Involvement of Romanian Students in Volunteering Activities During the COVID-19 Pandemic: Implications for Medical Education and Healthcare

Abstract

This article is related to Sustainable Development Goal 3: Good Health and Well-Being and focuses on preparedness and response strategies, as well as resilient health systems capable of facing health crises. It presents the implementation and perceived effects of two student volunteering programs during the COVID-19 pandemic, underlining implications for medical education and healthcare. A cross-sectional study was performed using anonymous questionnaires among students from the University of Medicine and Pharmacy in Cluj-Napoca, Romania (April–May 2021); 51 student volunteers involved in activities from the Public Health Directorate of Cluj County (PHDCC) and 78 student volunteers involved in healthcare settings (HCSs) participated. The main reasons to become involved in volunteering activities with the PHDCC were the fact that students found the activity useful and necessary for the pandemic control (100%), an interest in helping other people (98.1%) and the need to be involved in the control of the pandemic (98.1%). Students participated in volunteering activities in hospitals, mainly to develop new medical knowledge and skills (94.8%) but also to apply the medical skills and knowledge they had (89.8%), because of the desire to help other people (88.4%) and the need to be involved in the control of the pandemic (87.1%). More than 90% of volunteers from the PHDCC reported an increase in knowledge regarding the transmission/prevention/clinical manifestations/diagnoses of SARS-CoV-2 and improved their abilities to conduct an epidemiological investigation, their communication skills and their capacity to develop and offer information/educational materials for different population groups and to make informed decisions with medical and legal consequences. Among volunteers in HCSs, the positive outcomes most frequently declared were the belief that this volunteering activity represents an important part of their future career, the opportunity to interact with people who were perceived as competent mentors and the fact that it helped them acquire new medical knowledge as well as made them feel useful. There were several differences noticed based on gender, previous volunteering experiences and volunteering position (student volunteer or student coordinator). Healthcare students might be a relevant resource in crisis situations.

1. Introduction

The Sustainable Development Goals (SDGs) are classified into five groups, named the “Five Ps”: (1) people (SDG 1, no poverty; SDG 2, zero hunger; SDG 3, good health and well-being; SDG 4, quality education; SDG 5, gender equality); (2) planet (SDG 6, drinking water and sanitation; SDG 12, responsible consumption and production; SDG 13, climate action; SDG 14, underwater life; SDG 15, life on Earth); (3) prosperity (SDG 7, clean and affordable energy; SDG 8, decent work and economic growth; SDG 9, industry, innovation and infrastructure; SDG 10, reducing inequality; SDG 11, sustainable cities and communities), (4) peace (SDG16, strong institutions for peace and justice) and (5) partnership (SDG17, partnerships to achieve the goals) [1]. This article is related to SDG 3: Good Health and Well-Being and focuses on preparedness and response strategies, as well as resilient health systems capable of facing health crises.

The COVID-19 pandemic was a significant game-changer for healthcare systems worldwide, which had to quickly adapt to a previously unencountered situation [2]. In several countries, national healthcare systems faced several periods characterized by the overworking of public healthcare workers, which paralleled the increasing number of reported cases of COVID-19 [3,4]. Moreover, the number of pre-existing healthcare workers who were willing to continue working in times of crisis decreased, and their activity was further hindered by a disproportionate burden of infection [5,6,7,8]. As there was no efficient treatment plan for the infection with SARS-CoV-2 at the very beginning of the pandemic, public health interventions were identified as efficient means of reducing the burden on the healthcare system [9,10,11].

In Romania, a country with a population of around 19 million people, during the COVID-19 pandemic (February 2020–April 2024), 3,529,735 cases of infection were detected, and 68,929 deaths were registered because of the disease [12].

The county-level Public Health Directorates were assigned a key role in the prevention of new infections by means of case investigations and contact tracing from the beginning of the pandemic. The hospital-level management of patients also had to be streamlined in order to accommodate the increasing number of COVID-19 cases. However, the higher amount of work did not result in a significant supplementation of healthcare workers in Romania, leading to the burn-out of the available workers and the inefficient control of the pandemic [4]. Newer sources of healthcare workers had to be identified, and student volunteers proved to be a reliable resource in public health settings during the pandemic after appropriate training [13,14]. Various reports showcased the initiatives that allowed students to provide adequate help in inpatient healthcare facilities and research programs, conducting epidemiological investigations, reducing social isolation, providing childcare to essential healthcare workers, offering virtual visits to obstetric patients and organizing vaccination programs [13,15,16,17,18,19,20,21].

In the autumn of 2020, an increase in the incidence of COVID-19 cases was observed in Romania, putting pressure on health systems. Moreover, due to the ongoing restrictions imposed by the pandemic at the beginning of a new university semester, medical, dental and pharmacy students were faced with a lack of clinical placements [22]. Volunteering in Public Health Directorates or in inpatient healthcare facilities could lower the burden on healthcare workers and could simultaneously offer an alternative to clinical practice by allowing students to conduct epidemiological investigations and provide help in COVID-19 wards [23].

In 2020, the Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania, comprised three faculties: the Faculty of Medicine, training medical students as well as nursing students; the Faculty of Dental Medicine; and the Faculty of Pharmacy. The percentage of female students varied between faculties, being around two thirds of medical students and of dental medicine students and more than 80% among nursing and pharmacy students. Among each faculty, there were student associations working closely with students and faculty management to help students with several academic and logistic aspects, as well as to encourage their involvement in several social and volunteering activities.

Students from the Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania (IHUMP), showed eagerness to be involved in fighting the pandemic, as seen in several volunteering activities conducted by the local students’ organization—the Medical Students’ Organization from Cluj (MSOC). The students had to face increasing levels of uncertainty about their roles during these times as a result of the unforeseeable development of the pandemic. Despite having already acquired relevant skills and knowledge, students in the field of healthcare are not yet fully trained professionals available to immediately provide support to public health institutions. The internal guidelines of the MSOC provided a starting framework for a collaboration between the Public Health Directorate of Cluj County (PHDCC), IHUMP, several hospitals and student volunteers. These collaborations led to two volunteering programs for public health support through either case tracing and patient counseling or clinical placements. Soon, other governmental and non-governmental organizations provided additional support.

In order to develop proper volunteering programs that would be of significant help to the healthcare system, a proper evaluation of the students’ needs and motivations should be conducted alongside the assessment of gaps in the system [14,15]. Previous work performed in other countries reported that motivational factors such as the desire to be of help and the wish to develop or improve skills played a major role in students’ choice to volunteer during the COVID-19 pandemic, while direct rewards, such as remuneration, receiving credit points or adding new activities to their CV, were perceived as less relevant [15,23,24,25,26,27]. Other studies from different countries in the context of pandemic-related volunteering report a lack of personal protective equipment (PPE) and fear of self or family infection as current major demotivational factors, which can be easily avoidable in the context of Public Health Directorate volunteering, where no contact with patients is expected [28,29,30].

A previous study performed in 2018 among third- and fifth-year medical students from the Romanian section of IHUMP showed that more than 80% of the first group and more than two thirds of the second group were involved in several volunteering activities during medical school [31]. Another study performed in June–July 2021 among Romanian and international students studying at IHUMP showed that one out of five medical students was involved in volunteer activities during the pandemic. Most of them opted to volunteer in a hospital setting (especially international students) and contribute to health education activities (especially women) [32].

