Experiences and Motivations Regarding The Roles in the Medical Student's Association at an Undergraduate Medical School in Saudi Arabia: A Qualitative Study

Abstract

OBJECTIVES

This qualitative study aimed to explore student perspectives toward extracurricular activities and motivating and/or demotivating factors of students for involvement with medical student association (MSA) at Alfaisal University, Riyadh, Saudi Arabia.

METHODS

Qualitative analysis of focus group interviews was employed. Inclusion criteria required participants to be College of Medicine students in years 1-5 of undergraduate study and have been a member of the MSA for at least a year or more. A total of four focus group interviews were conducted with four to six participants in each interview. All interviews were recorded and transcribed verbatim, following which an inductive thematic framework analysis was employed for data analyses. Similar ideas and concepts were grouped using codes, and themes were developed.

RESULTS

The first theme identified was motivating factors of students for joining the MSA, which included improvement of self-esteem and résumé, to avoid burnout, social experiences, to overcome shyness, to adjust to the university environment, and to increase research opportunities. The second theme revealed were the skills gained including problem-solving, conflict resolution and communication skills, organizational planning and management skills, and peer mentorship. The third theme identified were the various demerits of being involved with the MSA, including a lack of commitment from other students, lack of recognition, and for some, adverse effects on academic activities.

CONCLUSION

We conclude that the MSA appears to provide a positive opportunity to medical students to be part of various activities, creating a conducive environment for supporting overall well-being and potentially supporting adjusting to the university environment and facilitating the acquisition of various skills.

Introduction

Alfaisal University was established in Riyadh, Saudi Arabia 13 years ago with a student-centric focus. The College of Medicine (COM) at Alfaisal University offers a 5-year undergraduate program leading to a bachelor's in medicine and surgery (MBBS) degree. Many associations, clubs, and societies are available to students that are run and managed independently by the student body, the main example of which includes the medical student association (MSA). As medical undergraduate students are burdened with a relatively heavy load of curricular responsibilities and expectations, this can sometimes lead to “burnout,”^1,2 a syndrome exhibiting emotional exhaustion, depersonalization, and a diminished feeling of achievement. ³

Student involvement in extracurricular activities has been shown to positively affect student learning and development and has the potential to lower the frequency of burnout. Indeed, being able to find the time to engage in such activities to help themselves, their fellow students, and society at large may enhance student well-being.^3–10 Further acquisition of certain skills and attributes through involvement in the extracurricular activities may even improve student performance and enhance their employability. ¹¹

Evaluating perceptions of medical students in relation to extracurricular activities is of value as they are the key stakeholders in a medical school and can provide important insights which can help in identifying any misconceptions and in identifying barriers and enablers regarding participation and may ultimately lead to reform in medical education. ¹²

Motivation is defined as the driving force that leads a person to engage in certain behavior and although it is a broad concept, academic motivation is defined as motivation that drives a student toward attaining higher achievements in academics. ¹³ Many theories of motivation are described in the literature.^14,15 Although these theories have their own particular constructs and explanations, but there is much overlap and most are closely tied together.^14,15 Hattie et al. ¹⁴ have attempted to integrate the various theories of motivation and have identified various motivating factors that influence student growth and development. Two sets of motivating factors that affect medical students as described include: (a) altruistic or value-based factors with an inherent desire to help others including religious beliefs and (b) motives leading to development of a new skill and improving the resumes.^5,14

However, a review of the relevant literature revealed a paucity of studies examining the role of medical student associations in the development of students with respect to various essential skills and attributes gained through extracurricular activities provided by such associations. The main objective of this qualitative study was to explore the motivating factors behind joining MSA and its impact on the medical students at Alfaisal University, Riyadh, Saudi Arabia by exploring student perspectives toward extracurricular activities and motivating and/or demotivating factors of students for involvement with MSA.

