Abstract Background Health workforce shortages across Europe are limiting care capacity and these shortages are expected to worsen. In Poland, hospitals have increasingly engaged medical students in paid assistant-to-a-physician roles (PA) and structured volunteer positions (VOL), which may support service delivery while also offering students clinical experience. However, the scale, governance, supervision, eligibility criteria, working-time rules, and scopes of practice for PA/VOL engagement have not yet been mapped nationally. This study aimed to characterize the extent, distribution, and organisational features of PA/VOL engagement across Polish public hospitals. Methods A nationwide mapping study of all public hospitals in Poland was conducted. They were sent a structured 10-item request and asked them to report on their current PA/VOL engagement, the units involved, the eligibility requirements, the supervision arrangements, the working-time limits, the internal regulatory acts and the template duty scopes. Results Of the 549 hospitals contacted, 394 responded, yielding a response rate of 71.8%. Among responding hospitals, 99 (25.1%) reported employing PAs and/or engaging VOLs, comprising 562 PAs and 491 VOLs. There was pronounced regional variation: in some regions hospitals engaged hundreds of medical students, whereas in others these roles were not reported at all. Emergency departments were the most frequently reported settings. Ward/unit heads were most commonly indicated as supervisors, and hospitals reported various monthly hour caps. Only 36 of the 99 hospitals engaging students in PA and/or VOL roles reported having internal regulations governing these roles. Eligibility criteria for PAs most often required completion of Year 3 or 4, while 22 hospitals reported no requirements beyond student status. Duty profiles differed: VOL tasks more often reflected bedside support, whereas PA tasks were predominantly linked to documentation and care coordination. Conclusions Medical student clinical engagement in Poland has expanded rapidly yet it remains fragmented and unevenly governed. There is marked variation in eligibility criteria, supervision descriptions, working-time protections, and internal regulations. Implementing a minimum national framework that defines the scope of roles by training stage, requires mandatory onboarding training, establishes clear lines of supervision, and ensures working-time safeguards could reduce unwarranted variation while improving patient safety, educational value, and utility of workforce.