Disruption caused to medical education by the ongoing Covid-19 pandemic has been well described; however, subsequent sequalae such as volunteering and early graduation remain under-discussed.^21–23 One way volunteering may benefit students is through increased service-based learning, a method of teaching wherein students perform and reflect on roles which intersect with their academic curriculum while also addressing community needs.²⁴

Arguments for adding service roles to curricula are grounded in educational theory, but due to medical school curricula constraints this has not been possible to achieve formally to date. The medical profession relies on experiential learning to refine situational judgement.^25,26 Lave and Wenger’s Communities of Practice (CoP) theory posits that learning is driven by novices working alongside experts and through the process of legitimate peripheral participation they move towards becoming experts themselves.^27–29 The theory was not intended to be a prescriptive model but rather a framework which may guide how to maximise knowledge sharing.^30,31 Gaining experience as part of a clinical team and openly reflecting on it in informal settings can allow students to acquire tacit knowledge and personal growth which formal teaching cannot achieve.²⁷ In this way, even if service-learning roles do not directly offer knowledge-based teaching, they may improve self-confidence, analytical abilities and communication skills.³² The argument that integrated service roles may improve interpersonal skills is also supported by research concerning the educational principle of continuity, which suggests that spending extended periods of time as part of a medical team and following patient care throughout illness episodes may be beneficial.³³ However, it could also be contended that if service roles were not designed and integrated with the principle of continuity in mind, they may further fragment schedules and disrupt existing continuity, including examination timelines. In this way, it is possible that the effects of the pandemic and volunteering may have disrupted existing continuity within medical education.In the future, if such roles were integrated alongside conventional placements rather than disrupting them, they may introduce a fresh degree of continuity. This continuity is key to longitudinal integrated clerkships, a role in which students stay in the same place, with the same group and the same clinical team for extended periods of time.³⁴

Differences between conventional clinical placements and service roles are subtle, since they could involve students being in identical clinical environments but performing different activities. Whilst ‘conventional’ placements are heavily focused around students extracting learning potential from clinical environments, service roles involve balancing the objectives of additional stakeholders, such as the service provider.³⁵ O’Byrne et al. (2020) suggested that, whilst conventional placements can provide a stable learning environment, they may not provide students with the confidence and skills that might be required during a pandemic.³⁶ Conventional placements may be designed to focus on students maximising learning experience, and moving too far towards service provision may too be detrimental.³² A concern that has been raised about service learning pertains to the heterogeneity between different placements, both in terms of the quality of the learning experiences and the grading of these learning experiences.³⁷ By contrast, standard clinical placements often revolve around predefined learning objectives which correspond to standardised assessment criteria.³⁸ This could be attributed to the principal of constructive alignment, which has been widely adopted in medical education in order to ensure that teaching and assessment are aligned with required learning objectives.^39,40

Service-based learning is not equivalent to conventional volunteering, such as the type which is likely to have occurred during this pandemic. Service-based learning incorporates structured volunteer-based activities with pre-defined learning objectives and, crucially, reflective practice.³² It has been postulated that whilst ‘service-learning’ may offer benefits to students, ‘community service’ may hinder their progress.³² On this basis, it is plausible to argue that pandemic voluntary experiences could have been detrimental to medical education. The volunteering that may have occurred during the pandemic was likely to have been unstructured and independent of medical school learning objectives. Such volunteering is commendable, but may offer only incidental or occasional learning opportunities, rather than the clearly defined outcomes of conventional placements. During any future waves of COVID-19, as well as other potential disasters, it may be more beneficial to employ principles of constructive alignment by formalising volunteering roles as medical education opportunities, with defined outcomes and reflection.^40,41 Prior to the pandemic, there were suggestions for increased provision of service-based learning beyond the clinical experience achieved through traditional clinical placements within UK medical curricula.³² In the UK, these suggestions have been in the form of apprenticeship style final-years.^42–44 Though there has been some study of apprenticeships, there has been little empirical research able to recommend specific program structures and implementation steps for service-based learning, especially in earlier years of the medical curriculum.^24,45 However, early efforts to introduce service roles have shown promising results.⁴⁶

The year of medical school in which such programmes are implemented may be an independent factor in determining the success of the programme. For example, Elam et al (2003) suggested that incorporating service-based learning early in curricula may help in developing a community-based perspective towards clinical practice.⁴⁷ Working in voluntary roles under the supervision of nurses and allied healthcare professionals teaches the importance of interprofessional collaboration in delivering care, an early understanding of which can reap dividends in future years of medical training.⁴⁸ Importantly, there is only a limited body of evidence exploring practical considerations of volunteering roles. The early literature does generally concur that matching activities to learning goals and organising reflective learning and assessments can contribute to successful service learning structures.³² This study aims to build on that body of literature by identifying volunteering structures which students found useful during the pandemic, as well as those that they did not.

The current study presents a unique opportunity for research whereby we are able to compare attitudes and perceived outcomes of students who volunteered with those who did not on a large scale. This will help to inform volunteering infrastructure during future waves of COVID-19, as well as informing the structure of current clinical placements and apprenticeships. Our findings may also have implications for re-structuring overseas medical electives where students volunteer without clearly defined curricular or learning objectives.

Our first COVIDReady study sought to explore the willingness to volunteering during the Covid-19 pandemic; COVIDReady2 now seeks to explore the educational impact of volunteering. In the short term, our findings may inform infrastructures for medical student volunteering in future waves of the Covid-19 pandemic. In the long term, our findings may inform the structure of clinical placements, electives, and apprenticeships. We anticipate future studies may explore the effects of volunteering on academic performance and career progression.