Attitudes and Practices Regarding Volunteering Among Romanian Medical Undergraduate Students

Study sample and data collection

Between May and June 2018, a cross-sectional survey was conducted with third and fifth-year students of the Faculty of Medicine at the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. The study was approved by the Iuliu Hatieganu University of Medicine and Pharmacy's Ethics Commission (Approval no. 194/19 April 2018).

All students in years 3 and 5 from the Romanian section of the faculty were invited to participate in the study by completing an anonymous questionnaire between May and June 2018.

There were 510 participants in the final sample, with 260 students in year 3 of study (out of a total of 324) and 250 students in year 5 of study (out of a total of 308). As a result, students in year 3 had an attendance rate of 80.2%, and students in year 5 had an attendance rate of 81.1%. Among the students of year 3, 36.5% are boys and 63.1% are girls. Among the students of year 5, 29.6% are boys, and 70.4% are girls.

Instrument for data collection

The questionnaire investigated socio-demographic (age, gender) as well as attitudes and behaviours of undergraduate medical students toward volunteering. The concerns investigated were:

- How helpful it is for students to engage in voluntary activities (possibilities of responses on a 5-point scale ranging from very useful to not at all useful).

- Undergraduate volunteering participation is influenced by a variety of factors: individual variables (personal motivation and interest, the desire to improve the personal curriculum vitae, encouraging influence from other colleagues) and institutional elements (presentation of volunteer opportunities for students by teaching staff); The possible responses were graded on a 5 point scale ranging from to a significant extent to not at all.

- At the same time, the questionnaire investigated if during their undergraduate studies the students were involved in some forms of volunteering (Possibilities of answering Yes, No), and what were the volunteer activities in which they were involved. Moreover, the questionnaire tried to get information regarding motivation and willingness to get involved in volunteering activities during or after medical education (Possibilities of answer Yes, No, I don’t know).

Attitudes regarding volunteering

The findings reveal that the majority of students from both years of study appreciate the value of volunteering in the medical profession, with more than 90% of both years considering volunteering useful or very useful. Thus, 43.6% of students in the third year of study and 47.2% of students in the fifth year of study consider it very useful to get involved in volunteer activities. Also, 49.8% of students in the third year and 45.6% of students in the fifth year consider it useful to get involved in volunteer activities. On the other hand, 3.9% of students in the third year and 3.6% of students in the fifth year consider volunteering not at all important.

When asked about the elements that motivate medical students to participate in volunteer activities, students in their third year identified personal motivation as the most important factor (64,8% consider this factor to contribute to a very high extent). Around 16% of third-year medical students believe that presentations of volunteering possibilities by university teaching staff help to increase students' involvement to a very high extent, while one-third believe that the goal to improve CV also contributes to a high extent. Almost one-third consider that the influence/example of colleagues contributes significantly (see Table 1).

Among fifth-year students, motivation and interest were the most important factors, with 61.% of students considering they play a significant role in encouraging students to participate in voluntary activities. A quarter of fifth-year students recognized the presentation from the university teaching staff as a very important aspect. Around one-third believe that the desire to improve CV contributes significantly. Around one-third of them regard the influence of colleagues to be relevant to a very high extent (see Table 1).

Practices regarding volunteering

Our findings show that more than half of the third year group declared that they we involved in some forms of volunteering activities already (60.38% of students participated in the Organization of Medical Students (OSM), an organization under the leadership of student leaders of the university, and only 5.38% were involved in other organization, and 18.07% declared that they were involved in both), while less of the fifth year did so (34,8% of students participated in the organization of medical students (OSM), and around one-third were involved in other organization, while 8,8% declared that they were involved in both ) (see Table 2).

With Around one-third of both years, students were involved in student exchanges, student organizational activities, or administrative activities. Among third-year students, almost half of the students were involved in health education and medical support activities, while only 7.30% volunteered in the emergency and medical assistance service. On the other hand, 28.8% of the fifth-year students declared that they were involved in student exchanges, student organizational activities, or administrative activities, and only 6.4% declared they volunteered in the emergency and medical assistance service (see Table 2).

Students were asked if they would like to participate in volunteer activities while in medical education and most of the students in the third year answered “yes”, ( 83.2% of the students), 7.8% answered “no” and 9% answered, “I don't know”. Among the students in the 5th year, 74.8% of the students answered “yes” 15.6% answered that they do not want to get involved in such activities during the faculty and 9.6% answered, "I don't know".

Most of the students of both years expressed their willingness to participate in volunteer activities after graduation. Thus, 55.3% of third-year answered “yes” while 33.2% answered “I don't know”, and only 11.5% answered that they do not want to participate in research projects in the future. Among the students in the 5th year, 62.8% of the students answered “yes”, around 14% answered, "I don't know", and 14% answered that they do not want to get involved in such activities after graduation.