Methods

To gain deeper insights into the students’ perceptions, motives, and possible barriers toward participation in extracurricular activities, a qualitative study design employing semi-structured focus group interviews was employed to enable a more holistic understanding of the students’ perceptions that may provide information and insights about their opinions, feeling and attitudes. ¹⁶ The ontological and epistemological basis for this research is a mix of post-positivism and interpretivism. ¹⁷ By employing a qualitative approach, we tried to reveal deeper insights of the medical students to focus on understanding the reality as subjective and ever changing.^17,18

This qualitative approach was selected because of the richness of data that qualitative research can produce, and the unexpected results that we may find that contrasts with quantitative methods. ¹⁹ The qualitative study was conducted at the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia in 2018‒2019. This study was approved by Alfaisal IRB (approval number: IRB-18066). Alfaisal IRB approved written informed consent form was used and signed by all participants and the principal investigator prior to the interviews. Purposive sampling was employed to recruit the students for the focus groups interviews.

The reporting of this study followed the EQUATOR guideline for qualitative research and the completed checklist is included as a Supplementary File. ²⁰

Published literature and guidelines in qualitative research suggest that there is no defined number of focus groups for data collection as the overriding principle is data saturation. ¹⁸ It is a good practice to sample until saturation is reached which refers to the point where no new themes or codes emerge from the various focus groups. However, when focus groups are to be the sole source of data collection, it is recommended to have a minimum of four to five focus groups. ¹⁶

The major inclusion criteria were that participants needed to be from year 1 to 5 of College of Medicine and a current member of the MSA for at least a year. An email was sent to all members of the MSA asking for volunteers for interviews. The students who replied positively were informed for the date and venue of the interview. Any student not from college of medicine and not a member of the MSA were excluded from the study. Consent form provided information about the purpose of the study and the option to withdraw from the study at any time. Additionally, a brief overview of the purpose of the focus group interview was given to the participants. Prior to signing the consent form the participants were assured of confidentiality. Participants were informed that that their identities will be anonymized, and that no identifying data will be shared with anyone. These practices were followed as the audio-files and transcripts were anonymized. ²¹ All analysis was performed without any identifying data of the participants.^22,23

All participating students were asked to attend a single focus group discussion. A total of 4 focus group interviews were conducted with the number of participants ranging from four to six in each. The interviews were conducted in English language by a faculty member with experience in conducting focus group interviews. The moderator was given a list of open-ended questions to facilitate the discussion regarding their primary role in MSA, explore the primary reason and motivating factors for joining the MSA and their positive and negative experiences while being a part of MSA. The participants were also asked about any skills that they gained and any barriers or obstacles that they faced during their involvement with MSA. They were also asked about the effect of MSA on their academics and why would they recommend MSA to other medical students. Enough time was allowed for feedback from each participant. An average time of 40 min to one hour was spent in each focus group interview. A total of four focus group interviews were conducted with a total number of 20 students. The age range of the students was from 19 to 22 years, and they belonged to Year 2 to final year in undergraduate college of medicine. Eleven females and nine male students participated in these interviews. The first interview had four students, all females, the second interview had five students, two females and three males and the third interview had six students, two females and four males and the fourth interview had five students with three females and two males. Their involvement with MSA ranged from 1 to 4 years at the time of interviews. They belonged to different committees of the MSA including Growth and Development, Events Team, Undergraduate Research Committee, Treasury, Quality and Support and Public Relations committees. Some students were working in more than one committee. An inductive thematic framework analysis was employed to carry out data analysis.^24–26

Statistical Analysis

The five-step approach elucidated by Kiger and Varpio ²⁶ was employed for our study. Starting with familiarizing ourselves with the transcribed interviews, initial codes were generated by finding the similarities and patterns in the interviewees’ responses. All similar ideas were grouped together as codes and similar codes were grouped as emerging themes. The themes were reviewed and discussed with co-authors. The process was repeated until no new information appeared, and all responses were coded. Dependability is achieved by achieving data saturation which was achieved after coding the third focus group interview transcript as no new themes emerged after that. To enhance conformability, an attempt was made to control bias by constant comparison of data, performing a valid literature search and checking and rechecking data. Triangulation of data is important to the trustworthiness of qualitative studies. As the interviews were coded and themes developed, data was checked by three other colleagues and any differences were addressed by discussion as using a second source or a second method can produce more accurate, comprehensive, and objective findings.

