The World Health Organization (WHO) declared the novel coronavirus (COVID-19) first reported in December 2019 a global pandemic approximately 3 months after the outbreak [1]. However, this global pandemic has had a greater impact on countries that lack healthcare resources to deal with the disease and vulnerable groups with limited access to healthcare within those countries, thereby further intensifying health inequalities [2]. This was also observed in the COVID-19 vaccination rates, with only 32.6% of the populations in low-income countries vaccinated as of September 2023, which is lower than the global vaccination rate of 70.5% [3]. Furthermore, the impact of the emerging infectious disease is also reflected in the socioeconomic situation, with an expected 4.4% increase in income gaps between countries after COVID19, which had been decreasing before the pandemic [4]. Therefore, it is important to make efforts to address health inequalities through global cooperation because they are not limited to just one country and can affect not only healthcare but also society as a whole in all countries worldwide.

For global cooperation to resolve important global issues, the United Nations declared the Millennium Development Goals (MDGs) in 2000 and the Sustainable Development Goals (SDGs) in 2015, aiming to achieve them by 2030. MDGs are focused on having donor countries support the economic development of developing countries for poverty eradication based on the agenda discussed among donor countries in international development cooperation since the 1990s. However, SDGs are different in that they seek sustainable development through global governance to eradicate poverty and reduce inequality in all countries including developing countries [5]. This change in perspective can be examined in line with the fact that international health, which focused on supporting activities of developed countries to promote health in countries lacking resources since the foundation of the WHO in 1948, has led to the discussion on global health since the 2000s [6]. Global health differs from international health in that it pursues the health equity of all people within and among countries through international cooperation on all matters that directly or indirectly affect health beyond national borders [7]. This is in line with the SDG for good health and well-being, “Ensure healthy lives and promote well-being for all at all ages” [4]. Thus, it is necessary to focus on global health to understand and reduce health inequalities between and among countries for all people.

In medical education for training prospective doctors, discussions on determining global health competencies (GHC) that medical students must have for systematic global health education (GHE) have been ongoing. Guidelines about GHC for medical students were discussed by a consultative group, and the United States and Canada derived the core competencies of global health in a joint expert committee of the Global Health Education Consortium and the Association of Faculties of Medicine of Canada’s Resource Group on Global Health [8]. Moreover, in the United Kingdom, the Global Health Learning Outcomes Working Group presented GHC required for medical students as global health learning outcomes [9]. Recently, the Consortium of Universities for Global Health (CUGH) involving educational institutions and related partner organizations from numerous countries globally suggested Interprofessional Global Health Competencies (IGHC) that can be applied to GHE with a competency-based approach in various fields of study and classified GHC by level so that they can be applied to students of different levels [10]. IGHC of the CUGH were developed as a tool to measure the self-confidence of IGHC by Stuhlmiller and Tolchard [11], on which a validation study was also conducted.

Research on GHC in Korean medical education is in its initial stage and can be found in some studies. Kim et al. [12] surveyed the educational needs of students from health-related majors, including medical students, by applying IGHC of the CUGH to them. In addition, a Delphi study was recently conducted to identify GHC for Korean medical students based on GHC discussed overseas [13]. Despite insufficient discussion about GHC in Korean medical education, GHC are critical for nurturing future doctors to display leadership in global cooperation in the global community and lead changes in health inequalities from a macroscopic view. Accordingly, the 2022 Korean Doctor’s Role that defines the role and competencies of doctors also addresses public health in terms of social accountability and GHC in global health activities and healthcare policy engagement [14]. Furthermore, the accreditation in Korean medical education also recommends including content related to global health in the missions and graduation outcomes of medical school [15]. Therefore, the Korean medical education circle should also put efforts into training doctors with GHC and systematically prepare GHE based on GHC to put these efforts into practice.

