Culturally competent doctors start here: Investigating the impact of a cultural diversity course on Korean medical students

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In regard to diversity, the Diversity, Equity, and Inclusion (DEI) principle is indispensable. This study examined the changes in understanding cultural diversity after a course was completed at a medical school in Korea. Methods: A quasiexperimental study was employed to investigate the change in student attitudes toward cultural diversity after completing the Cultural Diversity (CD) course. A total of 85 first-year medical students were selected as the study participants and were surveyed via a 14-question survey at two points: before the commencement of the course and after its completion. The data were analyzed quantitatively via paired sample t tests to observe changes over time. Results: The overall average scores for all the questions from all the students after completing the course were higher than those before the course. However, among the 14 questions, questions 2, 3, 4, and 9 showed statistically insignificant differences (p > 0.05). The overall average scores for all the questions from the students increased after they completed the course. However, for four specific questions—questions 2, 3, 4, and 9—the differences between the pre- and postcourse scores were not statistically significant (p > 0.05). Additionally, the independent variables, including age, gender, religion, and income level, did not have a statistically significant relationship with the dependent variable, which is the change in scores from pretest to posttest. Conclusions: Students demonstrated positive changes after completing the course, indicating a need for further research to assess the effectiveness of this class. Cultural diversity DEI curriculum ethics undergraduate medical education medical students Figures Figure 1 Introduction Cultural diversity (CD) plays a pivotal role in healthcare, as it leads to improved patient outcomes, facilitates effective communication, and helps reduce health disparities among different demographic groups [ 1 ]. As the world becomes increasingly interconnected, the need for cultural competence and balance among medical professionals becomes increasingly imperative [ 1 – 4 ]. Therefore, the Diversity, equity, and inclusion (DEI) principle highlights the imperative of cultivating an environment that embraces differences in race, ethnicity, gender, sexual orientation, and various other characteristics [ 5 ]. The DEI principle is gaining prominence as a guiding framework in various sectors, including education, [ 6 ] business, [ 7 ] and healthcare [ 8 ]. In medical education, equity, diversity, and inclusion emerge as outcomes when addressing discrimination [ 6 , 8 – 10 ]. By removing barriers and promoting inclusivity, medical education evolves into an environment characterized by prevailing equity, active encouragement of varied viewpoints, and a sense of value and support for individuals from all backgrounds [ 6 , 9 ]. In recent years, Korea has experienced a significant shift from ethnic homogeneity to increased CD [ 11 , 12 ]. Medical schools are pursuing internationalization efforts by recruiting foreign students with diverse ethnic backgrounds [ 13 ], and medical students are provided with increased opportunities to interact with multicultural patients to foster the recognition of the importance of CD in healthcare delivery [ 11 ]. Consequently, CDs have been incorporated into the curriculum of medical schools. However, variations exist in the delivery methods of cultural diversity education among medical schools, and the emphasis on the DEI principle varies across institutions. This study aims to examine the changes in understanding cultural diversity after the course was completed at a medical school in Korea. Materials and methods The cultural diversity course The course was developed to provide medical students with an understanding of cultural diversity. Its outcomes were designed and adjusted on the basis of the cultural competence model [ 2 ], with the key objectives of enabling students to recognize and appreciate diversity in themselves and others, as well as to articulate the meaning and significance of cultural diversity in healthcare. This course is compulsory for first-year medical students at Yonsei University Wonju College of Medicine (YUWCM). In delivering this 3-hour course, we utilized the LEARN model [ 2 ] as a foundational framework, offering a systematic and effective guide for students to enhance their cultural competence and communication within healthcare settings. The course was divided into three main parts: an introduction, main instructions, and a conclusion and recap (Table 1 ). In the introduction phase, we spent 15 minutes assessing students' grasp of cultural diversity, followed by a 15-minute orientation session. Table 1 Structure of the cultural diversity course Phase Process Time Activities Delivering methods Introduction Phase Checking student understading about CD before starting the class 15 mins Presurvey Questionnaire Class