497 Journal of Rawalpindi Medical College (JRMC); 2022; 26(3): 497-502

Original Article

Perception of undergraduate medical students regarding

civic responsibility through service learning by visiting
persons with different abilities
Sajida Naseem1, Syeda Hanaa Fatima2, Saima Rafi3, Lubna Meraj4
1 Associate Professor Community Medicine, 3 Assistant Professor Community Medicine,
Shifa College of Medicine, STMU, Islamabad. Shifa College of Medicine, STMU, Islamabad.
2 Assistant Director Medical Education, 4 Associate Professor Medicine,

Shifa College of Medicine, STMU, Islamabad. Rawalpindi Medical University, Rawalpindi.

Author’s Contribution Corresponding Author Article Processing
1 Conception of study Dr. Sajida Naseem, Received: 23/06/2022
1 Experimentation/Study conduction Associate Professor Community Medicine, Accepted: 20/09/2022
2 Analysis/Interpretation/Discussion Shifa College of Medicine, STMU,
2,3 Manuscript Writing Islamabad
3,4 Critical Review Email: sajidanaseem@gmail.com
4 Facilitation and Material analysis

Cite this Article: Naseem, S., Fatima, S.H., Rafi, S., Conflict of Interest: Nil Access Online:
Meraj, L. Perception of undergraduate medical students Funding Source: Nil
regarding civic responsibility through service learning
by visiting persons with different abilities. Journal of
Rawalpindi Medical College. 30 Sep. 2022; 26(3): 497-
502.
DOI: https://doi.org/10.37939/jrmc.v26i3.1984

Abstract
Objectives: Addressing various attitudes of students, can be a challenging task for educationists, so it is generally
embedded in the hidden curriculum in most Medical Institutes. The purpose of this study was to build up civic
duty among undergraduates, rooted in their learning objectives of the curriculum through a visit to the school of
children with different abilities (CFSPF).
Materials and Methods: In year 4, students of Shifa College of Medicine during the clerkship of Community
Medicine, were taken on a field visit which is part of the curriculum. CFSP is privately run by an NGO, it has 45
enrolled individuals with different mental and physical abilities. The medical students visited CFSPF in small
groups for 8 months (Sep 2019 to April 2020) where they interacted with the individuals with special needs in
their environment. Students were able to practice empathy through the general physical examination and other
entertaining activities. In this qualitative study, this strategy was assessed by exploring the medical student’s
perceptions.
Results: Focus Group discussions were conducted with the medical students and themes identified were:
interaction with children having different abilities, being thankful to the Almighty, philanthropy, learning to
empathize, the feeling of including them in our society, selfless smile, the contribution of services, and developing
various attributes.
Conclusion: Students found the visit to a school for children with different abilities useful. The interaction in a
different environment has revealed opportunities for a wider scope of learning.
Keywords: Civic responsibility, Empathy, Persons with different abilities, Service learning.
498 Journal of Rawalpindi Medical College (JRMC); 2022; 26(3): 497-502