To the best of our knowledge, there are currently no studies that take a closer look at Romanian medical students’ volunteering behavior during the COVID-19 pandemic by supporting either the Public Health Directorate or the hospital sector. Understanding the key factors that motivate and hinder students from taking part in such activities would be of great help in better organizing and sustaining future volunteering programs. Using a culturally sensitive approach, relevant lessons could be derived from our paper for the future development of student initiatives both during and outside of crisis situations.

This study presents the implementation of two student volunteering programs aiming to support the PHDCC and various inpatient healthcare facilities during the COVID-19 pandemic and takes a closer look at the motivational factors and barriers that influenced the volunteers’ decisions to become involved and continue their work. Furthermore, we provide insight into the benefits that such programs have in the educational process of the students.

2. Materials and Methods

2.1. Volunteer Program Procedures

2.1.1. Organization of Volunteering Activities in the Public Health Directorate of Cluj County

The activity of the project was based on the needs of the community, which were previously assessed by the county’s Public Health Directorate, and was further guided by the university and the local medical students’ association. These measures ensured the best practices and proper support of the volunteers by including the expertise of three independent organizations: the PHDCC, IHUMP and MSOC.

The first call for volunteers was shared in September 2020 in the official student social media groups. The initial announcement generally stated that the PHDCC was in need of volunteers to offer phone counseling to the general population and to help build a database of patients infected with COVID-19 and their direct contacts in the county. The following day, the registered students were informed of their specific tasks of conducting epidemiological investigations and case tracing. Later, in September and October 2020, students from IHUMP registered for volunteering activities and received training in order to be able to perform their activities. During the training, a Public Health Directorate representative presented key points about patient counseling, contact tracing and legislative regulations. The volunteers were divided into 8 teams coordinated by student volunteers who assigned the cases, supervised their work and offered help when needed. The student coordinators were selected from an initial group of nine volunteers who had been involved since the project’s inception. All nine were invited to take on the coordinator role, and eight accepted. These coordinators received additional training and ongoing support from the PHDCC to help them gradually assume greater responsibilities, particularly as new waves of volunteers joined the project.

The volunteers signed a contract with the PHDCC, including a privacy and confidentiality policy regarding the patients’ personal data, as well as a list of their rights and responsibilities. The assessment method for the volunteering hours was commonly agreed upon: considering that for each conducted epidemiological investigation, the volunteers were responsible for writing and sending a legal notice to every infected person and traced direct contact, one volunteering hour was offered for every five legal documents that were sent. An additional contract with the MSOC was signed by each volunteer, thus offering benefits based on the amount of volunteering hours: a minimum of 30 h provided the status of an active volunteer in the local students’ organization, and by having a minimum of 120 h, the students would receive the necessary credits for the yearly mandatory clinical clerkship.

In order to ensure the consistent application of isolation and quarantine measures, as well as having continuous access to up-to-date legal and epidemiological knowledge, regular meetings with PHDCC representatives were scheduled. The volunteers worked from home, having no contact with the patients or their contacts, and, when needed, logistical resources were offered by the Public Health Directorate (e.g., SIM cards). According to the aforementioned contract, the main responsibilities of the volunteers were as follows:

• Patient counseling. Patients who were tested positive for COVID-19 were called by the volunteers and were given the necessary information about the test result, isolation measures and medical surveillance; patients could also address their concerns during the call. Based on the updated local laws and contact definitions, they were also asked to identify their direct contacts.
• Contact tracing. The identified contacts were then called by the volunteer for counseling and were responsible for informing the volunteer about the occurrence of COVID-19-specific symptoms during quarantine, in which case they would be tested at home.
• Providing legal documents. The volunteers were responsible for requesting personal identification data, including the address of isolation/quarantine and the patient’s general practitioner. The volunteer was then responsible for filling the database and sending a legal notice regarding the isolation (for the positive cases) or quarantine (for the direct contacts) duration, based on updated legal notices.

On 28 November 2020, a new software was introduced to Romania, CoronaForms, the use of which became mandatory starting on 1 January 2021. The platform allowed for a new method of case reporting and legally notifying patients about quarantine/isolation. The platform could be accessed only from tablets offered by the PHDCC. Initially, 6 volunteers were provided with a device; later a total of 10 volunteers had access to CoronaForms. Therefore, the students who continued their work without access to CoronaForms had to report the patients’ information to coordinators who had access to this platform, who would then add the data to the platform.

2.1.2. Organization of Volunteering Activities in Inpatient Healthcare Institutions

The timeframe during which medical students had the opportunity to volunteer in the hospital environment began in November 2020 with the issuance of Emergency Ordinance no. 197 [33]. This action was perceived as necessary due to the increasing number of COVID-19 infections during that period, including infections among medical personnel. These in turn created difficulties in covering the necessary shifts in the healthcare units designated as support hospitals for COVID-19-positive patients. Students had the opportunity to continue volunteering until March 2022, when the state of alert was lifted for the territory of Romania.

With the publication of the Emergency Ordinance no. 197, students were notified by Iuliu Hatieganu University of Medicine and Pharmacy about the possibility of registering as volunteers for activities in inpatient healthcare settings. They had to fill in a registration form, which they could download from the official university website, and the university would centralize and transmit the lists of the students who wanted to participate to the National Center for Coordination and Management of Intervention (NCCMI). The distribution of students was determined according to an analysis of the needs of each hospital, which was carried out by the NCCMI. This distribution was then communicated both to the university and to the County Emergency Situations Inspectorate within the radius of each hospital.

The activity was carried out on the basis of (1) a contract between the student volunteer and the Cluj County Inspectorate for Emergency Situations and (2) the volunteering form issued by the hospital where the volunteer was assigned. The contract mentioned certain rights of the students (the right to participate as a volunteer, the right to be ensured by the hospital of their health and safety depending on the nature of the activity they carried out, the right to be granted a monthly reward for performing the activity, etc.) and also some of their obligations (the obligation to perform the activity established by the hospital, the obligation to participate in the training organized within the hospital, the obligation to maintain data confidentiality, etc.), as well as the minimum number of 120 h per month that could be performed according to a program of 8 or 12 h a day. The volunteering form included a detailed description of the activities expected to be performed by the students, including monitoring and providing care and assistance to the patients.

There was a coordinating physician in each hospital department responsible for their assigned students. The coordinator was in charge of training the volunteers, as well as determining the organization of the hospital wards and assigning tasks. Student training took place on the first day of volunteering. Students were shown the place where they could obtain personal protective equipment (PPE), with the healthcare unit having the obligation to provide it; the correct way of equipping and unequipping in order to minimize the risk of infection; the special circuits created in the hospital; and the way the wards were divided by COVID/non-COVID.

The tasks that the students had to fulfill were diverse, depending on the activity that was carried out in the ward. They participated alongside the medical team in various activities, from organizing medical documents to interacting with patients by obtaining medical histories and performing physical examinations or collecting biological samples, thus helping to make up for the staff shortage. Task assignment was performed both by the coordinating physician and by other healthcare professionals, such as resident physicians or nurses, who also had the role of providing advice or guidance when necessary.