Results

After analyzing the interview transcripts, the following themes and codes were developed.

Theme 1: Motivating Factors in Joining MSA

Codes under this theme were narratives or statements describing the motivating factors leading to their joining MSA and how it was perceived and helped the students in their professional growth and development (Table 1). This theme was discussed substantially in all focus group interviews. This theme is divided into two subthemes that is individual factors and social factors.

A. Subtheme: Individual factors:

Table 1.

List of motivating factors.

INDIVIDUAL FACTORS	SOCIAL FACTORS
Improvement in resume	For fun
Commitment	To avoid burnout
Networking	Stress relief
Overcoming shyness	Improved communication skills
Increased esteem and self-confidence	Adjustment skills
Being more proactive	Acceptance of others
	How to give and accept/use constructive criticism
	Conflict resolution

One of the main motivating factors that emerged from analysis of interviews was that some students joined because they wanted to improve their resume. Students pointed out that they were able to take ownership for their actions and for completion of assigned tasks. Being part of MSA expanded their horizons beyond studying, helped them in overcoming stress and at the same time they developed more focus on studies as well. They learned commitment and networking, overcame shyness, and gained increased esteem and self-confidence.

The undergraduate research committee of MSA is responsible for arranging research electives and other avenues of research with local and international faculty and they wanted to be a part of it or thought that being a part of it would improve their chances of getting a research elective or assignment. Multiple interviewees believed they joined MSA as they wanted to improve their prospects in future including Residency options after graduation. They explained that they took this as an opportunity to improve their resume. Other interviewees pointed out that they wanted to make the academics and extracurricular activities go together and saw it as an opportunity to improve their resumes.

This is what one student said in this respect

one of the reasons is to make academics and co-curricular activities go together and another reason why I joined is because I was looking at residency options in the summer this year and activities assume a lot of importance when you are applying for residency, it's not just your grades that they see there is events and activities and leadership skills that they also see so if motivating factors are considered this was a huge factor for me. (Year 3 student)

• B. Subtheme: Social factors

Some students pointed out that they joined for fun and to prevent negative effects of heavy academic load. Some students joined as their friends were already working in MSA and they wanted to experience it too. They also pointed out that they were curious about the working of the MSA and wanted to experience it themselves. Students felt happiness from the experience that they got from working in MSA and that was also identified as a motivating factor. They also learned to make reports of activities and receive feedback and the MSA platform provided them with opportunities for interaction in mixed groups (i.e., men and women).

This is what one student said in this respect:

if I just focused on academics, it would have a very negative effect on me overall mentally or academically so by joining a club, I could still have a little more fun in the university and I could still be a part of something.(Year 4 student)

Another factor identified was that students wanted to improve their self-esteem and confidence and overcome shyness. This is what one student had to say about confidence.

I wanted to be confident when I talk in a group of people. (Year 3 student)

Another motivating factor elaborated by several students in the focus group interviews was they wanted to be more proactive. It was also found that students who described themselves as introverts before joining the MSA, because of working in MSA they were able to become more comfortable with group settings, more sociable and this enabled them to reach out and connect with other people and groups. One quote in this respect was:

I joined because I wanted to be more interactive and proactive in my academic life which was different from my high school education… (Year 4 student)