Introduction was carried out from Sep 2019 to April 2020 after
taking approval from the Institutional Review Board
Ethics Committee. Permission was also taken from the
Teaching methodologies usually employed in medical
head of CFSPF. Students attending the 8 weeks
schools, address the core information and expertise
clerkship of Community Medicine, visited this private
required by students to become competent clinicians.
centre located at a 2 km distance from the medical
In lieu of participation and benefit to others, the values
college as part of their educational curriculum. This is
modelled within medical colleges focus much on
a non-profit organization, run by a group of people
personal accomplishments.
through donations. At CFSPF, medical students went
According to Christiano in 1996, the term civic is
in small groups, and in the presence of faculty, they
defined as a public benefit.1 Komives, Lucas, and
interacted with individuals with special abilities in the
McMahon defined civic responsibility as “the sense of
environment of the centre. Students performed general
personal responsibility individuals should feel to
physical examinations and were involved in other
uphold their obligation as part of any community”.2
entertaining activities for the children at the centre.
According to the Association of American colleges and
The different curriculum objectives covered through
universities 2002: “Five dimensions of civic
this visit included: building empathy among
responsibility that come in the higher education
undergraduate medical students, delivering school
literature include: (a) knowledge and support of
health services, health assessment of students,
democratic values, systems, and processes; (b) desire
interaction with special children, learning to handle a
to act beneficially in community and for its members;
special child, engaging school children in different
(c) use of knowledge and skills for societal benefit; (d)
educational and engaging activities. Before the visit,
appreciation for and interest in those unlike self; and
the study objectives were shared with the students and
(e) personal accountability”.3-5 According to Astin,
they were given a brief introduction. The medical
society is likely to grow from individuals to civic
students would then come up with ideas through self-
development if students develop these five
directed learning to achieve their study objectives.
dimensions.6
According to the curriculum designed by the Pakistan
A study conducted in 2015 in Pakistan stated service
Medical Commission students in year 4 while in the
learning as an approach that develops civic
discipline of Community Medicine go on community
responsibility among students in addition to academic
visits. The purpose of these visits is to practice the
learning.7 There is a need to extend the approach and
concepts taught in the formal education sessions. For
strategies in medical education to build a learning
more than 4 years, our students have been visiting this
environment for teaching such attitudes which are not
centre once during the clerkship. At present this
yet touched and are embedded in the hidden
centre has 45 registered students between the ages of 8
curriculum.
to 22 years. The centre has 7 teachers who have been
Service learning is a form of empirical education that
trained through workshops and certificate courses to
facilitates students to help society as well as benefits
deal with these individuals in terms of education,
them to develop leadership skills.8,9 Literature shows
training, and skill development. The Centre runs from
that service learning is becoming the part and parcel of
9 am to 2 pm, 5 days a week. Different skills are taught
many of the academic domains with positive results.10
including working on handlooms, singing, guitar, and
Limited literature is available regarding the perception
painting lessons. In the last 2 years, the students at the
of undergraduate medical students and their
centre have developed an affiliation with the
interaction with persons with special abilities,
undergraduate students to whom they consider as
therefore the objective of this study was to explore the
doctors, both look forward to meeting each other.
perception of undergraduates regarding civic
The medical students visited the school once during
responsibility through a visit to a center of persons
the clerkship for 4 hours from 9:30 am to 1:30 pm
having different abilities. This visit is a step towards
accompanied by the principal investigator. Different
inculcating civic responsibility as rooted in the
activities at the special children school for all the
curriculum.
batches included: icebreaking through one on one
interaction in the presence of a teacher, motor skills
Materials and Methods like holding a pencil to write and colour on the images
designed by medical students, face painting, speaking
A qualitative study involving 100 students in Year 4 of alphabets in English and Urdu language. All students
Shifa College of Medicine (SCM), Islamabad Pakistan
499 Journal of Rawalpindi Medical College (JRMC); 2022; 26(3): 497-502

