In total, five themes were identified: i) a new inter-professional working environment, ii) identification of unexpected psychosocial challenges, iii) rigors of a non-clinical environment, iv) clinical skill development, and v) learning in an interprofessional team. Exemplars from the transcripts were chosen to illustrate themes, based on their frequency and specificity. This provides a rich, textual description to accurately reflect the experience being described [40, 41]. To ensure confidentiality throughout, students’ demographic details are not reported to prevent inadvertent recognition. We have provided codes for each quotation listed, and these are detailed as follows: Focus group (G1, G2 etc.), line number (e.g. L142-5), student number (e.g. S4) and the event attended (e.g. LM = London marathon, BM = Brighton marathon).

A new inter-professional working environment

For our student participants, this was the first time they had worked within a true interdisciplinary team. They welcomed the opportunity to play their part and felt privileged to be part of a prestigious event.

“Like, I’m just a student on podiatry course and we’re helping out on one of the biggest events in London every year I felt very privileged”

G1 L425 S2 LM

Students saw, first-hand, how collaboration between clinicians enabled better outcomes for athletes who typically presented with more than one complaint.

“I loved it so much, I absolutely loved it, I thought it was amazing! Everything about it, the atmosphere, working with the doctors. Yes, a very, very positive experience and I’d love to do it again. In fact, I’ve signed up to run next year already!”

G3 L129-135 S4 LM

“It was really the first time we’d worked as part of a multidisciplinary team. I know on placement we sort of do, but we didn’t work with doctors and nurses, whereas this experience did include that, even first aiders and St. Johns… it was a really broad spectrum of healthcare professionals”

G1 L47-53 S3 LM

Students were able to contribute positively to patient care and the treatment process, and in so doing, bridge gaps in their knowledge and experience. They seemed genuinely surprised that different professionals could work well together, even though they had never met. This shed a different light on interprofessional working. Prior to the event students appeared to expect some form of hierarchy between clinicians but throughout the marathon, but a helpful and supportive atmosphere was clearly noted. This valuable and productive environment would seem more in-keeping with the professional workplace that students were now able to anticipate post-qualification.

“I felt there was a very good sense of camaraderie with everyone helping each other in the tent, especially the day before when we had the brief all the doctors were very supportive, and I didn’t feel there was any sense of hierarchy”

L3 L187-181 S6 BM

Interestingly, those taking part in this study share their university campus with a range of other healthcare students and interprofessional education is promoted throughout their courses. Nevertheless, the inter-professional working element of this volunteering experience was seen as being different and better. This may be because of the supportive atmosphere and lack of barriers between professionals and the focus of a shared aim to facilitate rapid care and discharge home wherever possible. It is possible therefore, that patient-facing placements offer additional opportunities for shared learning than has previously been recognised and such opportunities are not being fully capitalised.

“The fact that nursing and physio are all on this campus and we don’t really see each other at all. I think it is a bit… it could be improved… it’s a wasted opportunity… working with them in the capacity we have been trained for… more hands on with the patients together… its how healthcare practitioners work…”

G1 L482-491 S4,S5 LM

Identification of unexpected psychosocial challenges

Students in this study (including those with prior healthcare experience) were shocked by both the volume of runners requiring hands-on treatment and the wide range of presenting clinical complaints, not all of which were obvious physical injuries.

“Pretty shocking. I myself wasn’t too shocked about it as I have previous experience in healthcare, so I have seen those sorts of things before, but I’m not sure about everyone else. It was very, very shocking to say the least”

G3 L35-38 S1 LM

Considerable surprise was expressed at the emotional toll the event took on those runners taking part, over and above the expected physical exertion of running a marathon. Many runners take part to raise funds for organisations they have a deep and meaningful personal connection with

“A lot of people who were confused… very worked up… crying and not knowing what was going on”

G3 L72-76 S3 LM

One respondent simply reported how runners were:

“exhausted, disorientated, bewildered”

G1 L81 S5 LM

Consequently, all our students reported offering psychosocial support to competitors. For example, congratulating their effort, confirmation they were not a burden, and enabling acceptance that seeking care was not unexpected. Students reported drawing on the health psychology component of their education was a key component in their treatment of runners, as a holistic approach to managing presenting physical complaint(s). This approach appeared not to have been drawn on in as much depth during their clinical education so far.

Rigors of a non-clinical environment

All found the clinical environment (Fig. 1) a significant challenge as they had no similar experience to draw on. Students agreed that maintaining good infection control, safe disposal of clinical waste (including contaminated sharps), patient positioning for safety and comfort, effective time management and maintaining safe working practices, all required considerable additional thought. Indeed, some commented that the environment coupled with the psychosocial challenges described above were so different to their usual clinical setting, that adequate preparation would be difficult.

