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The delivery of medical student education has changed rapidly during the coronavirus disease 2019 (COVID-19) pandemic. Students in their pre-clinical years have transitioned to online courses and examinations. Students in their clinical years are not permitted on clinical rotations, and face uncertainties in career exploration and the residency application process. Medical students in all stages of training are volunteering and helping their communities. The future presence of COVID-19 throughout the United States is unknown, and medical students are eager to return to their training. This paper outlines current challenges in medical student education and the various responses that have been adopted. We also discuss possible future directions for students through involvement in telemedicine, outpatient clinic visits, and non-respiratory inpatient care tasks as adequate personal protective equipment, COVID-19 testing, and resources become more widely available.

BackgroundGenetic causes of dilated cardiomyopathy (DCM) are incompletely understood. LRRC10 (leucine‐rich repeat–containing 10) is a cardiac‐specific protein of unknown function. Heterozygous mutations in LRRC10 have been suggested to cause DCM, and deletion of Lrrc10 in mice results in DCM.Methods and ResultsWhole‐exome sequencing was carried out on a patient who presented at 6 weeks of age with DCM and her unaffected parents, filtering for rare, deleterious, recessive, and de novo variants. Whole‐exome sequencing followed by trio‐based filtering identified a homozygous recessive variant in LRRC10, I195T. Coexpression of I195T LRRC10 with the L‐type Ca2+ channel (Cav1.2, β2CN2, and α2δ subunits) in HEK293 cells resulted in a significant ≈0.5‐fold decrease in ICa,L at 0 mV, in contrast to the ≈1.4‐fold increase in ICa,L by coexpression of LRRC10 (n=9–12, P<0.05). Coexpression of LRRC10 or I195T LRRC10 did not alter the surface membrane expression of Cav1.2. LRRC10 coexpression with Cav1.2 in the absence of auxiliary β2CN2 and α2δ subunits revealed coassociation of Cav1.2 and LRRC10 and a hyperpolarizing shift in the voltage dependence of activation (n=6–9, P<0.05). Ventricular myocytes from Lrrc10 −/− mice had significantly smaller ICa,L, and coimmunoprecipitation experiments confirmed association between LRRC10 and the Cav1.2 subunit in mouse hearts.ConclusionsExamination of a patient with DCM revealed homozygosity for a previously unreported LRRC10 variant: I195T. Wild‐type and I195T LRRC10 function as cardiac‐specific subunits of L‐type Ca2+ channels and exert dramatically different effects on channel gating, providing a potential link to DCM.

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