Romanian Medical Graduates Reveal a Surprising Volunteerism Divide
Volunteering is widely celebrated as a cornerstone of community health, but a new study of medical graduates in Romania suggests that participation depends strongly on cultural background, social networks and the way opportunities are organized. Researchers at Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca surveyed 572 graduates from three graduating cohorts, 2021, 2022 and 2023, to investigate how students viewed voluntary service, what activities they undertook and whether they intended to continue after medical school. More than 90% of respondents said volunteering was important or very important, confirming broad support for the idea. Yet actual participation was sharply uneven. More than 80% of Romanian-section graduates reported volunteering during their studies, while fewer than half of international graduates did so. The pattern reversed when researchers asked about the future: approximately half of Romanian graduates expressed interest in volunteering after graduation, compared with about 67% of international graduates. The findings point to a potentially overlooked problem in medical education: enthusiasm alone may not be enough if students cannot easily access activities that fit their language, culture, schedules and professional goals.
The research, led by Andreea Iulia Pop and Lucia Maria Lotrean, used an anonymous online questionnaire distributed at the end of the final university year. The survey was available in Romanian, English and French and took approximately 15 to 20 minutes to complete. All eligible graduates from the university’s Romanian, English and French sections were invited, although only about 30% responded. The final sample included 392 Romanian-section graduates and 180 international graduates. Women represented 62.4% of participants, men 37.6%, and respondents ranged in age from 22 to 54 years, with a mean age of 25.25. The researchers assessed demographic and academic characteristics, opinions about the importance of volunteering, possible motivations and barriers, types of organizations joined, kinds of activities performed and intentions to volunteer after graduation. Participants rated statements using four- or five-point Likert scales, which convert subjective attitudes into ordered numerical responses suitable for statistical comparison. The questionnaire’s 14 attitude and practice items produced a Cronbach’s alpha of 0.71, indicating acceptable internal consistency.
Medical volunteering can take many forms, and the Romanian graduates’ responses reflected that diversity. Activities included student exchanges, administrative and organizational work, health education, medical support, emergency assistance, social and humanitarian projects and non-medical service. Romanian graduates were especially active in student exchanges, student organization activities, health education, medical support and emergency or medical assistance services. International graduates were more likely to report social-humanitarian volunteering. Much of the activity was facilitated by the Medical Students’ Organization from Cluj, which acts as an institutional bridge between students and community projects. Participants also mentioned initiatives such as vaccination campaigns, blood-donation drives, health-promotion programs and projects providing medical care under specialist supervision. Romania does not generally have the student-run free clinics found in some parts of the United States, so students often contribute through organized projects in which qualified physicians or teachers oversee clinical work. That distinction matters: volunteering in medicine is not equivalent to independent practice. Students can support patient histories, health education, logistics, follow-up and supervised care, but professional responsibility and clinical decision-making remain with licensed healthcare personnel.
The strongest reported motivation was not résumé building or even clinical training, but personal motivation and interest. More than 70% of graduates strongly agreed that intrinsic motivation was central to volunteering. Community factors were also powerful. More than half strongly agreed that opportunities to socialize, build interpersonal relationships and help the community encouraged participation. Between roughly 43% and 52% strongly agreed that volunteering offered a chance to improve clinical knowledge, practical skills, clinical reasoning or case-management experience. The desire to contribute to the medical education of different population groups was another influential factor, with approximately 41% to 51% strongly endorsing it. By contrast, only about a quarter strongly agreed that teachers had provided volunteering opportunities, suggesting that formal academic guidance may lag behind student interest. Curriculum vitae enhancement was recognized as a motivation by roughly one-third to two-fifths of respondents, but it did not dominate the results. The data therefore portrays volunteering as a hybrid activity: altruistic and community-oriented, but also connected to professional identity, social belonging and experiential learning.
