Knowledge, attitudes and practices of telemedicine education and training of French medical students and residents.

INTRODUCTION: Telemedicine is a remote medical practice that is progressively expanding in France. In 2018, regulatory changes authorised telemedicine to become part of daily clinical practice. Telemedicine education and training (ET), however, has not been widespread, despite its integration in the medical curriculum since 2009. The objective of this study was to examine the self-perceived knowledge, attitudes and practices (KAP) and ET of telemedicine ET from medical students and residents in France. METHODS: A national survey was distributed online (15 December 2018 to 3 March 2019) to approximately 135,000 medical students and residents in medical schools (n = 38). The survey consisted of a total of 24 binary and Likert-scale questions covering telemedicine ET and KAP. RESULTS: In total, 3,312 medical students and residents completed the survey. Synchronous video consultation was the most well-known telemedicine activity (86.9%); asynchronous tele-expertise was the least recognised (40.3%). Most respondents (84.8%) stated they were not familiar with telemedicine regulations. The relevance of telemedicine for improving access to care was acknowledged by 82.8% of students and residents; 14% of respondents stated they had previously practised telemedicine during their studies; 14.5% stated they had received telemedicine ET; however, 97.9% stated they were not sufficiently trained. DISCUSSION: This is the first national scale study on telemedecine ET by medical students and residents, to date. Despite positive attitudes, participants were found to have limited telemedicine ET, knowledge and practices. The demand for telemedicine ET is increasing. Such studies that incorporate the perspectives of medical students and residents may strengthen the implementation of telemedicine ET in the future.

Pali and Echo Phenomena: Symptoms of Persistence and Perseveration.

Some neurological or psychiatric positive, productive symptoms are an abnormal persistence of a sensorial feeling or abnormal repetition of a motor, behavioral or cognitive process corresponding to a perseverative symptom. Palinopsia, palinacousis, and related sensorial symptoms have been described. Verbal and motor symptoms include echolalia, palilalia, echopraxia, and motor perseveration. Cognitive disorders induce perseverative behavior, perseverative thinking, including palipsychism, flashbulb memories, and reduplicative paramnesia (also known as "palimnesia") and many related perseverative symptoms. We propose a review of physiological phenomena and pathological symptoms involving these perseverative or repetitive characteristics and discuss the potential mechanisms and neural network involved in this productive semiology.

Telemedicine in stroke: organizing a network--rationale and baseline principles.

Telestroke is the specific term used for the application of telemedicine in stroke. It is a consultative modality that facilitates care of patients with acute stroke at underserved hospitals by specialists at stroke centers and can play a vital role in minimizing the overall medicosocial impact of stroke. Telestroke should not be viewed as a new form of stroke therapy, rather as a means of supporting the increased delivery of evidenced-based medicine in stroke. The design and implementation of a hub-and-spoke telestroke network are complex and require state-of-the-art technology and close, organized collaboration between healthcare professionals if they are to be achieved. Telestroke is becoming part of clinical practice in some regions. It provides rapid access to specialized treatment and it could also potentially lead to major improvements in basic on-site management. Telemedicine is also being used for secondary prevention, rehabilitation, education and long-term stroke care. However, for progress to continue and in order to ensure the long-term sustainability of telestroke, various medicolegal, economic and market issues need to be resolved.

Barriers, legal issues, limitations and ongoing questions in telemedicine applied to stroke.

The use of telemedicine services, such as telestroke, is still highly fragmented and its deployment in an integrative healthcare system is challenging. Factors impeding the growth of telemedicine include confidence and malpractice issues, technical advances, reimbursement, licensing, credentialing costs, cost effectiveness, and legal issues. These barriers, limitations and requirements in the routine use of telemedicine are reviewed, in addition to medical activities, the objectives of telestroke, technical aspects, funding, legal issues, evaluation and quality management. As telemedicine induces a new form of interrelationship between health care providers, mutual trust and acceptance need to be developed in telemedicine services. Furthermore, education and training will be crucial in order to facilitate the use of telestroke over the next decade.