However, although Korean medical schools highly perceive the need for GHE, there is a lack of systematicity in GHE because only a certain amount of time is allocated in the form of a class or special lecture within a specific program, rather than having an independent program [16]. Accordingly, GHE must be discussed based on GHC for Korean medical students, prior to which it is necessary to identify medical students’ perceptions toward GHC and analyze their educational needs. Thus, this study examined Korean medical students’ perceptions toward GHE and participation in global health activities and determined the priorities for educational needs based on the difference between the importance level and the current level of GHC.

This study investigated medical students’ perceptions of GHE and participation in global health activities based on the results of a survey involving 678 medical students at medical schools in South Korea and analyzed the differences in perceptions of global health and GHC levels as well as the priorities in educational needs.

The results of analyzing perceptions of GHE are as follows. Although 12.1% (82/678) of the respondents perceived that GHE was sufficiently carried out in the Korean medical school curriculum, 60.6% (411/678) of the respondents perceived the need for GHE, showing a difference. This indicates that, in contrast to the highly perceived need for GHE among Korean medical students, insufficient GHE experience is provided within the current medical school curriculum. Kim et al. [16], who analyzed the status of GHE in Korean medical schools, confirmed a high percentage of schools assigning global health-related courses and special lectures in the form of 1- or 2-hour lectures in certain programs rather than having an independent program. Accordingly, this type of GHE is not perceived as a sufficient educational experience for students. Therefore, we can confirm the need to identify and discuss needs for GHE in Korean medical education because despite Korean medical students’ high perceptions of the need for GHE, the current medical school curriculum fails to sufficiently meet these demands.

As for the status of global health activities, 11.7% (79/678) of Korean medical students participated in global health activities, mostly club activities or external programs related to global health rather than activities organized by the medical school. Kim et al. [12] who studied health-related major students including medical students at a single university in South Korea also reported that 9.8% of the respondents participated in global health activities, showing a similar level. However, the actual participation rate in global health activities is low compared to the high perceptions of the need for GHE. Moreover, global health activities are mostly carried out by students at the individual level, as a higher percentage of students participated in club activities based on student autonomy or programs operated by external organizations rather than activities organized by the medical school. This may limit the opportunities to participate in global health activities. Considering that 53.5% (38/71) of the students who participated in global health activities responded that they were interested in global health, medical schools must make efforts to provide experiences or information about global health for students at the school level.

As a result of analyzing the differences according to the respondent characteristics in perceptions to global health, significant differences in global health and interest in its careers depending on gender, participation in global health activities, and participation in GHE, excluding medicine grade, were determined. There was a significant difference in the intention to participate in global health experiences abroad depending on gender and participation in global health activities. By gender, female students showed more interest in global health and its careers and had more intention to participate in global health experiences abroad. This result is consistent with Cox et al. [20] who analyzed students at a medical school and nursing school in the United Ststes and discovered that a higher ratio of female students with statistical significance showed an interest in global health careers than male students. Cox et al. [20] also confirmed that the female gender had a significant positive effect on interest in global health careers. Studies have explored gender differences in vocational interest, reporting that more women were interested in people-oriented fields and men in things-oriented fields [21]. In light of this, because global health activities require a multidisciplinary approach as well as communication and cooperation with people in various fields, women with an interest in people-oriented fields showed a significantly higher ratio of preference and intention to participate. Future research must conduct additional analysis to specifically reveal gender differences in interest in global health among Korean medical students.

Furthermore, those who participated in global health activities and GHE showed a high interest in global health and its careers. A study analyzing the factors affecting the interest in global health careers revealed the relationship with global health experiences and confirmed a significant positive relationship in research activities among global health experiences [20]. This implies that global health activities or educational experiences of Korean medical students may also be related to interest in global health. Accordingly, future research must analyze the effect of Korean medical students’ global health activities or educational experiences on interest in global health and classify global health activities into specific types. Moreover, those who participated in global health activities and GHE showed high intention to participate in global health experience abroad, but only those who participated in global health activities showed a statistically significant difference. As 93.1% of the courses in global health curriculums were lectures in current GHE in Korean medical schools [16], many students might have experienced GHE through lectures. On the contrary, as global health activities involve student participation through club activities, external programs, medical volunteer work, and clinical training, there may be a difference in the method of experience from GHE. Moreover, as intention is a key factor in predicting actual behavior [22], it is necessary to understand the intention to participate in global health as it can predict future participation in global health activities. As the significant difference in the intention to participate in global health is not found in participation in GHE, we can consider that GHE in the form of lectures may have limitations in attracting participation in global health activities. This implies the need to provide educational experiences in various teaching methods including student activities other than lectures in GHE.