The differences between Romanian and international graduates were particularly revealing. International graduates placed greater emphasis on gaining experience in clinical reasoning and case management, on teachers presenting volunteering options and on the desire to help the community. Romanian graduates gave more weight to the influence of colleagues who already volunteered. This may indicate that peer networks are a major gateway to participation. Students who are embedded in local organizations may learn about opportunities informally, receive encouragement from friends and understand the administrative and linguistic context needed to join. International students, by contrast, may face barriers even when they are highly motivated, including unfamiliarity with Romanian institutions, language differences, limited local networks or uncertainty about how volunteer roles relate to their future careers. The researchers suggest that some international graduates may become more interested after returning home, where volunteering opportunities could be easier to access or more strongly supported by national healthcare systems. In this interpretation, the lower participation rate during medical school does not necessarily signal lower commitment to service; it may instead reflect unequal access to the social infrastructure that makes volunteering possible.
To identify factors associated with participation, the researchers used chi-square tests, t-tests and multivariate linear regression models. Regression analysis allows investigators to examine the relationship between one outcome, such as having volunteered, and several possible predictors at once, including age, gender, study section, graduation year and motivational attitudes. The results showed that Romanian-section membership was associated with greater volunteering involvement in all three cohorts. In 2021, participation was also linked to stronger agreement that volunteering was important and to intrinsic motivation. In 2022, socialization and interpersonal relationships were significant positive factors, while stronger belief that volunteering improved clinical reasoning was unexpectedly associated with lower participation. The same negative association appeared among international graduates. The authors suggest that this may reflect the kinds of activities students actually performed: many projects may have been humanitarian, educational or organizational rather than clinically intensive, meaning that frequent volunteers did not necessarily view their service as a direct route to advanced reasoning or case-management skills. In 2023, women and Romanian graduates reported higher participation.
The predictors of future volunteering were not identical to those associated with past participation. International graduates were more likely than Romanian graduates to express an intention to volunteer after graduation, particularly in the 2021 cohort. Across several analyses, women showed stronger post-graduation interest. The perceived importance of volunteering was generally a positive predictor, as was the influence of colleagues. Among Romanian graduates, future intentions were also associated with a desire to improve clinical knowledge and skills. Among international graduates, intrinsic motivation and personal interest were especially important. One result challenged the assumption that career advancement always sustains service: in the 2022 cohort, stronger agreement that volunteering improved the curriculum vitae was negatively associated with the intention to volunteer after graduation. The researchers propose that students who had treated volunteering primarily as a résumé-building activity may have felt less need to continue once they had completed their studies. By contrast, motivations rooted in community responsibility, personal meaning and professional development may be more durable after graduation.
The findings also illuminate why certain forms of medical volunteering attract students while others remain difficult to sustain. Emergency and medical assistance services were less popular than organizational work, exchanges, health education and general medical support. Participation in emergency services commonly requires specialized training and an examination, creating an additional barrier before students can even begin. Such work may also involve exhausting shifts that compete with lectures, clinical placements and study time. During the COVID-19 pandemic, however, Romanian medical students demonstrated how rapidly their roles could expand when health systems were under pressure. Students assisted public health directorates with case investigations and contact tracing, supported patient follow-up, worked in vaccination centers, helped deliver medicines and food to isolated people and contributed in hospitals under supervision. These experiences show that student volunteers can provide valuable surge capacity, but they also raise questions about training, safety, supervision and recognition. At the university, volunteer hours could contribute to organizational status or, in some circumstances, clinical clerkship credits. Formal recognition may help institutions retain volunteers, provided that service remains educationally meaningful rather than becoming unpaid labor disguised as curriculum.
The study has important limitations that temper the headline figures. It examined graduates from a single medical university, so its results may not represent Romanian medical education as a whole or institutions with different structures and volunteer cultures. The response rate was approximately 30%, and students already interested in volunteering may have been more likely to complete the survey, producing self-selection bias. Because the study was cross-sectional, it captured attitudes and reported behavior at one point rather than tracking individuals over time. Associations in the regression models do not prove that a particular motivation caused someone to volunteer. Unmeasured influences, such as financial circumstances, prior volunteer experience, family responsibilities, language proficiency and access to transportation, could also affect participation. Nevertheless, the study offers a detailed baseline for understanding medical volunteerism in Romania. Its central message is that most students value service, but participation is shaped by the availability of structured opportunities and the networks that connect students to them. The authors argue that medical schools could improve engagement by integrating supervised service-learning into curricula, recognizing volunteer contributions through academic credit and designing culturally inclusive programs. If those measures reduce barriers for international students while preserving student choice and professional oversight, volunteering could strengthen both community health and the next generation of physicians.