Students expressed their opinion that the transition from high school environment to that of the medical school could be very difficult for the students for several reasons. They described the pressure they are exposed to during their years of study due to assignments, exams, on-calls and late shifts associated this with increased feelings of burnout and thus they lose motivation quickly. For some students turning to extracurricular activities was a means to relieve their stress. They believed that MSA provided them with a space to improve their skills and enjoy their time away from studying. The availability of several committees in MSA also provided them various opportunities to meet the varied interests of medical students. From committees arranging events to committees providing help and support in academics and future pathways, MSA has been a place where students escape from the various stresses in medical school. This is what a student had to say in this respect:

we wanted to know how to transition from high school studying to this (university) studying and I think mostly because for me I came from a state high school in India and the education system is really different from here so I wanted to get oriented and pass my blocks (modules) and I joined in second year which was MSA events first. Also, I believe that there should be a healthy relationship between extra-curricular activities and studies because as I have mentioned they both go hand in hand. (Year 3 student)

It does help you in your studies too because you get to have yourself de-stressed somewhere and then activity and then you can focus better on your studies. (Year 3 student)

Many students stressed the fact that being part of MSA helped them in networking, and improved interaction with peers and seniors. This helped them in learning skills like communication skills, adjustment skills, acceptance of others, and how to give and accept/use constructive criticism, critical reflection, and conflict resolution skills, and they learned to write written reports of the activities they were organizing.

Another motivating factor identified by interviewees was a culture of social and financial support from the university administration for MSA activities. They pointed out that due to this culture of support, they were able to participate in several activities and organize events from the MSA platform for various social and cultural occasions. They were particularly appreciative of the financial support from the university in terms of budget requirements that helped in organizing such events. One quote in this respect was as follows:

I think it is very rare that you would have such a college that is extremely student centered and helps you with all the events, considers students first, so it is very rare to have such supporting university. (Year 5 student)

Theme 2: Skills Gained by Joining MSA

Second theme that emerged from analysis of the interviews was the skills gained by students by working in MSA. Students highlighted that their involvement with MSA improved their problem-solving skills, and led them to develop self, non-academic dimensions with development of leadership skills. They were also able to learn to take responsibility and improved their communication skills. The skills that were highlighted included communication skills, time management, leadership, decision-making, adjustment, organizational, planning and implementation skills. Students identified that working in MSA and organizing events (conferences, culture and other special days) under its auspices helped them to develop new friendships and they were better able to handle the work environment. They also learned problem solving skills and professionalism.

Students stressed that they were able to improve their communication skills by interacting with peers and learning from them. This experience also led them to learn how to take constructive criticism.

Several students expressed their opinion that working in MSA led them to improve their time management skills. They learned how to prioritize the tasks assigned to them and learning to balance their studies with the activities they were involved in. They learned to overcome procrastination and avoid distraction by being task focused. One student said:

yeah it really helped me in time management, like I would always sit in the weekends and always just be studying, but now I know I have to complete my studies on the weekdays, so I have to be a part of an event in the weekend. (Year 3)

One of the skills that students learned was making reports of activities that they planned and conducted. They were able to gather, analyze, and evaluate information and write the reports in a logical and coherent order. These reports were reviewed by senior students and feedback was given to the team members on aspects that required improvement. Students felt that this helped them with their communication skills and their ability to take and respond to constructive criticism. This peer mentorship was highlighted and appreciated by several students.

A repeated code across almost all interviews was improved decision-making powers, learning to meet deadlines, and setting their priorities right. As part of decision-making skills, they also learned conflict resolution, planning and implementation, taking charge of the teams, and learning from mistakes. One student had this to say in this respect:

I am confident with the decisions that I make with the way that I make my decisions, with approaching different situations I understand that I have experience to back me up and that I have been through thick and thin whether with MSA during studying or studying without.

They also learned not to judge others and how to deal with difficult situations and people that they termed as “free loaders” and “slackers.” Students learned to be prepared for work environment and learned professionalism through their experiences at MSA. All these attributes were identified and were common across all interviews.

Many students identified that being involved in MSA and through this platform being involved in a diverse range of activities helped them to learn professionalism and to be prepared for real-life work environment. They stressed that their involvement in MSA led them to be more professional and taught them how to work with older colleagues and at the same time learning from them and mentoring the younger colleagues and learned to work in teams. One student (Year 5) said this in this respect:

Considering that the academic process in Saudi Arabia is mainly school then university then getting a job. It's quite you’re expected to grow in such a small period of time. So, you might not learn the proper life lessons of becoming an adult and working in a professional environment in that period of time.