In order to encourage the participation of as many medical students as possible in this project, certain incentives were provided. First of all, the student volunteers who respected the program minimum of 120 h per month were offered a monthly reward of RON 2500. Furthermore, if the student did not manage to complete all the required hours due to infection with COVID-19 or if the measure of isolation at home/quarantine was required by law, the reward was still granted. In addition, in the case of student volunteers who were assigned to hospitals located outside the cities in which they studied or resided, the following was ensured at their request:

(a)

Accommodation and meals (provided by the beneficiary unit or by the local or the county public administration authority within which the beneficiary unit operated);

(b)

An additional monthly reward of RON 20 per day (provided by the county emergency inspectorate that signed the contract with the volunteer student);

(c)

Transportation at the beginning and at the end of the volunteering period (the specific means of transport were provided by the General Inspectorate for Emergency Situations and its subordinate structures).

2.2. Research Methods

2.2.1. Sampling and Procedure for Data Collection

The study procedure was reviewed and approved by the Ethics Committee of IHUMP (Approval no. 98/5.04.2021). A cross-sectional study was performed by means of anonymous questionnaires among students from IHUMP. The study was performed from April to May 2021.

For this study, all student volunteers that worked at the PHDCC (N = 113), as well as students who were involved in different volunteering activities in inpatient healthcare settings in Cluj county (N = 150), between October 2020 and April 2021 were recruited.

Students were informed about the study through two social media groups used for the communication of student volunteers (one for those supporting the Public Health Directorate and another for those working in inpatient healthcare settings). The volunteers were informed that their participation in the study was voluntary and that their involvement consisted in filling in an anonymous online questionnaire. Reminders were sent to the student to motivate them to fill in the questionnaire. Students who agreed to participate under these conditions were then given access to the online questionnaire.

A total of 51 student volunteers involved in activities from the Public Health Directorate (participation rate of 45.1%) and 78 student volunteers involved in healthcare settings (participation rate of 52%) answered the questionnaire.

2.2.2. Instruments for Data Collection

Two questionnaires were specifically developed for this study, using not only relevant data from the literature that focused on the involvement of students in volunteering activities during the COVID-19 pandemic but also consultations with students from IHUMP involved in the two volunteering programs, in order to focus on the relevant items in accordance with their lived experiences [15,24,26].

Due to time-related and logistical constraints (the necessity to perform the study while the programs were functioning and the possibility to contact the volunteers only through online questionnaires, as well as the limited possibilities to motivate the target group to participate in more than one survey), the validity and reliability of the questionnaire could not be assessed before the survey.

The questionnaire for the volunteers in the PHDCC was developed using Google Forms and contained closed-ended questions with options for answers on a 5-point Likert scale. It was divided into six sections, among which five were accessible to every participant and one was restricted to the volunteers who were still actively involved in the volunteering activity at the point of filling out the form. The sections addressed the following topics: (1) general characteristics of the participant, (2) motivational factors for involvement in the volunteering project, (3) overall experience during the activity, (4) barriers encountered during the volunteering activity, (5) actual status of the volunteer and (6) motivational factors for continuing the activity. All sections of the survey available to the responder had to be answered in order to submit the response. When considered necessary, the possibility of elaborating their own answers was offered to the respondents in addition to closed-ended questions.

The questionnaire addressed to the volunteers in inpatient healthcare settings was also developed using Google Forms. It investigated the following aspects: (1) general characteristics of the participants, (2) the factors that motivated the students to participate in the volunteer activity, (3) the way in which the students carried out their activity, (4) the presence of COVID-19 infections among volunteers and students’ perceptions of the infection risk and (5) the overall effects of the volunteering activity.

2.2.3. Statistical Analysis

The results to various questions are depicted as frequencies considering the total number of respondents. We used t-tests for comparisons between student volunteers and student coordinators (among students involved in volunteering program at Public Health Directorates), as well as those between female students and male students (for both volunteering programs) regarding the investigated aspects; a similar approach was used to compare students who were involved in volunteering activities before with those who were not, as well as to see what kind of differences were noticed between those who were still involved in volunteering activities at the moment of the survey and those who stopped this involvement (for both volunteering programs).

Bivariate correlations were performed in order to identify how the perceived effects of volunteering correlated with each other for each volunteering program. According to Cohen, a strong correlation was considered at r > 0.50, while moderate and weak correlations were considered at r > 0.30 and r > 0.10, respectively.

Data were analyzed using IMB SPSS Statistics for Windows version 26 (IBM Corp., Armonk, NY, USA). The significance level was considered at p < 0.05.

3. Results

3.1. Participants’ Demographics

Out of the 51 students involved in the supporting activities of the PHDCC, 80.4% were female. Regarding the study field, 68.6% were medical students, 21.7% dental medicine students, 7.8% studying nursing and 1.9% pharmacy. The study year had the following distribution: 15.7% in the first study year, 27.3% in the second, 11.8% in the third, 21.6% in the fourth and 11.8% each in the fifth and sixth. Overall, 78.4% of the respondents had previous volunteering experience. Moreover, 84.3% volunteered in the current project in the position of student volunteers, while 15.7% had the responsibility of student coordinators. At the moment of the survey, 37.2% of the respondents were still involved in this type of volunteering activities.

Out of the 78 students who were involved in the volunteering activities in inpatient healthcare facilities, 35.9% of them were male and 64.1% were female. Most of them were medical students, constituting a percentage of 87.2%, while only 12.8% studied nursing. Regarding the distribution by years of study, 11.5% were third-year students, 61.5% were fourth-year students, 20.5% were fifth-year students and 6.5% were sixth-year students. A total of 84.6% of students also participated in other volunteering activities before the COVID-19 pandemic. Moreover, 57.7% of the participants were still involved in volunteering activities at the moment of the survey.

3.2. Volunteering Activities in the Public Health Directorate of Cluj County

3.2.1. Motivational Factors

A summary of the motivational factors that determined the students to voluntarily support the activities of the PHDCC can be found in

Table 1. Motivational factors that led the students to volunteer in the Public Health Directorate (Total N = 51).

	Strongly Agree/Agree	Neither Agree nor Disagree	Strongly Disagree/Disagree
I found the activity useful and necessary for pandemic control	100%	0%	0%
I felt the need to be involved in pandemic control	98.1%	1.9%	0%
I wanted to be of help to other people	98.1%	1.9%	0%
I felt the need to help the public institutions responsible for pandemic control	94.1%	5.9%	0%
I had more free time that I wanted to use for volunteering activities	50.9%	19.6%	29.5%
I wanted to improve my medical abilities	74.5%	19.6%	5.9%
I wanted to improve my abilities in areas other than medicine	94.1%	3.9%	1.9%
I wanted to have volunteering activities on my CV	70.6%	15.7%	13.7%
I wanted credits for mandatory clerkships	13.8%	17.6%	68.6%
I wanted to be involved because other friends/colleagues were also involved in the activity	21.6%	11.8%	66.6%

. The most commonly identified items were the fact that students found the activity useful and necessary for pandemic control (100%), the need to be involved in the control of the pandemic (98.1%) and the desire to help other people (98.1%) and the public health institutions responsible for the pandemic control (94.1%), as well as the intention to improve skills in areas other than medicine (94.1%). More than two thirds had reasons such as improving their medical skills or improving their curriculum vitae. On the other hand, the benefits of receiving credits for the mandatory summer clerkship and the involvement of other friends/colleagues were less frequently mentioned, with only 13.8% and 21.6% of respondents, respectively, agreeing or strongly agreeing with these items. There were no significant differences regarding the perception of motivational factors between the student volunteers and student coordinators, but female students declared more frequently than male students that they felt the need to help the public institutions responsible for pandemic control. Students who were still involved in volunteering activities at the moment of the survey had a higher tendency to strongly agree that they were important for their curriculum vitae, while those who completed their involvement declared with stronger agreement that they became involved in this activity because they found the activity useful and necessary for pandemic control.