“It’s just one of those things that you learn just by being there, so if you got told beforehand I still don’t think it would have helped”

G3 L256 S6 BM

“you just cannot prepare for this experience”

G3 L213 S6 BM

The environment took other, more unexpected, tolls. Many students found they were applying their knowledge of safe manual handing simply to enable runners to enter and exit the medical facilities unharmed, (i.e., without falling) which had a notable personal physical impact on student volunteers.

“I mean we are not unfit, but I think all of us were suffering physically for two days afterwards - you felt like you had run the marathon the next day.”

G3 L280-281 S4 LM

Clinical skill development

Throughout students reported that they had been involved in the management of a diverse range of complaints. By way of example, Table 1 illustrates the range and number of injuries recalled by students from one marathon medical station. Students reported that they were able apply and hone their specialist clinical skills with a group of patients (runners) who they had seen far less frequently in their clinical education to date. This, together with the impact of time pressure reported below, enhanced their confidence in their own ability

“The experience for me proved to be very, very different from a normal clinic. It was all about using your initiative. … As a student I still feel we are second guessing ourselves about how to approach treatment. On the day it was a very good experience but frantic at the same time. It was definitely something that I can look back on and say ‘look I learnt a lot from that”

G3 L115-120 S1 LM

“definitely more confident, like with blisters and when to lance them, we saw so much at XXXX and we never saw any in clinic, so I was a bit nervous about doing them [blisters]…. but after that day I feel more confident about when to lance or not, and what advice to give”

G2 L256-260 S1 BM

Table 1 Conditions managed at one marathon

Moreover, the wide range of transferable skills students were able to implement were reported to be of particular value. This was not only in terms of hands-on foot care such as padding, strapping and wound care, but additionally application of their understanding of physiology and general medical pathology (for example for those runners with constitutional needs around dehydration).

“the applying of general [medical] knowledge was quite useful, you didn’t realise you had all this other knowledge and when you’re out doing different things; it’s not just 'podiatry'”

G4 L315-317 S3 LM

Gaining confidence in skill acquisition was important to students. Many reported being shown new techniques by other clinicians that they were then able to apply successfully under close supervision. Gaining positive feedback from patients and other health professionals further boosted their confidence.

“I didn’t feel like we were just assisting the physios, we just worked together really. I learnt a lot off them, especially massaging technique”

G2 L28-30 S1 BM

“I’d definitely do it again. I learnt a lot from it”

G2 L81082 S4 LM

Learning in an interprofessional team

For many of the student volunteers, the nature of the event coupled with the challenging environment, offered a diverse learning opportunity where a different approach to learning was reported. Students were providing care for a group of people who were new to them, both in terms of being an athlete with an acute injury and having limited background referral detail. It’s relevant to note that the students’ experience to date often focussed more on chronic pathology. Students reported learning from each other and from other medical team members. They found information from runners themselves invaluable to make up for the lack of information they were used to having available in a traditional clinical placement. Runners had often encountered their particular complaint/injury previously and were able to offer ideas and guidance. Counter-intuitively, the time-pressured nature of the event seemed to help some students as they felt they had to cope and provide an appropriate level of care – a key skill for practice.

“I learnt on the spot and I’m not particularly good at pads and when I did it, I did it right”

G2 L81-82 S4 LM

Despite the reported difficulties posed by the environment, many were keen to explain how much they felt they had learned from other clinicians. Some took the opportunity to observe new techniques and approaches both to patient assessment and provision of care from other professionals.

“this man came in and had fallen over and it looked like his finger was broken so you’d then go and just talk to one of the doctors, and then you learn from it as you listen to how they assessed it”

G4 L234-6 S3 LM

While not yet qualified, many students reported feeling fully engaged with the reciprocal nature of the interprofessional learning process, where other professionals were also able to learn from them. Thus, the potential for learning appeared to be reciprocal for many of those volunteering:

“they learned a lot off of us... They didn’t know what we could do”

G1 L314 S2 LM

“We sort of bounced off of each other and learned from each other”

G3 L313 S2 LM

While the students’ feedback was broadly positive, some moderating effects adversely affecting learning were also reported. For example, some students found working with an unfamiliar team in a different clinical environment prevented them from learning as much from this volunteering opportunity as they would have wished. The environment was difficult as space was limited, particularly when lots of runners were in situ with different clinicians trying to work together. The environment, psychosocial burden, physical demands and time pressures, coupled with students’ own expectations, meant for some that the event was difficult to cope with. In turn, this limited their ability to learn. Some students reported a need to find a role they were comfortable with and gain confidence as the day progressed, highlighting how individual learners cope and adapt in different ways:

“I felt overwhelmed by the chaos… so I was based outside and I had an absolutely fabulous day… it was positive for me to feel as if I was making a difference”

G1 L142-45 S5 LM