orientation 15 mins Ice breaking Main Instruction Phase CD introduction 30 mins Lecture Presentation Case studies 30 mins Student activities Group discussion And feedback Conducting patient interviews with an emphasis on embracing cultural diversity 30 mins Lecture Presentation Case studies 30 mins Student activities Role-playing and feedback Conclusion and Recap Phase Checking student understading about CD after completing the class 15 mins Postsurvey Questionnaire Closing the class 15 mins Summarize In the main instruction phase, we started with a 30-minute introductory session on cultural diversity, using presentations and case studies. This approach aims to explain the importance of cultural beliefs and practices, help students understand diversity in themselves and others, and encourage empathy toward patients' cultural backgrounds during medical interactions. We emphasized the need to address biases, prejudices, and stereotypes to provide fair and respectful healthcare. Effective communication across different cultures and social contexts was stressed, along with careful handling of sensitive issues. Afterward, we held a 30-minute group discussion in which the students received feedback from peers and lecturers. Next, we dedicated 30 minutes to conducting patient interviews, focusing on embracing cultural diversity, using presentations and more case studies. We highlighted the importance of effective communication in medical settings, especially with foreign patients, and the need to understand verbal and nonverbal cues. Confirming patients' preferred language and being sensitive to their cultural backgrounds were essential to overcoming communication barriers. We encouraged strategies such as offering free interpretation services and personalized patient support to create a welcoming environment. Furthermore, we emphasized recognizing cultural differences and catering to the specific needs of various patient groups, including English-speaking, former Soviet Union, Southeast Asian, or Arab populations, to ensure an inclusive and patient-centered approach. This segment included a 30-minute activity involving role-playing exercises and feedback. Finally, in the conclusion and recap phases, we spent 15 minutes evaluating students' understanding of cultural diversity. The session ended with a 15-minute summary, summarizing the key points and insights gained during the course. Study methods The research was carried out at YUWCM in Wonju, Korea. Ethical approval for the study was obtained from the Institutional Review Board (IRB) at YUWCM (IRB number: CR324313). This quasiexperimental study involved an entire group of first-year medical students who participated in a cultural diversity course during the academic year 2023–2024. Eighty-five first-year medical students who completed the CD course were surveyed via a 14-question questionnaire with a 5-point Likert scale. This survey was conducted two times (Table 1 ): prior to the commencement of the course (presurvey) and upon the completion of the course (postsurvey). The presurvey were distributed during the first 15 minutes before the course started by sending a questionnaire. Postsurvey were administered immediately after the students completed the main instruction phase, allowing for a response period of 15 minutes to answer the same questionnaire. Only students who completed all questions in the questionnaire were included in the study, while those who left any questions unanswered were excluded. The survey questionnaire was developed by reviewing and adapting literature and was reviewed by two experts. One expert specialized in medical education, while the other had expertise in international healthcare. The questionnaire consisted of 14 questions (Table 2 ), each answered via a 5-point Likert scale. The respondents indicated their level of agreement on a scale from "1" for "strongly disagree" to "5" for "strongly agree." For the statement "3. International students should abandon their own customs and values while studying," and a rating of "5" indicates strong disagreement, whereas a rating of "1" signifies strong agreement. Table 2 Survey questions on students’ attitudes toward cultural diversity 1. Every individual should take responsibility for acquiring knowledge about different ethnicities and cultures. 2. Minorities should embrace the values and customs of the majority. 3. International students should abandon their own customs and values while studying. 4. International students pursuing studies in a foreign country should adapt to the customs and values of the new country while preserving their own. 5. Empathy and open-mindedness are essential in achieving cultural balance. 6. Cultural balance is important in today's society. 7. Cultural diversity among healthcare workers can enhance the overall quality of healthcare services provided. 8. It is essential for healthcare professionals to acquaint themselves with the customs of diverse ethnicities and cultures within a multicultural context. 9. Just like many others, healthcare workers are not immune to harboring biases. 