3.2.2. Conducted Activities and Volunteers’ Perceptions

Most volunteers considered the training they received before the beginning of the activities as appropriate, with 84.3% agreeing or even strongly agreeing in retrospect that it was sufficient for their activity. The highest rates of agreement related to possible improvements in the training were in the following fields: presentation of particular cases of noncompliant patients (47.1%), presentation of strategies of communication with difficult patients (41.2%) and a better presentation of the laws that are relevant while performing an epidemiological investigation (41.2%). In comparison, fewer volunteers felt the need to be offered more in-depth fundamental knowledge regarding SARS-CoV-2 (29.4%) or regarding the pandemic (27.4%). The student volunteers reported lower levels of satisfaction regarding the quality of the training compared to the student coordinators. No other differences among these items were identified between the volunteers and coordinators or based on other differences (gender, previous involvement in volunteering activities or involvement in these activities at the moment of the survey).

Communication with the supervisors was widely rated as good at the very least among the student volunteers (95.3% rated it as very good and 4.7% as good), whereas in the case of student coordinators, the reviews were mixed: 62.5% rated their communication with the supervisor from the PHDCC as good, 12.5% as neither good nor bad and 25% as bad.

Regarding the timeframe during which the students were involved in this volunteering activity, highest percentage of participants offered support for 3–4 months (43.2%), followed by 29.4% for 1–2 months, 23.5% for more than 4 months and 3.9% for less than 1 month. Student coordinators had a statistically significant tendency to be involved in these volunteering activities for a longer period of time, while those involved in volunteering at the moment of the survey also demonstrated a longer period of volunteering activities.

3.2.3. Outcomes of the Volunteers’ Involvement

A list of the abilities and knowledge that the responders felt they gained can be found in

Table 2. Abilities and areas of knowledge in which the volunteers reported they improved as a result of their work in the Public Health Directorate (Total N = 51).

	Strongly Agree/Agree	Neither Agree nor Disagree	Strongly Disagree/Disagree
1. I improved my ability to conduct an epidemiological investigation	100%	0%	0%
2. I improved my knowledge regarding the transmission and prevention of infection with SARS-CoV-2 in the home, workplace and community	92.1%	7.9%	0%
3. I improved my knowledge regarding the clinical manifestations and diagnosis of infection with SARS-CoV-2	94.2%	3.9%	1.9%
4. I improved my knowledge regarding the medical resources available in Cluj County for the diagnosis and treatment of infection with SARS-CoV-2	78.4%	13.7%	7.9%
5. I better understand the medical, psychological and socio-economic impact of the pandemic through the perspective of patients, the medical system and society	88.3%	9.8%	1.9%
6. I better understand the role of the county Public Health Directorate in the prevention and control of some diseases	88.3%	9.8%	1.9%
7. I improved my patient communication abilities	94.1%	5.9%	0%
8. I improved my ability to work with medical legislation	84.3%	5.9%	9.8%
9. I improved my critical thinking and evidence-based decision-making skills	86.3%	11.8%	1.9%
10. I developed my ability to create and offer materials/information that can play a role in the education of different population groups regarding different medical problems	96.1%	3.9%	0%
11. I gained more self-confidence regarding the acquisition and analysis of information and making decisions with medical and legal consequences	98.1%	1.9%	0%
12. I improved my time-management abilities	80.4%	9.8%	9.8%
13. I improved my stress-management abilities	72.5%	15.7%	11.8%

. More than 90% of students reported an increase in knowledge regarding the transmission/prevention/clinical manifestations/diagnoses of SARS-CoV-2 and improved their ability to conduct an epidemiological investigation, their communication skills, their capacity to develop and offer informational/educational materials for different population groups and their ability to make informed decisions with medical and legal consequences. Students coordinators declared stronger beliefs with regard to the fact that the volunteering activities improved their knowledge regarding the medical resources available in Cluj County for the diagnosis and treatment of infection with SARS-CoV-2, and indicated that the experience helped them to better understand the medical, psychological and socio-economic impact of the pandemic through the perspective of the patients, medical system and society as well as the role of the county Public Health Directorate in the prevention and control of some diseases; they also recognized to a higher extent that it helped them improved their abilities to work with medical legislation. Moreover, female students were more convinced that it helped them to improve their communication skills, while those who were still involved in volunteering activities at the moment of the survey indicated stronger beliefs that these activities helped them to better understand the role of the PHDCC and improved their abilities to work with medical legislation.

The most commonly identified items that contributed to lowered motivation levels during volunteering activities were the following: the lack of time due to university-related activities (80.4%), the technical difficulties encountered during the reporting process of the epidemiological investigations (62.7%) and the level of stress/fatigue (50.9%). Other barriers encountered by the students were the following, in the order of their perceived relevance: personal/familial problems (39.2%), the lack of flexibility of the activity in public institutions (31.4%), the communication with coordinators (23.5%), the lack of acknowledgement regarding the work done (23.5%), the lack of proper training (17.6%), the difficulty of conducting an epidemiological investigation (15.6%), the lack of material incentives (13.7%), boredom (7.8%), the lack of time due to involvement in other pandemic-related activities (5.9%) and the feeling that there is no need to pursue the volunteering work to achieve one’s goals (5.9%). A respondent mentioned the fact that she was constantly contacted telephonically by people in need of information, which also affected her enthusiasm. The student coordinators more often reported high levels of stress/fatigue as a relevant barrier to conducting their work compared to the student volunteers. Moreover, the students with prior volunteering experience reported a higher level of frustration regarding the lack of flexibility of public institutions. This lack of flexibility and the lack of time due to other faculty-related activities were also more frequently declared by students who were no longer part of the volunteering program.

Overall, 37.2% of the respondents continued their volunteering work at the time of filling out the questionnaire, while 1.96% reported being involved in an additional public health project. Moreover, 7.8% completely switched their volunteering activity, with the most common options being a volunteering project in collaboration with general practitioners for following up on patients diagnosed with COVID-19 and a volunteering program in hospitals aiming to offer better care for stationary patients diagnosed with COVID-19. A total of 58.4% of students were not involved anymore in a pandemic-related project. The student coordinators were more likely to be involved in the Public Health Directorate volunteering project at the time of study than the rest of the volunteers, while those who were previously involved in volunteering activities had a stronger tendency to renounce.