Theme 3: Demerits of Working in MSA

Under this theme, we identified the instances where students faced problems while being part of the MSA. The most common complaints were lack of commitment as pointed out by some fellow team members. For lack of commitment shown by some co-members in MSA, one student had this to say:

…there would be other people who would like not come on time and be super late and come when everything is already done and you know at the end of the day we all get the same certificates everything and they are not putting as much efforts as we are. (Year 4)

Another issue identified was that they had to work with difficult people and tackle difficult situations, but the students expressed this positively by learning how to deal with such people and situations. One student said the following in this respect:

I've actually come across and experienced, having to work with a certain people that never seem to be on the same frequency as you, they had their own motives perhaps different than your own and you know disagreements that disconnect between what each person wants to achieve I try to take that positively in the sense that I just learned how to deal with these people, it's just that you meet so many different kinds of people not always you're going to come across people who are the same as you. (Year 5 student)

A few students also pointed out that sometimes it negatively impacted their studies. They felt that sometimes commitments with MSA overwhelmed them and this led to affecting their academic grades; however in reply to the question, whether they would recommend joining MSA, most of the interviewees replied in affirmative with very few exceptions.

Discussion

The most unique and important finding of this study is the acquisition of skills by the students due to their involvement in extracurricular activities through the platform of MSA. This engagement in extracurricular activities is related to acquisition of number of skills and attributes including critical thinking, leadership skills, and social skills as previously reported by Thompson et al. ¹¹ These skill sets are also desired by the employers. ¹¹ Data from the US National survey of Student Engagement has identified that students who participated in service learning which included community service within an educational program have reported higher learning and academic development achievements.^11,27 Students’ opinion that their involvement through the platform of MSA in gaining these skills which could not have been acquired with just academic studies is supported by previously published studies. This also provided an outlet to students to demonstrate their capabilities. ¹¹ Several skills were gained by students and all these skills are essential to aspiring physicians and students are likely to apply these skills during their undergraduate years and in their clinical practice. These are also likely to add value to the student resume and the employers are also likely to find them useful and desirable. ¹¹

Improved professionalism and developing interpersonal skills as cited by several students is another important feature and important takeaway finding from this study. This finding is in accordance with another study from Saudi Arabia which also showed that being involved in extracurricular activities led student to improve their interpersonal skills. ²⁸ As these physicians are leaders of tomorrow, therefore developing these essential skills including leadership skills, problem solving skills and communication skills is essential for their professional development. The study found that this development happens with student involvement in extracurricular activities. Few studies have highlighted that when students play leadership role in a club or organization they are bound to improve their interpersonal skills as compared to those students who did not hold any leadership positions. ²⁹

This study also highlights several important factors that motivated students to be involved in MSA and extracurricular activities. ¹³ These individual factors included students desire to improve their resumes and to enhance their self-esteem. They found that being involved with MSA increased the opportunities for research and this in turn may lead to better prospects in the future. These findings are similar to the findings in another study from the same institute which also reported improvement in resume as the most frequently cited motive for involvement in extracurricular activities.^12,30 Other studies from abroad have also shown similar findings where improvement in resume was cited as the main factor for student involvement in extracurricular activities and research projects. ³¹ The findings demonstrated that working from the platform of MSA provided students with necessary autonomy and they were free to engage in activities that they wanted to do and found useful.

Many students cited that they just wanted to have fun and wanted to Improve networking with peers. They wanted to work in MSA because their class fellows were already working in the MSA. This finding is echoed in two previously published studies from the Middle eastern region.^4,32 Thompson et al. ¹¹ have also pointed out that having fun and social elements of extracurricular activities is a necessary part of student life and are imperative motivational factors.

