clinical experiences. The GPs identified the incorporation of the uncertainty that is present in general practice consultations; targeting of individual GPs’ SDM learning needs and explanation of the potential benefits of SDM on consultation outcomes as important methods to facilitate the implementation of SDM in practice. Conclusion: This is the first UK study to explore GPs’ perceptions of SDM training and provide recommendations for practice. As SDM occurs in partnership with patients, further research should obtain and incorporate patients' views alongside those of GPs in the evaluation of future programmes.National Institute for Health Research (NIHR

A meta-analysis of long-term effects of conservation agriculture on maize grain yield under rain-fed conditions

Conservation agriculture involves reduced tillage, permanent soil cover and crop rotations to enhance soil fertility and to supply food from a dwindling land resource. Recently, conservation agriculture has been promoted in Southern Africa, mainly for maize-based farming systems. However, maize yields under rain-fed conditions are often variable. There is therefore a need to identify factors that influence crop yield under conservation agriculture and rain-fed conditions. Here, we studied maize grain yield data from experiments lasting 5 years and more under rain-fed conditions. We assessed the effect of long-term tillage and residue retention on maize grain yield under contrasting soil textures, nitrogen input and climate. Yield variability was measured by stability analysis. Our results show an increase in maize yield over time with conservation agriculture practices that include rotation and high input use in low rainfall areas. But we observed no difference in system stability under those conditions. We observed a strong relationship between maize grain yield and annual rainfall. Our meta-analysis gave the following findings: (1) 92% of the data show that mulch cover in high rainfall areas leads to lower yields due to waterlogging; (2) 85% of data show that soil texture is important in the temporal development of conservation agriculture effects, improved yields are likely on well-drained soils; (3) 73% of the data show that conservation agriculture practices require high inputs especially N for improved yield; (4) 63% of data show that increased yields are obtained with rotation but calculations often do not include the variations in rainfall within and between seasons; (5) 56% of the data show that reduced tillage with no mulch cover leads to lower yields in semi-arid areas; and (6) when adequate fertiliser is available, rainfall is the most important determinant of yield in southern Africa. It is clear from our results that conservation agriculture needs to be targeted and adapted to specific biophysical conditions for improved impact

Technology-Mediated Higher Education Provision during the COVID-19 Pandemic: A Qualitative Assessment of Engineering Student Experiences and Sentiments

The advent of COVID-19 at the beginning of 2020 put universities worldwide into one of the most significant educational disruptions ever experienced. The unrelenting pandemic forced universities to turn to technology to ensure continuity of education. This abruptly changed learning modes for students, with potential implications on the quality of education and the student experience. Therefore, it became necessary to study experiences and sentiments toward learning under the pandemic through the lens of students. Perspectives on the new norm of learning can shed more light on digital technology's roles in learning. The new understanding is potentially useful for conceptualizing future technology-mediated higher education provision. This study follows qualitative research approaches, engaging eleven postgraduate students in three U.K. universities for in-depth semistructured interviews. Thematic analysis is adopted, interpreting sentiments into three interchangeable themes. The findings show that learning during the pandemic has raised many concerns for the future adaptations of online learning. A key finding from this study is that students are generally disappointed by their experiences of online learning effectiveness during the pandemic. One reason for this disappointment is the absence of adequate interactions amongst students due to the reduction in informal student engagement opportunities. The study also suggests that educators need to rethink current technology-mediated education delivery approaches to ensure effective learning. Similarly, students also need to be flexible and openminded, enabling them to adapt to the emerging higher education landscape