The active volunteers also completed the last section targeted at understanding the motivational factors that led them to continue their activity. The items that were selected included the following, from the most often perceived as relevant to those rarely perceived as relevant: the feeling that the volunteering activity helps people (100%), the feeling of improving non-medical abilities (100%), the feeling of using free time in a useful way (94.7%), the feeling of improving medical abilities (94.7%), receiving positive feedback regarding the work performed (84.2%), the perceived pressure on the public health department (84.2%), the feeling that the provided work helped in fighting the pandemic (84.2%), support from the coordinator (78.9%), the habit of continuing the work one has started (78.9%), the feeling that the provided work is appreciated (68.4%), encouragement from the family (31.6%), receiving credits for a mandatory clerkship (26.3%) and the fact that other colleagues/friends continued their volunteering work (21.1%). No differences were noticed based on several characteristics of the participants (gender, role, previous involvement in volunteering activities, present status of volunteering within the program) with respect to these aspects.

As presented in

Table 3. Correlations between the effects of the volunteering program of the Public Health Directorate.

	2 *	3 *	4 *	5 *	6 *	7 *	8 *	9 *	10 *	11 *	12 *	13 *
1. I improved my ability to conducting an epidemiological investigation	NS	0.290	NS	0.285	NS	NS	NS	NS	NS	NS	NS	NS
2. I improved my knowledge regarding the transmission and prevention of infection with SARS-CoV-2 in the home, workplace and community		0.609	NS	NS	NS	NS	NS	0.426	0.333	NS	0.318	0.386
3. I improved my knowledge regarding the clinical manifestations and diagnosis of infection with SARS-CoV-2			NS	NS	NS	NS	NS	0.452		0.339	0.335	0.417
4. I improved my knowledge regarding the medical resources available in Cluj County for the diagnosis and treatment of infection with SARS-CoV-2				0.465	0.327	NS	NS	NS	NS	NS	0.419	NS
5. I better understand the medical, psychological and socio-economic impact of the pandemic through the perspective of patients, the medical system and society					0.546	0.359	NS	NS	0.356	0.306	NS	0.440
6. I better understand the role of the county Public Health Directorate in the prevention and control of some diseases						NS	0.430	NS	NS	0.442	NS	0.399
7. I improved my patient communication abilities							NS	0.397	0.294	0.317	NS	0.286
8. I improved my ability to work with medical legislation								0.444	0.370	NS	NS	0.559
9. I improved my critical thinking and evidence-based decision-making skills									0.485	0.486	0.371	0.741
10. I developed my ability to create and offer materials/information that can play a role in the education of different population groups										0.276	0.288	0.426
11. I gained more self-confidence regarding the acquisition and analysis of information and making decisions with medical and legal consequences											NS	0.435
12. I improved my time-management abilities												0.458
13. I improved my stress-management abilities

NS—non-significant; *—the numbers refer to the statements depicted in the first column.

, there were moderate correlations between several perceived effects of participation in the volunteering program of the Public Health Directorate, while strong correlations were observed with the perception that it improved critical thinking and stress-management abilities, as well as between the belief that it helped students to better understand the medical, psychological and socio-economic impact of the pandemic through the perspective of patients, the medical system and society and the belief that it helped them to better understand the role of the Public Health Directorate. At the same time, the positive effects of the program on improving students’ knowledge on the prevention and control of infection correlated strongly with knowledge gained about clinical manifestations and diagnoses.

3.3. Volunteering Activities in Inpatient Healthcare Facilities

3.3.1. Motivational Factors

Table 4. Motivational factors that led the students to volunteer in medical facilities (N = 78).

	Strongly Agree/Agree	Neither Agree nor Disagree	Strongly Disagree/Disagree
I found the activity useful and necessary for pandemic control	85.9%	5.1%	9%
I felt the need to be involved in pandemic control	87.1%	2.6%	10.3%
I wanted to be of help to other people	88.4%	6.4%	5.2%
I felt the need to help the public institutions responsible for pandemic control	78.2%	15.4%	6.4%
I wanted to apply the medical skills and knowledge that I have	89.8%	3.8%	6.4%
I wanted to improve my medical knowledge/abilities	94.8%	1.3%	3.9%
I had more free time that I wanted to use for volunteering activities	64.1%	6.4%	29.5%
I wanted to have volunteering activities in my CV	59%	17.9%	23.1%
I wanted credits for mandatory clerkships	64.1%	7.7%	28.2%
I was motivated by financial incentives	67.9%	14.1%	18%
I wanted to be involved because other friends/colleagues were also involved in the activity	59%	17.9%	23.1%

presents the motivational factors that led the students to volunteer in various healthcare facilities. The pursuit of developing new medical knowledge and skills (94.8%), the interest in applying the medical skills and knowledge they had (89.8%), the desire to help other people (88.4%) and the need to be involved in the control of the pandemic (87.1%) were the main sources of motivation. The possibility of including new activities in their CV (59%), the desire to obtain credits (64.1%), financial incentives (67.9%) and the participation of friends or colleagues (59%) were also selected. Female students declared stronger reasons related to development of new knowledge and skills, as well as to the improvement of their curriculum vitae. The desire to obtain new knowledge and skills was also more strongly declared by those who had previous volunteer experience, while for those who were still involved in these activities, the participation of friends and colleagues was more important.

3.3.2. Conducted Activities and the Volunteers’ Perceptions

One of the main tasks that the student volunteers performed was obtaining the medical history of the patients. For this, 73.1% of the students talked to the patients in person, while 10.3% of the students had phone conversations. The percentage of students who participated in the analysis of the patients’ medical history was 55.1%, and those who also documented the patients’ evolution in the files represented 66.7%. A smaller portion of the students had the duty to triage patients (28.2%). Approximately half of the students (51.3%) had to provide information to the patients. Volunteers who were responsible for providing direct care to patients and those who participated in drawing blood constituted approximately equal percentages, 64.1% and 65.4%, respectively. Other tasks that the volunteers were expected to perform were related to administrative activities regarding documents (56.4%) and informational and educational activities (29.5%). The highest percentage was made up of students who assisted healthcare workers when needed (89.7%), while the lowest percentage was represented by those who worked in the laboratory (2.6%). In total, 9% of the students declared that they also took part in other activities apart from those mentioned above. No statistically significant differences were noticed with regard to these aspects based on several characteristics of the participants (gender, previous involvement in volunteering activities, present status of volunteering within the program).

Regarding the volunteers’ perception of the risk of infection during the activity, 35.9% agreed or strongly agreed that they were afraid they could become infected during the volunteering activity. In contrast, 44.9% expressed disagreement or strong disagreement regarding the fear of getting infected, while 19.2% were neutral regarding this statement. However, 78.3% strongly agreed or agreed that they felt protected during the volunteering activity, and only 9% disagreed or strongly disagreed. Most volunteers agreed or strongly agreed with the fact that frequent testing of the population makes them feel safer (57.7%); on the other hand, those who felt neutral or disagreed/strongly disagreed with this statement represented similar percentages (23.1%, respectively 19.2%). A relevant concern of the volunteers was safety regarding the possibility of being infected with SARS-CoV-2 during their work, with 82.1% having direct contact with COVID-19-positive patients. However, a significant number of students mentioned sufficient training in avoiding a possible infection (97.4%) and the availability of PPE (98.7%). Despite all of these measures, 2.6% had to acquire their own PPE, 15.4% mentioned that there was a suspicion of being infected with COVID-19 during their work, 6.4% of the participants reported actually being infected during their activity and 5.1% had to interrupt their activity due to the infection. Again, no statistically significant differences were noticed with regard to the above aspects based on several characteristics of the participants (gender, previous involvement in volunteering activities, present status of volunteering within the program).