As a result of analyzing the differences according to the respondent characteristics in the level of perceptions of GHC, there was no significant difference according to gender and medicine grade, and the level of perceptions was significantly higher in those who participated in global health activities and GHE. These results are consistent with the survey on perceptions of IGHC conducted on students from health-related majors including medical students in South Korea, where the level of perceptions was significantly higher in those who participated in global health activities [12]. This is also in line with a study on nursing students in South Korea where the level of perceptions was significantly low in those who did not have experience participating in GHE [17]. Moreover, Lanys et al. [23] surveyed students who participated in the 10-year global health elective course at a medical school in Canada and examined their perceptions of the effect of the global health course on the improvement of GHC. The ratio of students perceiving that there was an effect on improving GHC remained high even after graduation. In addition, study results on nursing students in South Korea revealed the effect of GHE programs on improving GHC [24,25]. This implies that GHE or global health activities of medical students can be related to improving the level of perceptions of GHC. This raises the need to conduct research to determine the effect of GHE or health activities on GHC of Korean medical students.

The results of analyzing GHC educational needs showed a statistically significant difference between the present and importance levels in all 24 items of eight domains comprising GHC. In total, eight items were determined for the priorities in educational needs, with four items in first priority and four in second priority. These items belonged to the global burden of disease, globalization of health and healthcare, determinants of health, and healthcare in low-resource settings among the domains of GHC. This result is consistent with the analysis of educational needs of health students including medical students in South Korea that confirmed top priority items in the global burden of disease and globalization of health and healthcare [12]. We examined the course topics related to GHC found in the study by Kim et al. [16] who analyzed the current status of GHE in Korean medical schools and discovered that approximately 90% of schools covered content related to global health governance, and most schools included this as a course topic. However, only approximately 50% of the schools in this study covered content related to the global burden of disease, globalization of health and healthcare, and determinants of health that are top priority educational needs in GHC as a course topic. The percentage for healthcare in lowresource settings was even lower at approximately 30%. Global health governance may have been derived as a domain that does not have high priority in educational needs since a high ratio of schools covers this as a course topic. However, considering that it is the lowest domain in terms of the perception level of GHC, it is necessary to identify specific contents through further research. Although the global burden of disease, globalization of health and healthcare, determinants of health, and healthcare in low-resource settings are domains with the first and second priorities in educational needs, not a high ratio of schools has included them as a course topic, which raises the need to improve course topics in current GHE.

Moreover, the global burden of disease, globalization of health and healthcare, and healthcare in low-resource settings showed lower levels of perception than the overall average of GHC, which is consistent with the studies on Korean nursing students [17,26] and US graduate students [11] in which the global burden of disease and globalization of health and healthcare were low in terms of perceptions of GHC. This showed consistent results with previous studies in terms of Korean medical students’ perceptions of GHC. Because the priorities for educational needs in these domains are high, efforts must be made to improve GHE so that GHC can also be enhanced in light of the priorities.

In conclusion, global health is important in medical education for nurturing future medical professionals who understand health inequalities from a macroscopic perspective and participate in various activities to solve them. However, although perceptions of the need for GHE are high in Korean medical education, discussions on GHE are still at an early stage, and research deriving the GHC of medical students has been conducted only recently. This study has significance in making the first attempt to identify the level of perceptions of GHC and determine priorities in educational needs for GHC among medical students in South Korea, which will lay the groundwork for developing systematic GHC-based curriculums. Furthermore, the differences found in the level of perceptions of global health and GHC depending on participation in global health activities and GHE indicate that the role of medical schools is necessary for global health activities and education to improve GHC.