Findings showed that participation in extracurricular activities appears to affect the academic performance of students. Although the opinion of the participants was mixed on this issue with majority of the students stressing that it affects it positively while some believed it adversely affected their studies. This finding is consistent with previously published literature.^7,8,33 Lumley et al. found that students who engaged in teaching and research as part of their extracurricular activities were higher academic achievers. It can be inferred that the students acquire transferrable skills through extracurricular activities that can be applied in their academics and elsewhere. ⁷ In fact stopping such activities may negatively affect student assessment results. ⁸ Higher achieving students may have better time management skills that may lead them to devote more time for extracurricular activities. It is possible that involvement in extracurricular activities helped the medical students to concentrate on their studies better and the key concept was time management. Those students who were able to manage their time well with a balanced approach to the extracurricular activities and academics found the experience positive. ⁸

Several studies have highlighted that extracurricular activities play an important role in university adjustment as the transition to the stressful environment of higher education is challenging and quality of extracurricular activities and student involvement significantly improved adjustment to this stressful environment.^11,34 It is also reported that students who engaged in organized activities were more likely to continue with their studies than those who were not involved in such activities. ³⁴ This study has similar findings that students who were involved in extracurricular activities through the platform of MSA were able to adjust to the university environment better.

This study demonstrated that the extracurricular activities played a central role in student happiness and well-being. This finding is also supported by previously published studies. These activities also provided social support and helped students to adjust better to the university environment. ¹¹ There are some medical school programs that provides activities like yoga, soccer, and seminars on coping with stress and other social activities to improve student well-being. These programs although are offered not from the forum of medical student association, but re-enforces the study findings as the goal is to improve and replenish the coping reserve of medical students improving their well-being. ⁶

Limitations of the Study

This is the first study from Saudi Arabia that investigates the role of MSA as a formal platform for extracurricular activities and the various benefits, skills, and work ethics students were able to acquire while being a part of this organization. This study also highlights various factors that motivated the students to be involved in these activities. Caution needs to be exercised when generalizing the findings due to potential weakness of the small sample size, being self-selected volunteers from MSA and an inability to generalize qualitative data. No causal relationship is implied through these findings and more research is needed perhaps in a mixed methods setting to further explore these avenues. Further this study investigated a small cross section of students as it is limited to Alfaisal University. Alfaisal University students may have different motivations compared to government universities. On the other hand, this is a very multinational cohort, so it is perhaps a more reflective study of multiple and differential point of views and motivations.

Another limitation of the study is that it is possible that students may not have expressed their opinions particularly as they relate to the negative aspects of their experiences and this needs to be kept in mind while interpreting the results.

Conclusion

This research emphasizes the potential benefits of student involvement in Medical Student Association (MSA) activities. It shows that MSA offers unique opportunities for medical students to improve their well-being, resilience, and skills through various activities. Teamwork with peers positively affects emotional well-being and facilitates learning new skills. Extracurricular activities like voluntary work, team sports, and committee participation enhance graduates’ job prospects by developing essential skills and positive attitudes. To encourage student engagement, medical schools should highlight these benefits and address barriers to participation. Curriculum designers can integrate extracurricular activities into the curriculum, introducing research-based electives and activities that aid student development and stress management. University career services could highlight these activities as valuable to employers. Broader involvement in extracurricular activities may lead to improved transferable skills, leadership qualities, time management, well-being, and confidence, offering students opportunities to demonstrate their newly acquired abilities.

Supplemental Material

sj-docx-1-mde-10.1177_23821205241308799 - Supplemental material for Experiences and Motivations Regarding The Roles in the Medical Student's Association at an Undergraduate Medical School in Saudi Arabia: A Qualitative Study

Supplemental material, sj-docx-1-mde-10.1177_23821205241308799 for Experiences and Motivations Regarding The Roles in the Medical Student's Association at an Undergraduate Medical School in Saudi Arabia: A Qualitative Study by Muhammad Raihan Sajid, Junaid Kashir, Randa Khalid Yasin, Leen Darwish Jijakli, Akef Obeidat and Stella Howden in Journal of Medical Education and Curricular Development