A total of 65.4% of the students were involved in volunteering activities for more than 2 months, 30.8% for 1–2 months and 3.8% for less than 1 month. Those involved in volunteering at the moment of the survey had also a longer period of volunteering activities.

3.3.3. Outcomes of the Volunteers’ Involvement

When asked to evaluate the effects of the volunteering experience, most of the participants mentioned both positive outcomes and negative experiences (

Table 5. The effects of volunteering activities performed by the students working in medical facilities (N = 78).

	Strongly Agree/Agree	Neither Agree nor Disagree	Strongly Disagree/Disagree
1. It helped me acquired new medical knowledge	85.9%	6.4%	7.7%
2. It helped me improve my social skills	78%	16.7%	6.3%
3. I learned how to better organize my activities	80.8	12.8	6.4%
4. I learned how to better manage stressful situations	76.9%	16.7%	6.4%
5. During the volunteering program, I met new people who taught me a lot of things	89.8%	7.6%	2.6%
6. I think that my abilities were put to use in the community’s favor during this program	80.8%	15.3%	3.9%
7. I think that volunteering plays an important role in my future career	91%	5.1%	3.9%
8. Volunteering enhanced my sense of self-worth	70.5%	25.6%	3.9%
9. Volunteering made me feel useful	88.4%	7%	2.6%
10. The expectations for the volunteers were appropriate	85.9%	10.2%	3.9%
11. The knowledge gained during my studies helped me perform my tasks more easily	60.3%	25.6%	14.1%
12. There were moments when I felt overwhelmed by the amount of work I had to do	39.8%	19.2%	41%
13. There were instances when I needed help in order to fulfill my duties	57.7%	15.4%	26.9%
14. I encountered situations that interfered with my sleep schedule	28.2%	16.7%	55.1%
15. There were moments when I felt I could not focus on my tasks	27%	20.5%	52.5%
16. Volunteering lowered my academic performance	20.5%	15.4%	64.1%
17. There were moments when I wanted to quit volunteering	19.2%	12.8%	68%

). The responders reported improving several abilities, including the following: acquiring new medical knowledge (85.9%), organizational skills (80.7%), social skills (78%) and stress-coping mechanisms (77%).

Among the positive outcomes, the belief that this volunteering activity represents an important part of their future career (91%) and made them feel useful (88.4%), interacting with people who were perceived as competent mentors (89.8%) and realistic expectations regarding their responsibilities (85.9%) were most often selected. A relevant downside of the experience was the fact that some activities made them feel overwhelmed (39.8%) or that students needed additional help while conducting them (57.7%). Female students were statistically significantly more convinced that volunteering helped them with social skills and to feel more useful, while they were also more likely to declare that sometimes they felt overwhelmed by the work. Those who were previously involved in volunteering activities had stronger beliefs that these activities are important for their careers and made them feel useful. Those who were participating in these activities at the moment of the survey were more convinced that the knowledge gained during their studies helped them perform the tasks more easily and that the expectations for the volunteers were appropriate.

As presented in

Table 6. Correlations between the positive effects of the volunteering program in medical facilities.

	2 *	3 *	4 *	5 *	6 *	7 *	8 *	9 *	10 *	11 *
1. It helped me acquired new medical knowledge	0.569	0.483	0.577	0.693	0.491	0.756	0.307	0.533	0.546	0.316
2. It helped me improve my social skills		0.590	0.562	0.656	0.509	0.615	0.441	0.594	0.662	0.346
3. I learned how to better organize my activities			0.821	0.559	0.497	0.534	0.335	0.419	0.342	0.372
4. I learned how to better manage stressful situations				0.453	0.430	0.532	0.417	0.372	0.315	0.317
5. During the volunteering program, I met new people who taught me a lot of things					0.547	0.642	0.307	0.504	0.691	0.342
6. I think that my abilities were put to use in the community’s favor during this program						0.639	0.372	0.544	0.466	0.230
7. I think that volunteering plays an important role in my future career							0.426	0.670	0.594	0.306
8. Volunteering enhanced my sense of self-worth								0.641	0.334	NS
9. Volunteering made me feel useful									0.661	NS
10. The expectations for the volunteers were appropriate										0.291
11. The knowledge gained during my studies helped me perform my tasks more easily

NS—non-significant; *—the numbers refer to the statements depicted in the first column.

, almost all positive perceived effects had moderate or strong correlations with each other. Correlations were noticed also between several perceived negative effects, the strongest being between the feeling of being overwhelmed by the activities, having difficulties in focusing on the task sometimes and disturbances in sleep (see

Table 7. Correlations between the negative effects of the volunteering program in medical facilities.

	13 *	14 *	15 *	16 *	17 *
12. There were moments when I felt overwhelmed by the amount of work I had to do	0.456	0.539	0.522	0.231	0.287
13. There were instances when I needed help in order to fulfill my duties		0.380	0.413	NS	NS
14. I encountered situations that interfered with my sleep schedule			0.601	0.265	0.342
15. There were moments when I felt I could not focus on my tasks				0.320	0.467
16. Volunteering lowered my academic performance					0.351
17. There were moments when I wanted to quit volunteering

NS—non-significant, *—the numbers refer to the statements depicted in the first column.

).

4. Discussion

The SDGs have gained a lot of interest within the scientific community and civil society in the last years [34]. This study adds to the body of literature addressing SDG 3 related to health and well-being.

This study investigates two student initiatives implemented during the COVID-19 pandemic in Cluj County, Romania. The common aim of these initiatives was to contribute to preparedness and response strategies, as well as to help health systems to be capable of facing health crises created by COVID-19 pandemic, by offering aid either to the Public Health Directorate or to various inpatient healthcare facilities in Cluj County. The presented structure and timeline of the volunteering projects could serve as a starting point for other initiatives that might arise as a response to crisis situations.

We mention the following factors that played key roles in the administration of the projects: (1) the involvement of representatives from all the stakeholders in the decision-making and feedback processes (PHDCC, IHUMP, MSOC and NCCMI), (2) having a clear hierarchy and guidelines that would help the volunteers face possible difficult situations and (3) taking into account the motivations and barriers that could influence the commitment of the volunteers and assuring their appropriate training. We suggest using the aforementioned factors as a guideline for the implementation of other projects in crisis situations, as the time invested in all of them proved to be efficient for long-term resource management. Such practices are in line with other recommendations that arose from several studies performed throughout the course of the pandemic [35,36]. Although, in our case, the benefits of involving several main organizations in the whole process proved to be efficient, collaboration with multiple associations must be assessed on a case-by-case basis, keeping a balance between the additional resources and the drawbacks of a more complicated decision-making process. Several ways of motivating and preparing students for volunteering activities in crisis situations should be used, paying attention to different characteristics and interests such as gender, educational year and previous involvement in volunteering activities.