underwent general and physical examinations, their

height and weight were recorded on the WHO-
approved growth chart. These were later explained to
the teachers, to communicate their findings to their
parents. The school children were also offered free
check-ups at the college hospital, medical students
took the responsibility of arranging their consultation
with the concerned specialty as well as physiotherapist
and speech therapist. Out of the five dimensions of
civic responsibility in higher education as described by
the American Colleges and Universities we tried to
achieve three of those through the interaction of
medical students with persons having different
abilities unlike themselves.
There are 5 clerkship batches in year 4 MBBS,
comprising of 20 students each, making a total of 100.
At one time, 20 students visited the centre. Students
voluntarily took along small eatables and gift packs as
part of their service to this school.
The perception of students regarding their visit and
interaction with the school children was recorded
through a focus group discussion conducted by the
principal investigator. The focus group was conducted
after each batch returned from the visit. All students
volunteered to participate, however, 10 students from
each clerkship batch were randomly selected through
simple random sampling for discussion, thus making a
total of 50 students. The purpose of the study was
again explained to the students in detail along with the
rules regarding confidentiality before starting each
Focus group discussion. The topic guide comprised of
around 10 questions in English language and the
discussion lasted for about 60 minutes which was
mediated by the moderator.
Both electronic, as well as written recordings of the
discussion, were carried out by the note-taker. The
data was transcribed by two investigators
independently. Triangulation was done. Themes were
generated. Data was collected till saturation of
responses was reached upon enrolling students. By
exploring the perception of medical students through
focussed group discussion civic responsibility among
students was assessed.
Results
Eight main themes were generated according to the
focus group guide discussion which was developed
through thematic analysis.
Figure 1: Conceptual framework regarding civic
responsibility among medical students
Learned to empathize
Most of the interviews revealed that the students felt a
sense of empathy while interacting with persons with
different abilities
“I could feel the inadequacy of school children, not being
able to communicate what they wanted to make us
understand”
“Upon not understanding the children command, I felt so
unable to understand when I have all my senses functional”
“I met one of the parents, tears in their eyes pour tears”
Interaction with other than mainstream children
Living in a community where you get a chance to
interact with all the mainstream children, the
interaction with children having different abilities was
a unique experience for all the students.
“As the first student followed the command comfortably, I
felt something was achieved, can do more but not much
came out later.”
“I never knew how to interact with special children unless I
met them, by no means it’s easy”
“Challenge of professional life, an impending challenge is
having consultations with their families and themselves”
“I was always interested in becoming a pediatrician, but
now I see these children also come under this specialty,
which makes me re-think!”
“We were taught the pathology of diseases, but this is what
is going to come eventually in clinics. How do doctors
interact with such patients and their parents needs to be
taught in classrooms before we are taken to clinics?”
“I would like to know if the doctors give any hope to their
parents, if they do how honest they are!”
500 Journal of Rawalpindi Medical College (JRMC); 2022; 26(3): 497-502
“Seeing physically disable twins brothers at the first glance
was shocking, I could think of what their parents would be
going through! How would they be looking after their needs
physically as well as financially!
“At the first look of the students sitting in the class, they all
looked happy, welcoming, and eager to meet us, some of
them calling out Doctors are here!”
Working with no for-profit organization/
contribution of services
Most of the students felt that the environment in which
these children were nurtured was very pleasant. The
teachers were very supportive and welcoming.
“The school environment was so calm, the principal and
staff were welcoming, putting us at ease to interact freely. I
realized how selfless and contended are the staff and
administration, warmth was felt”
“I salute the passion teachers have in dealing with children
with advanced different abilities, hats off to them!”
Learning to give: Gain from the visit
Most of the students revealed that a visit to this
organization was very beneficial to them.
My gain: “It was one of my lifetime experiences, seeing and
interacting these children with a cause”
“I have changed my mission statement, putting others who
are in need first, myself later”
The selfless Smile
Most of the students were glad to see the children
happy as it made them realize the blessings they have
which they take for granted.
“The smile on the school children face upon our activities
made me think how unlucky we are when having everything
we run after so many things and still are unhappy, while
these children are happy with our meeting”
Blessed we are!
Visit helped students to reflect on their own blessings
“The moment I saw the differently-abled children, I thanked
Almighty”
To Have and to get “We should get out of this race of
societal norms and focus on what can we do for these
children”
Philanthropy
In the interviews, it was uncovered that most of the
students were willing to contribute physically as well
as in monetary terms for the welfare of these
organizations and children.
“I have started generating funds for this organization, using
my contacts and personal skills”
“With a group of Information Technology (IT) experts, I am
working on creating a website to spread the noble work
being done”
Attributes
Developing communication skills and the role of a
collaborator were the attributes developed among the
students which is an important part of their
curriculum as well.
“When I open my clinic, I will provide free of cost services
and medications for this marginalized group”
“I will visit these children frequently and assist them where
ever I can to address their medical issues as well as their
needs”
Discussion
Studies carried out worldwide have repeatedly
emphasized the need for community-oriented medical
