Global health prioritizes the worldwide enhancement of health and health care equity and is increasingly gaining significance because disease issues transcend national boundaries, necessitating international or global cooperation for management [1]. The opening of health care markets, the international expansion of the health care industry, the increase in foreign workers and multicultural families, and the prominence of social issues related to global health inequalities are further fueling demand for and interest in systematic global health education (GHE) [2-4].

GHE plays a crucial role in promoting the understanding of global health issues and proposing strategies for their resolution [5]. Students who complete GHE understand disease patterns more accurately, perform clinical skills more comprehensively, show enhanced cultural sensitivity, develop the ability to provide health care in diverse cultural settings, and may choose global health careers [6]. However, GHE is sometimes considered merely a personal interest and is not given due attention among medical students [7].

Post-coronavirus disease 2019, understanding of and interest in global health have become even more important [8]. Medical students need global health competency (GHC) to understand, respond, and collaborate in health and medicine from an international perspective, and systematic educational programs are needed to motivate and strengthen GHC to support global health careers. A study involving 500 medical students from 75 countries showed that 94% agreed on the importance of GHE [4]. However, only 28% of North American medical school graduates completed GHE during their studies [9], and of 128 medical schools, only 47 (37.5%) offer global healthrelated courses [10].

In Korea, most universities deliver 1-2-hour lectures or special sessions on global health topics within specific courses, but few offer a separate regular GHE course [11]. Additionally, global health-related extracurricular activities are limited to overseas clinical practice and medical volunteer work [11]. Only 11.7% of students have participated in global health activities, mainly through clubs and extracurricular activities [11]. Most medical schools invite doctors in global health-related fields to help students explore similar career paths [11]. This can be advantageous in inducing temporary interest in global health, but it is limited at enhancing medical students’ GHC and sustaining their interest in global health [6].

When developing GHE programs, a competency-based approach is essential. This requires defining GHCs and designing concomitant educational programs. Efforts to define or integrate GHCs have been ongoing [12]. In Korea, a recent Delphi study attempted to reach a consensus among experts on GHCs [13]. Korean medical students have reported perceiving their GHC level as low relative to the importance they attribute to GHCs, indicating a need for GHE [14]. Related research on nursing education has been conducted [2,3], and studies investigating the feasibility of and student satisfaction with online global health courses in medical schools are also available [15]. Although most Korean medical schools include GHCs as graduation outcomes [11], research on developing GHC-based programs and analyzing their effectiveness in medical education is scarce.

Therefore, this study aimed to develop and implement a GHC-based program for medical students and compare participants with non-participants to analyze programrelated changes and the program’s effectiveness. The findings are expected to enhance students’ GHCs and foster enthusiasm about global health. To achieve the research objectives, the following research questions were formulated: (1) Does GHE improve students’ global health awareness? (2) Does GHE enhance students’ global competencies? (3) Does GHE enhance students’ global citizenship? (4) Does GHE enhance students’ GHCs? (5) What is students’ GHE satisfaction level?

This study developed and implemented a GHC-based global health program for medical students and investigated the educational intervention’s effects. The intervention group outperformed the control group in the posttest, showing improved scores in interest in a global health career, understanding of the necessity of GHE, global competency, global citizenship, and GHCs, which indicates that the program effectively enhanced their performance in those areas. The results are discussed in detail as follows.

First, although the program effectively raised awareness of the necessity of GHE and boosted interest in global health careers, it did not increase interest in global health itself or boost students’ intention to participate in global health activities. These results suggest that attending global health classes increases interest in global health careers [18]. However, they contrast with other studies indicating that such attendance also increases general interest in global health itself [14,19]. This difference may be attributed to the fact that previous studies have examined general awareness rather than program-induced changes in awareness. It also suggests that, even with a program or course, classroom-based global health classes taken on their own have limitations for inducing academic interest in global health and encouraging participation in global health practical activities. Previous research has shown that the intention to participate in global health activities is related to direct experience with such activities [14]. Hence, providing opportunities for meaningful participation in global health activities can increase students’ participation intention. This study did not provide students with opportunities to directly participate in global health activities, which could explain these results. The best-performing GHE programs are hybrid programs that mix theory with relevant global practical experiences [20]. These programs allow students to develop essential competencies in a real-world context, which is crucial for effective learning in GHE. However, programs that send students abroad through international partnerships are difficult to implement because they require financial support and a cooperative system [21]. An alternative is to use distance learning technologies to facilitate interactive classes with students from various countries simultaneously [22]. Introducing such methods in future programs could be beneficial educationally, although students will not experience other countries directly.