A similar organizational framework was already evaluated as crucial in the incipient phases of another student-led initiative from United States of America (USA) during the COVID-19 pandemic [14]. The authors emphasized the positive effect of having student co-leaders, in line with the positive results regarding the satisfaction level of students regarding communication with their superiors that were reported in our study. Moreover, planning a community needs-driven program also proved effective during the pandemic in the USA [37].

Our work confirms the results of other similar studies, supporting the fact that volunteers were mainly motivated by intrinsic factors such as the desire to help other people, the wish to be involved in the control of the pandemic and the feeling of being useful during a pandemic, whereas the extrinsic factors, such as material and curricular benefits, played a less relevant role [15,23,24,25,36,37,38,39,40,41,42,43,44,45,46]. When comparing the two types of volunteering programs that we studied, it became obvious that altruistic and humanitarian reasons were perceived as the most relevant in both cases, whereas for the students who worked in a clinical setting characterized by financial incentives offered to volunteers, the financial aspect was considered relevant by two thirds of them. Moreover, some volunteers providing help in a clinical setting perceived the activity as an escape from the daily routine during the pandemic, with the other group not having the benefit of working outside their normal environment. It has also been suggested that volunteers who are motivated by a genuine concern for other people have a higher rate of volunteering, in contrast with those focused mainly on personal gains [47]. Other motivational factors that were either not found as relevant in our study or not investigated at all due to the format of our program were cited in other studies, such as networking for further doctoral studies or specific concerns for socially disadvantaged groups [24,39]. Another relevant indicator of the willingness to volunteer was previous experience as a student volunteer, with similar findings being reported [15,39,41,48,49]. As seen in the wave of new volunteers that supported the Public Health Directorate in the second phase of recruitment, previous volunteers discussing their experience in the program was a relevant motivation for students to join the workforce, similar to an experience described previously [40]. Moreover, some studies pointed out a possible link between external incentives, such as money or credit points, and the interest of the volunteers in their work [24,39]. It has also been suggested that working in non-patient-contact activities is preferable for most students and that the study year may have a major implication in the students’ choice of volunteering [28,29,50]. However, mixed results have been described regarding the correlation between study year and willingness to volunteer, with some researchers describing the earlier study years as more motivated and others stating the opposite [50,51].

Generally, these results confirm that students are a highly motivated source of healthcare workers during crisis situations, and the studied motivational factors should be kept in mind when developing such initiatives and applied accordingly, taking into account the volunteer culture of the involved population.

There were some gender differences noticed in our study with regard to motives for involvement, with female students being more interested in improving their CV and in obtaining new knowledge and skills or, on the other hand, in helping public institutions with pandemic control. Interest in improving one’s CV might be a factor that affects the persistency of involvement in volunteering activities, while the desire to learn new things and obtain new knowledge is a stimulating factor for all but is stronger for those with previous volunteering experience.

Most of the volunteers working in a clinical setting were involved in obtaining the medical histories of the patients, assisting healthcare professionals in their work and providing direct care or performing minor procedures for the patients. Similar tasks conducted by volunteers were reported in other programs, using a general approach of having the student force address the gaps in the wards’ daily routines [15,23,46]. Another approach was also described, with students having more specific tasks that they could routinely perform, such as assisting with the pronation and supination of ventilated patients or primarily focusing on a limited number of activities, such as triaging [30,44]. In our study, the majority of students involved in volunteering activities in clinical settings agreed that there were appropriate expectations from them and that they had the chance to obtain valuable insights from people working in the hospital; around two thirds of students also recognized that the knowledge gained during their medical studies helped them performed the tasks more easily.

Even though the two initiatives were not constructed with the specific aim of offering a structured learning experience for the students, mostly due to their original plan of responding to a crisis situation, a large number of students mentioned developing different skills and acquiring knowledge in this new setting, and several positive effects were correlated with each other, showing that the programs enhanced a wide range of knowledge and skills, with important long-lasting effects on the professional and personal lives of participants.

Regarding the volunteers in the Public Health Directorate, most of the skills and knowledge gained were in the fields of epidemiological investigations, communication, health education and capacity to make informed decisions with medical and legal consequences. Other studies reported similar results, pointing out the relevance of extra-curricular activities for informal education [15,23,36,38,45,46,52,53].

Volunteers in healthcare facilities mentioned as positive effects of the volunteering program the development of their medical abilities, as well as their social skills and stress-coping mechanisms. These results are in line with other projects that reported students having acquired clinical skills and developing an evidence-based practice [14,34,36,43,44]. However, this type of activity in healthcare settings is also associated with a higher risk of work-related infections and worries about proper training and access to PPE. Working from home during the pandemic could be seen as a low-risk–low-reward activity, where the volunteers have a space to develop soft skills while not being exposed to the virus.

Other studies focusing on similar projects additionally reported a different kind of impact, i.e., a reduction in the social isolation of the elderly through phone conversations during the pandemic [50,51]. Although we did not collect data about this specific impact, we have reason to think that regular conversations with socially isolated populations made a significant impact regarding their overall well-being during nationwide contact restriction measures.

These results highlight the relevance of recruiting student volunteers in crisis situations, when the healthcare system may be overwhelmed, while at the same time considering the skills expected from them at the point of recruitment and after proper training. Initially, the involvement of medical students in activities during the COVID-19 pandemic was perceived as questionable due to either the lack of preparation for a worldwide pandemic or the dangers associated with their work. Nonetheless, in agreement with our and previous reports, we make a case that students are a valuable resource that can help reduce the breakpoints of an overwhelmed medical system, and the time invested in training and managing possible dangers is worthwhile because of the additional help they can provide as public health workers.

In another study describing a student initiative in the UK, proper training, the relationship with the supervisors and regular meetings evaluating the conducted activities were mentioned as important factors in the success of the project [38]. In our study, we noticed good reviews from the volunteers with the Public Health Directorate regarding training and communication with the supervisor. Our responders further identified some improvements that could have been made in the training process, most notably wishing for a more in-depth presentation of methods they could use while speaking with difficult or noncompliant patients and a more efficient depiction of relevant laws that regulate the epidemiological investigation process. Another study mentioned another specific aim for their training, focusing also on trauma-informed interview techniques [54]. Our results also show that among those participating in the volunteering program of the Public Health Directorate, student volunteers rated the quality of the training lower than student coordinators. This could be due to the online presentation the student volunteers received, in contrast to the on-site training provided for the students who enrolled first and became student coordinators, or also due to the lower number of students that had to be trained initially compared to the second wave of training, when many more volunteers participated and may not have had the same opportunity to raise questions or concerns. Moreover, student coordinators had a higher chance of continuing their volunteer activity at the time of the survey. The students working in the Public Health Department who were still volunteering at the time of the survey mentioned as relevant factors that kept them motivated the feeling that their work was appreciated (68.4%), the positive feedback they received (84.2%) and the support they received from the coordinator (78.9%). On the other hand, interacting with people who were perceived as competent mentors was also underlined by the volunteers in the healthcare settings as an important asset.