education in a community-based setting for
measurable wider outcomes in the field of medical
education at both the undergraduate and postgraduate
levels. These are in lieu of the results of our study in
which interaction with persons with different abilities
was carried out. The undergraduate medical students
suggested incorporating this in the curriculum to have
a positive impact on students learning outcomes. It
helps them to build and practice empathy, think
holistically for this marginalized population, and
practice philanthropy.
There has been a paradigm shift in the delivery of
healthcare services from individual to family
extending to the community to maximize its benefit
under the umbrella of the Higher Education
Commission (HEC) in Pakistan. Becoming a
meaningful educated citizen is rarely seen in the
context of culture despite the strong inherent religious
beliefs. This corresponds to our study in which the
interaction of medical students with these persons has
an impact that they will reconsider their career goals to
help such persons in the future.11 Over the past two
decades, the focus of curriculum delivery has shifted
from community-based teaching to community-
oriented teaching. Therefore the emphasis is on linking
what is being taught to fulfil the community needs.
Not only it is confined to medical-related fields but
also extended to literature and art. The results of our
study also build on the existing evidence that such
community-based projects provide emotional,
financial, and logistic support.12
Emily Morrison in 2016 suggested that the invisible
faint change happening globally emphasizes the
development of good communication skills and
empathy through community participation and service
learning. It is in line with the findings of our study, in
which the undergraduate medical curriculum includes
the component which educates the students about
empathy and service learning ultimately addressing
community needs.13 The study carried out on a
501 Journal of Rawalpindi Medical College (JRMC); 2022; 26(3): 497-502
community service project in Singapore suggested that
a community-based approach if incorporated into the
medical curriculum will enhance medical student's
abilities by enabling them to give better outcomes in
clinical settings in terms of leadership and interactive
skills as seen in our study in which students felt being
considerate in choosing their specialty after this
interaction.14
Furthermore, the incorporation of interdisciplinary
medical humanities courses is likely to inculcate public
service and social accountability among the upcoming
professional generation, as our results also support
that this community-oriented activity has shown
positive effects on the students but the support by the
faculty is beyond the scope of this study and needs
further research about it.15,16 Moreover, our study was
found to be consistent with published literature which
describes civic behaviour as activities oriented towards
care, concern, and development of others as well as
society which contributes to the allocation of resources
and paves way for decision-making.17 In the United
States, Service-learning has become popular in
academics. The data in our study also contributes to a
clearer understanding of this as the students are being
exposed to community service as part of their
educational training.18
Though the concept and practice of service learning is
part of social accountability, which is attached as a
component of the curriculum and is being endorsed by
higher education throughout the world, its boundaries
along with rationality, need to be addressed. The
number of hours spent on these additional activities
bringing outcome and its measurement in terms of
assessment is in itself debatable. Its presumed benefits
are unquestionable, as was also seen in the context of
our outcomes.19
Moreover, evidence shows that Service learning if
incorporated into the curriculum helps in developing
more professional attitudes and skills among the
students in the future enabling them to become more
responsible in real-life situations, which is also in line
with our study.20,21 Not only enhancing their skills but
also contributing to positive health outcomes.22 A
multitude of attributes of a physician embedded in the
curriculum of community health sciences including
empathy, professionalism, communication,
collaboration, scholarship, management, and medical
expertise was nurtured. The results suggested that the
students developed a sense of managerial role as they
were thinking of creating a network to liaison with
their organization and develop strong relationships.
Also, they felt that this helped them to enhance their
capabilities as a good communicator and collaborator.
According to American Psychological Association,
many pieces of research show that the new generation
should be given a variety of new options preferably a
less formal environment in academics, which will
improve their learning, especially at the
undergraduate level. So, all these attributes are also
inculcated among the students when they work in the
community and help them develop these skills in their
practical life.23
Students felt community service empowered them to
make a difference. Though they are students, still they
can make a difference and contribute to the
community to which they even do not belong. Service-
learning courses provide opportunities for
undergraduate students to not only develop as
competent professionals but as well as individuals
with social responsibility.24, 25
The duration of visits to the centre with students
having different abilities was short. Follow-up was not
done by the same students academically, however,
about 5% of undergraduate students visited the centre
on their own.
Undergraduate medical students suggested regular
visits of all 5year MBBS students each year to centres
with students with different abilities. More emphasis
should be laid in the preclinical years to develop and
demonstrate empathy, thus contributing towards
social responsibility as well as understanding the
issues faced at the community level in this regard.
Conclusion
Undergraduate medical students found the visit to the
school of children with different abilities useful. The
interaction in a different environment has revealed
opportunities for a wider scope of learning.
Acknowledgments
The author would like to thank the administration of
“Care for Special Person’s Foundation” for allowing
undergraduate students of SCM to interact with their
students on regular basis, thus providing an
opportunity to learn and benefit mutually.
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