Discussions

In this study, we investigated attitudes and practices regarding involvement in volunteer activities among medical students at the Faculty of Medicine and Pharmacy in Cluj Napoca, Romania. The target groups were students in the 3rd and 5th year of study, from the Romanian section. So far, this is the first study of its kind conducted in Romania. There are several studies conducted in the literature at the international level on the importance, necessity, and benefits of involving medical staff in volunteer activities since the early years of study. According to the findings of our research, the vast majority of students who responded to our survey believe that volunteering is useful and contributes to their professional development. The findings of other research studies published in the literature supplemented the value of involvement in volunteerism as previously reported by other medical students. Community service in the area of medicine involves a faster maturation of the student in overcoming challenges and thinking creatively to find answers for the communities (Loh et al., 2015).  Students have improved communication skills, organizational abilities, and flexibility in interacting with challenges, particularly if confronted with unfamiliar or unexpected situations. The students admitted that the abilities and emotional strength they obtained helped them grow as people. Many agreed that the experience would help them become better physicians (Haidar et al., 2020; Loh et al., 2016; Pravder et al., 2022; Rovers et al., 2016).

An interesting perspective on volunteering is described by Rovers et al. (2016). They discuss the concept of volunteering, which is in fact a voluntary activity, meant to help others, but, according to existing studies on the motivation of involving medical students in volunteering, they emphasize a much more complex activity. In the study, the authors treat this point of view from two perspectives: one in which volunteers are willing to volunteer, but the context matters less, and another in which volunteers select the type of voluntary activity based on the costs and benefits of their services, and the context for volunteering matters the most (Rovers et al., 2016).

Through this research, we tried to establish what are the factors involved in the decision of medical students at the Faculty of Medicine and Pharmacy in Cluj Napoca, to get involved in volunteer activities. Most of the students of both years reported that motivation and self-interest are the determining factor in the decision to volunteer, while, the desire to improve the personal curriculum vitae, encouraging influence from other colleagues presentation of volunteer opportunities for students by teaching staff, are also important factors.

Therefore, comparing the motivations of our study participants with the participants of the research conducted by Rovers et al. (2016), which followed the attitudes of medical students regarding the involvement in volunteer activities such as medical service trip, we notice some similarities. As a result, the majority of responses are based on personal interest: the opportunity to engage with cultural diversity, to collaborate with other medical practitioners, the educational possibilities, the possibility to enhance clinical skills, while the contribution of this professional experience in compiling the CV was considered to a lesser extent. Regarding the influence of other colleagues who participated in volunteer activities, the findings underline their interest in convincing other students to get involved in these activities. The participants said they would advise others to join in community service because it enhances horizons, but they said that community service should be chchosenoice, not imposed (Loh et al., 2016). Another study describes an interesting method in which teachers encourage and offer opportunities to participate in volunteering. Thus, Houston's McGovern Medical School organized a Day of Service to encourage medical student volunteerism. The Day of Service is a yearly one-time volunteering event in the spring that involves all first-year medical students. The office of the medical school found local volunteer opportunities and assigned groups of students to each (Haidar et al., 2020).

Regarding the activities carried out by students during medical education, they differ internationally. In the United States, several medical schools have included volunteering in the compulsory curriculum under the term Service-Learning, which is a planned educational experience that incorporates community service with planning and reflection. Students situate their positions as health professionals, activists, and residents in a wider societal framework through service learning (Haidar et al., 2020; Loh et al., 2016; Sheridan et al., 2010). Another method of volunteering is performing volunteer in the Student-Run Clinic (SRC), which is a place where students provide healthcare services under the supervision of certified healthcare professionals. Most SRCs assist the underserved, including the poor, homeless, and/or unemployed (Huang et al., 2021; Johnston et al., 2020).

Because the mandatory curriculum in medical education in Romania does not include participation in volunteer activities during college, it is up to the students to decide whether or not to participate in these activities. The findings of our study show a higher level of involvement in OSM activities among students in year 3, most likely due to the wide range of opportunities offered by this organization within UMF Cluj, particularly in projects that are likely to be recently established, which explains why there is such a large difference between the two groups of students. OSM annually organizes events in which volunteer opportunities are presented. Students also reported participation in other volunteer organizations. In terms of activities preferred by students, most preferred to get involved in student exchanges, student organizational activities, and administrative activities, and in health education and medical support activities. Furthermore, a much lower percentage of students stated that they were volunteers in the emergency services, probably due to the selection of participants through staged exams,  but also probably due to the demanding work schedule. Other findings have shown a strong desire of medical students to actively help in medical emergencies (Gouda et al., 2020).

Interest and willingness to perform volunteering during undergraduate studies were higher among students from both year of study, while willingness to perform volunteering after graduation were less. The published studies showed that the students were motivated to participate in community service by their past experiences, current motivations, and future goals. Reasons for community service participation include previously positive experiences with community service and current aspirations such as compassion, self-discovery, and so on. Students reported increased empathy, enhanced communication, organizational, judgment, social, and leadership abilities. Thus, participating in community service during medical school improves post-graduate participation. Because time is limited and performing community service is encouraged, students selected only a few more relevant or viable volunteer activities to engage in (Loh et al., 2016).

Numerous limitations apply to this investigation. It enrolled only third and fifth-year students and utilized an exploratory questionnaire to investigate undergraduate medical students' attitudes and behaviors toward volunteering. Future research using quantitative and qualitative methods conducted among students of all academic years would provide more valuable data.