The global health program improved students’ global competency, namely intercultural communication and sustainable development action. Students noted improvement in their intercultural communication competency through discussion of health issues in various cultural contexts in the GHE program. This finding partly aligns with previous research suggesting that global health programs can improve medical students’ ability to interact with patients from different cultural backgrounds [23]. This is likely because while cultural diversity was discussed among students in the “Cultural Anthropology of Global Health” contents, there was no direct interaction with patients from diverse cultural backgrounds. Students’ cultural competency significantly impacts the success of GHE [24]. Therefore, future programs should consider programs that allow collaboration among students from diverse cultures or interact with patients. Students should have opportunities to recognize and respect cultural differences and learn to value effective verbal and non-verbal communication in such contexts. Sustainable development action competency refers to the capacity to perform actions aimed at collective well-being and sustainable development. Study participants noted that the program also enhanced this global competency. Specifically, students improved their ability to organize national advocacy activities related to health issues, seek solutions for global health emergencies, and focus on global governance for the long-term development of healthcare systems. Evidently, through the program, students became more confident and willing to participate in actions contributing to global health.

The GHE program also enhanced students’ global citizenship, that is, their social responsibility, global knowledge, and global citizen participation. Global citizenship signifies an individual’s ability to understand and be aware of global issues and problems beyond their local and national boundaries and act and practice with a sense of responsibility [25]. This includes recognizing one’s role as a community member, respecting diverse cultural backgrounds and values, and adopting an attitude of collaboratively seeking solutions to international problems [26]. Global health, as a field that addresses health problems and solutions across countries, is related to global citizenship, which addresses problems that need to be solved globally. Therefore, this study confirmed that global health programs implemented for medical students significantly enhance their understanding of and engagement with global health issues [27]. As a result, these programs effectively promote their sense of social responsibility and global citizenship.

Study participants showed improved scores in all eight GHC areas, indicating the program’s effectiveness in line with previous research showing that GHE effectively promotes medical students’ understanding of the global disease burden, health disparities, and economic risk factors [21]. The study’s findings also align with those of studies showing that medical students who participate in a global health elective develop higher awareness of the social determinants of health [28]. It has been reported that global health programs enhance students’ competencies such as communication skills and altruism [27]. Additionally, students who received more GHE reported higher self-assessed competencies in areas such as the global burden of disease, social determinants of health, culture and health, climate and health, health promotion and disease prevention, strategies for equal access to health care, and global health care systems [29]. Considering this effectiveness, it suggests that expanded education in global health is necessary for students, and that its effects should be continuously analyzed based on GHE competencies.

Lastly, students expressed high overall satisfaction with the program. Their positive evaluations included reports of having gained a broad understanding of and new perspectives on global health. The student-led participatory classes covering each lesson topic and featuring discussions, film viewing, and interviews with doctors active in the field of global health constituted the main contributor to the students’ high program satisfaction. However, because the program implemented in this study was conducted within an integrated curriculum, which is characteristic of medical school education, the students were unable to fully concentrate on the program content, and the high assignment burden was identified as an area for improvement. Generally, students have varied perspectives on GHE; they range from GHE advocates to skeptics, and prioritizing GHE as part of a busy curriculum is challenging [7]. Future planning and placement of classes within the block system should consider these points to seek efficient solutions.

This study’s significance lies in its implementation of a GHC-based GHE program for medical students that was developed domestically and verified as effective through comparison with a control group. The results are expected to raise awareness of the necessity of GHE in medical school education and provide foundational data for improving future GHE programs.

Nevertheless, this study has some limitations. Although students from medical schools who had never conducted GHE were selected for the control group, completely controlling the influence of hidden curricula that may arise in extracurricular courses or educational environments is challenging. The differing educational goals of the medical schools involved in the study, such as those driven by specific missions or cultural values, may also have impacted the results. Although the study controlled for students’ experience with global health activities as a covariate, participants’ characteristics, such as overseas activity experience or language fluency, could not be entirely excluded [19]. These factors could influence GHE effectiveness, suggesting the need for more precise research taking these into account. In addition, regarding the use of a control group, a waitlist control group design should be considered in future iterations. Participants in the waitlist control group will complete the surveys and receive the same training program after the initial study period, ensuring equitable access to the educational intervention.

Recommendations for future research on GHE programs are as follows. Medical schools abroad, such as in the United States and Canada, are attempting to develop common standards for GHE and create guidelines for core global health curricula [9]. Similar efforts should be made domestically to develop standard guidelines through consensus among medical schools. Building GHE partnerships between countries to facilitate student exchange programs is also important and requires university-level support and efforts. Such cooperation can lead to the offering of field experience-based global health programs, the effectiveness of which can then be analyzed. Moreover, since students’ interest in global health may decrease as they advance in their studies [19], continuous monitoring of changes in interest among increasingly more educated students is necessary. Additionally, research and development related to interprofessional GHE programs for healthcare professions should be expanded [30].