This study demonstrated the relationship between volunteering and academic performance, represented by AGPA, in the pre-clinical phase of undergraduate medical education. Unlike many previous studies that rely on student self-reported data, our study was able to use actual institutional data to understand this relationship. Another unique aspect of this research was conducted in the UAE, as much of the research on this topic reports findings from North America or Europe.
Relationship between volunteering and AGPA
The results of the current study suggested a positive correlation between AGPA and volunteering among medical students. However, this relationship differs across the three pre-clinical study years. In year one, the relationship was negative (r = − 0.024), while in years two and three, the relationship was positive (r = 0.209 and r = 0.194 respectively). However, it was only significant in year two (p-value is 0.047). Our observation concurs with Tinto (1993), who studied students’ decisions to volunteer and reported that the transition from high school to college might affect students’ inclination to volunteer based on factors such as the consistency in norms and expectations between past environment and new ones and how well prepared students are to navigate participation and involvement in a new environment.17 First year in a medical college is usually a transition phase from high school to college where the uncertainty level among the students witnessed to be elevated.18 Students may not be immediately aware of the balance between academics and non-academics needed to maintain academic standing, with first years especially feeling this stress as they have the added pressure of ensuring they fulfill the progression requirement mandated in the degree plan of the MBBS program, where the student is required at the end of year one to achieve minimum AGPA to progress from phase 1 (year one) to phase 2 (years two and three).
As for the year one students, an insignificant negative correlation was reported in the first cohort (r = -0.062; p-value is 0.654). The students in Cohort 1 are unique in that they were the first cohort of students in the newly founded university, who are nicknamed “The Pioneers”. There is a high likelihood that these students had the same degree, or even greater degree, of uncertainty, which could have reduced students’ motivation to volunteer. This may aid to elucidate the obtained negative correlation between the two variables in year one and first cohort students. Cohort 1 also had access to a limited number of volunteering activities in the early years, with more competition over these limited slots, which could also explain the insignificant negative relationship between the two variables.
A positive insignificant correlation was observed across Cohort 2 and Cohort 3 (r = 0.236; p-value is 0.430 and r = 0.160; p-value is 0.215 respectively). The positive relationship in later cohorts and years two and three could support the claim that students are more assured of their environment after year one and feel more empowered to volunteer while maintaining achieved AGPA. Despite the assuring environment, the positive relationship was not significant, except in year two. Holdsworth (2010) explored how student motives to volunteer change over time, noting ‘opportunity’ as one motivation contributing to whether or not a student would volunteer their time. Opportunity “capture circumstances that students find themselves in” which includes commitments to external activities and having spare time.19 Year two is noteworthy because it is the only year of the first three years that does not have high stakes and a high-pressure end-of-year bar exam.
The types of volunteering activities could also be a factor. It is noteworthy that most activities available across the three study years were primarily focused on interpersonal and communication skills. Year three students may not find these activities of great interest as their motives for volunteering may shift towards activities that build hands-on skills in preparation for clinical placements. Skills building was noted as a motive in Holdsworth (2010), and Handy et al., (2010) described how often initial motives for students to volunteer is to contribute to the development of their resume.19,20 Intergenerational interactions and community-oriented experiences can provide medical students with experiential learning opportunities beyond a traditional medical school curriculum.6 These experiences hone essential communication skills and promote an increased understanding of the contextual health problems faced by community members.6
Notably, a significant positive correlation between the two variables was observed in year two. Students are perhaps better oriented and aware of expectations, with more personal development in an assuring environment. They are also alleviated from stress related to having to sit a progression bar exam hence, they may be more willing to navigate participation and involvement in volunteering activities.
Students on the higher and lowers ends of academic performance, as expressed by AGPA, volunteered less frequently than students with optimal performance. Our results do not agree with the findings of previous literature, which suggested that students with higher levels of service/service-learning reported higher grades, attendance, and other academic success outcomes.21,22 Our results in Fig. 3 indicated that students with optimal performance are engaged in voluntary activities (AGPA 2.5–3.5; events 611) more than those with suboptimal performance (AGPA < 2.5; events 148) or high-performance students (AGPA > 3.5; events 221). Students with optimal academic performance and volunteering engagement may have the personality traits to build a work-life balance, hence they are expected to create a harmonious work-life integration that is critical to improving physical, emotional, and mental well-being and ultimately improvement of their career.23 Students on the highest and lowest ends of academic performance demonstrated a low level of participation in volunteering probably because students with lower AGPAs are more concerned about their academic standing, whereas students with higher AGPAs are more focused on academic aspects. Types of volunteering activities could also have an impact on the students’ motivation towards volunteering.
Characteristics of students who volunteer
The results of this study show that there is equal participation in volunteering from a gender perspective as both females and males have a similar level of involvement in volunteering activities (mean of volunteering number 6.41 ± 0.62 and 6.81 ± 1.06 respectively; p-value = 0.756), though the percentage of females (76.5%) among the studied population is far more than that of the males (23.5%). Additionally, the level of participation in volunteering activities among non-UAE nationals was significantly higher than that of the UAE nationals (mean of volunteering number 7.41 ± 0.68 and 4.64 ± 0.79 respectively; p-value = 0.009). Given the limited amount of research in this area using the UAE as a context, it is impossible to account for why non-UAE nationals volunteer more than UAE nationals. However, Astin & Sax found that the predisposing factor for volunteering was that the student had volunteered while in high school.2 The UAE has a unique cultural landscape featuring a diversity of high school curriculum, with many attending private schools and some UAE nationals attending government schools. A further area of exploration could include taking a deeper look at students’ high school context to determine better if the student had previous volunteering experience or if certain high school curriculums promote volunteering more than others.
This study has several limitations. First, any volunteering the student might have participated in outside of the university that was not reported to the university was not considered in the student’s volunteering record. This might have introduced a shortage in the actual volunteering record of the students. Second, the data in this study constitutes a sample from a single medical school. It would be worthwhile to conduct follow-up studies that compare several programs across multiple institutions and extend the research to include the clinical phases of the medical program.
Volunteering is a long-term commitment that should be approached through a motivational orientation and provides significant practical implications for students.9 It has been described that an organization’s reputation as well as a student’s culture and dispositional factors such as personality traits, beliefs, and values, influence students decision to volunteer.8 A case study of students in the UK suggests that both students and stakeholders recognize that the promotion of volunteering should seek to align institutional practices to promote and support volunteering with young people's expectations and aspirations.24 Previous research recommended preventing mandatory volunteerism in educational institutions as these policies tend to decrease future intentions to volunteer.11
Further research directed to test students’ personality traits related to volunteering motivation and motivational orientation (extrinsic/ intrinsic) are required to provide an indication of the functional motives that are most salient to students and inform in the design of a rewards system that could motivate students to volunteer further. Moreover, medical schools can seek to explore how volunteering opportunities can promote the development of competencies and values, such as encouraging intergenerational volunteerism by emphasizing a culture of community involvement; connecting students with volunteer opportunities that are in alignment with the phase of their educational development; and providing the guidance necessary to create new volunteer initiatives, including financial and promotional support. Exploring the development of an institutional infrastructure to promote student volunteerism would benefit the community population and help to empower and provide learning experiences for a vulnerable student population during times of extraordinary uncertainty, such as with the current COVID-19 pandemic. Further studies can inductively explore the extent of alignment between volunteering and degree plans to understand antecedents to academic performance (e.g., volunteering variables) that could play a moderating or mediating role in the correlation studied in this research.