The motivation to participate in the volunteering program of the Public Health Directorate was decreased by the difficulty of balancing academic activities and volunteering, stress/fatigue and the technical difficulties encountered during the reporting process of the epidemiological investigations. Other studies presented solutions for some of these limitations, represented by the use of a software that simplifies data gathering, reporting and centralizing volunteering hours [13,17,37]. In our study, the students with previous volunteering experience additionally reported higher levels of frustration due to the low levels of flexibility in this specific program. A possible explanation could be their previous work as part of a student organization that offered activities more fitted to the schedules, values and skills they are expected to have. In contrast, the work in the Public Health Directorate was regulated by various local and national protocols that were not specifically tailored to accommodate student workers. Another important result was the higher prevalence of stress reported by the student coordinators who had a higher responsibility level, although a higher percentage continued working at the point of data collection compared to the other student volunteers. Problems with the availability of psychological support and the psychological burden of the pandemic for students have been raised previously [15,26,40,43,46]. As a high number of the volunteers in our study indicated that stress associated with the work affected them, psychological and logistical support to mitigate these concerns should be kept in mind as a possible way to improve the well-being of the students, as well as to improve the functioning of the overall project. A finding in other studies was that students who volunteered during the pandemic had in fact a higher level of psychological well-being compared to those who did not [44,55].

The volunteers in hospital settings reported less often that their activity interfered with their academic performance but mentioned more often the sense of being overwhelmed or facing interruptions in the activity due to testing positive for COVID-19. Similar results have been reported in various populations [16,23,24,42,44,46,54], but there were also other factors identified that were not relevant or studied among our volunteers, such as commitments to part-time jobs, a lack of PPE or assumptions that more than enough help is already available [23,26,44]. A specific barrier concerning the volunteers that had direct contact with COVID-19 patients was the infectious risk. A significant number of our volunteers were concerned about this possibility, with 6.4% eventually being infected despite the prophylactic measures. This risk was described as a significant barrier to joining a volunteering task force in several studies [8,27,55]. However, there are findings that report that these fears decrease with the time involved in the program [35]. Although the access to PPE was not an issue reported widely by our respondents, this was an important problem in other volunteering programs [30,35]. Moreover, having a higher level of responsibility was a factor, with some of the volunteers mentioning feelings of being overwhelmed or helpless. [46]. In our study, a clear association was also noticed between feeling that the activities were overwhelming and having sleep problems. Joint efforts should be made in order to evaluate and communicate the solutions to these commonly encountered issues in student initiatives that respond to critical situations.

In our study, some students reported quitting the initial activity with the PHDCC in order to pursue a different volunteering program that allows them to work directly with the patients in the hospital. As this initiative was available before other clinical opportunities, several students may have been drawn to help by their intrinsic motivation but were willing to pursue other opportunities when they appeared, according to their personal interests. When offered both opportunities simultaneously, they may have chosen the preferred project and benefited more from a long-term experience.

This study is subject to several limitations. The generalization of our results is limited by the number of participants and by the relatively short time frame of the volunteering experiences assessed by the study. Moreover, the retrospective study design also limits the interpretation of the results on a larger scale. We also focused on specific types of volunteering during the pandemic (i.e., epidemiological investigations and clinical placements), and even though our results are similar to those for other forms of volunteering, such as research positions or childcare for essential workers, relevant differences can limit our view. At the same time, this is an exploratory study, and the validity and reliability of the instruments for data collection could not be assessed before the survey, although they included several items in line with data from the literature and opinions of the volunteers based on their lived experiences. The data are based on what participants declared, but anonymous questionnaires were used in order to encourage sincerity and avoid socially desirable responses. The students involved in the volunteering programs were mainly students from the Faculty of Medicine, and this was due to the fact that they might have consider this type of volunteering activity more appropriate for them, while the fact that the volunteering programs were more heavily promoted to them might have also contributed.

Nevertheless, this is the first study from Romania that provides insights into the implementation of different student initiatives in the context of COVID-19 pandemic and into the motivation and barriers that influence the volunteering activities of Romanian medical students during the COVID-19 pandemic. We also discussed in the same context the educational benefits of the initiatives.

5. Implications for Practice and Future Research

Both types of volunteering proved effective in both contributing to the health response during the pandemic and educating the students. Therefore, students should be offered access to several volunteering opportunities, and they should make an informed decision according to their interest, perceived benefits and downsides.

Overall, the projects had significant strengths that helped to address the public health needs during the COVID-19 pandemic, including the fast implementation, flexibility and receptivity to making changes as a result of the feedback process but, in hindsight, some weaknesses restrained the full capacity of such an initiative, for example having the volunteers carry out the same work instead of sharing tasks based on their skills, reported as an essential element in another program, or having a complicated data reporting mechanism [14].

This type of programs could also be offered outside of crisis situations, but in this case, we suggest switching the perspective from focusing on the beneficiary (i.e., patients receiving care) toward having the students’ learning experience as a focal point [56,57]. In this case, clear learning objectives, support and appropriate supervision should be discussed with the students before making the decision to volunteer. Whereas voluntary work is widely endorsed in our university, it was not treated as a teaching tool officially recognized by awarding ECTS-Credit points until this specific program. This was a successful first step in acknowledging the benefits the students can receive from voluntary work. However, as other studies have also pointed out, there might be discrepancies between the medical knowledge and skills that such volunteering opportunities offer and those obtained in a regular clinical internship [15]. These differences should be properly addressed during the learning process of the students, and adequate measures should be implemented in order to address the learning goals of the study program.

Altogether, our results indicate that multiple factors play a role in the level of involvement of the volunteers, and a more ample research initiative should be carried out to properly study the interplay and relevance of these factors, while considering the cultural differences in various studied populations. Furthermore, keeping the motivational factors and the barriers volunteers encounter during their work in balance should be a regular topic in debriefing and feedback sessions in order to keep the volunteers engaged in their work.

Further research in the domains of student initiatives, the commitment of student volunteers and the educational benefits of these programs should be conducted in order to create a proper guideline for organizing unitary actions, not only during public health crisis situations but also as part of the medical curriculum. Adequate modalities of disseminating such results at international student communication sessions, conferences and congresses and through the public reports of universities and student organizations should be encouraged.

6. Conclusions

This article is related to Sustainable Development Goal 3: Good Health and Well-Being and focuses on preparedness and response strategies, as well as resilient health systems capable of facing health crises.

We presented two student initiatives implemented in Cluj County, Romania, the aim of which was to support the actions of the Public Health Directorate and different inpatient healthcare facilities during the COVID-19 pandemic. The main aspects that contributed to their successful implementation were the involvement of key stakeholders in the decision-making process, appropriate training, straightforward directives for the volunteers and a proper analysis of their motivation and the barriers they might encounter. Intrinsic motivation proved to be the driver of their willingness to volunteer, whereas other academic commitments, stress/fatigue and sometimes concerns about safety represented barriers to their work.

The student volunteers contributed to conducting necessary epidemiological investigations and to lowering the burden on healthcare professionals in clinics while simultaneously acquiring various soft and medical skills, as well as general knowledge regarding the COVID-19 pandemic. This indicates that students in the field of healthcare are a relevant resource in crisis situations that various medical systems might encounter and should be trained and involved in preparedness and response activities, being able to contribute to the development of resilient health systems capable of facing health crises.