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.

Introduction Telemedicine is a remote medical practice using information communication technology (ICT), and has been increasing in France since 2009. With all new forms of medical practice, education and training (ET) is required for quality and safety. To date, implementation of telemedicine ET has not been assessed in France. The objective of this study was to describe the implementation of telemedicine ET and evaluate the knowledge, attitudes and practices (KAP) of deans and associate deans from all medical schools in France. Methods A cross-sectional non-mandatory, descriptive online survey with a self-administered questionnaire was performed from 15 November to 6 December, 2017. Respondents were accessed through the ‘ Conférence des doyens des Facultés de médecine’. Results There were 48 respondents with a 47.4% response rate among deans. Telemedicine ET was limited in France; 10.4% in 1st year medicine (PACES); 4% in the final 3 years of medical school (D.F.A.S.M.) and 18.8% in medical residency. Emergency medicine, dermatology, radiology, neurology and geriatrics were specialties with implemented telemedicine training during residency. Of all respondents, 90% expressed a need to increase telemedicine ET, among which 75% accepted external support. A highly positive attitude towards telemedicine practice was reflected by 60.4% of respondents, and 56.2% practiced telemedicine at least once. Discussion This study was the first to assess national telemedicine ET implementation in France. Telemedicine was integrated into initial medical education; however, telemedicine ET remains limited despite the positive attitudes of deans and associate deans. Further research would need to be conducted on telemedicine ET implementation and KAP of medical students and residents.

Hyperglycemia induces all isoforms of transforming growth factor β (TGFβ), which in turn play key roles in inflammation and fibrosis that characterize diabetic nephropathy. Sphingosine 1-phosphate (S1P) is a signaling sphingolipid, derived from sphingosine by the action of sphingosine kinase (SK). S1P mediates many biological processes, which mimic TGFβ signaling. To determine the role of SK1 and S1P in inducing fibrosis and inflammation, and the interaction with TGFβ-1, 2 and 3 signalling in diabetic nephropathy, human proximal tubular cells (HK2 cells) were exposed to normal (5 mmol/L) or high (30 mmol/L) glucose or TGFβ-1, -2, -3 ± an SK inhibitor (SKI-II) or SK1 siRNA. Control and diabetic wild type (WT) and SK1(-/-) mice were studied. Fibrotic and inflammatory markers, and relevant downstream signalling pathways were assessed. SK1 mRNA and protein expression was increased in HK2 cells exposed to high glucose or TGFβ1,-2,-3. All TGFβ isoforms induced fibronectin, collagen IV and macrophage chemoattractant protein 1 (MCP1), which were reversed by both SKI-II and SK1 siRNA. Exposure to S1P increased phospho-p44/42 expression, AP-1 binding and NFkB phosphorylation. WT diabetic mice exhibited increased renal cortical S1P, fibronectin, collagen IV and MCP1 mRNA and protein expression compared to SK1(-/-) diabetic mice. In summary, this study demonstrates that inhibiting the formation of S1P reduces tubulointerstitial renal inflammation and fibrosis in diabetic nephropathy.

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