10. I feel comfortable expressing my culture at the university. 11. The course provides opportunities for students to engage in diverse cultural activities. 12. The university administration should address cultural issues affecting students, such as providing an adequate number of holidays for major festivals ensuring equal consideration for all. 13. The curriculum should incorporate the concept of multicultural awareness and sensitivity, fostering a more inclusive educational environment. 14. Student clubs within our college should actively promote and encourage the proportional involvement and participation of students from diverse cultures and nationalities. The collected data were analyzed via IBM SPSS Statistics Version 27. The average score for each question and the overall average score were computed and rounded to one decimal place. Descriptive statistics were used to analyze the sociodemographic characteristics of the students, whereas a paired-sample t test was used to determine significant differences between presurvey scores and postsurvey scores. Additionally, multiple linear regression was performed to examine the statistical significance between the dependent variable (the change in pre- and posttest data) and the independent variables (age, gender, religion, and income level). Ethic approval The study was approved by the Yonsei University Wonju Severance Christian Hospital. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki [ 14 ], as reflected in prior approval by the Institutional Review Board of the Yonsei University Wonju College of Medicine (IRB No. CR324313). Informed consent was obtained from all research participants. Results Sociodemographic data Among 85 first-year medical students, 51 completed the survey without omitting any information (Table 3 ). The mean age was 22.75 years. In terms of gender distribution, 64.7% were males, whereas 35.3% were females. Regarding religious affiliation, a significant majority (72.5%) identified as atheists, with smaller percentages for Catholics (3.9%), Christians (15.7%), Protestants (3.9%), and Buddhism (3.9%). Income levels exhibited variability, with 43.1% earning 25% or less of the average income, 2.0% falling within the 25% − 50% range, 13.7% within the 50% − 75% range, and 41.2% reporting an income exceeding 75% of the average. Table 3 Sociodemographic characteristics Characteristic n (%) Age (Mean ± SD) 22.75 ± 2.25 Gender Male 33 (64.7%) Female 18 (35.3%) Religion Atheism 37 (72.5%) Catholic 2 (3.9%) Christian 8 (15.7%) Protestant 2 (3.9%) Buddhism 2 (3.9%) Income level 25% or less of average income 22 (43.1%) 25% − 50% of average income 1 (2.0%) 50% − 75% of average income 7 (13.7%) More than 25% of average income 21 (41.2%) The average scores of the presurvey and postsurvey The average score of the postsurvey was higher than that of the presurvey, at 57.27, whereas it was 51.77 (p < 0.001) (Table 4 ). Table 4 The average scores of pre- and postsurveys on students' attitudes toward cultural diversity Question Presurvey Mean (± SD) Postsurvey Mean (± SD) P value Question 1 (Q1) 3.62 (± 1.051) 4.25 (± 0.905) < 0.001 Question 2 (Q2) 2.88 (± 1.114) 3.02 (± 1.365) 0.341 Question 3 (Q3) 3.48 (± 1.129) 3.50 (± 1.336) 0.742 Question 4 (Q4) 4.06 (± 0.873) 4.21 (± 0.977) 0.312 Question 5 (Q5) 4.31 (± 0.805) 4.56 (± 0.669) 0.032 Question 6 (Q6) 4.10 (± 0.823) 4.56 (± 0.639) < 0.001 Question 7 (Q7) 3.83 (± 1.061) 4.56 (± 0.725) < 0.001 Question 8 (Q8) 3.83 (± 0.857) 4.40 (± 0.721) < 0.001 Question 9 (Q9) 4.15 (± 0.668) 4.15 (± 0.826) 0.699 Question 10 (Q10) 3.63 (± 1.121) 4.00 (± 0.929) 0.003 Question 11 (Q11) 3.62 (± 0.932) 4.10 (± 0.153) 0.001 Question 12 (Q12) 3.81 (± 0.951) 4.25 (± 0.905) 0.002 Question 13 (Q13) 3.87 (± 0.768) 4.37 (± 0.768) < 0.001 Question 14 (Q14) 3.56 (± 1.018) 4.35 (± 0.764) < 0.001 Total 51.77 (± 5.476) 57.27 (± 6.142) < 0.001 Changes in the question response In general, a positive trend was observed, with the average score increasing from 51.77 (± 5.476) in the presurvey to 57.27 (± 6.142) in the postsurvey (Table 4 ). Notably, there was a statistically significant improvement in the postsurvey scores for several questions. In particular, Questions 1, 5, 6, 7, 8, 10, 11, 12, 13, and 14 demonstrated significant increases, all with p values less than 0.05. However, Questions 2, 3, 4, and 9 did not exhibit statistically significant changes, as their p values exceeded 0.05 (Fig. 1 ). Multiple regression The regression model yields an intercept coefficient (B) of 3.010 (SE = 10.468), with a t value of 0.288 and a p value of 0.775 (Table 5 ). This result suggests that the intercept is not statistically significant. None of the independent variables reached statistical significance (p > 0.05), indicating that age, gender, religion, and income level do not have a significant predictive relationship with the dependent variable (the change in pre- and posttest data) in this model. Table 5 Multiple linear regression analysis of the effects of changes in the average presurvey and postsurvey scores on students' attitudes toward cultural diversity Independent variables B Std. Error t value P value (Intercept) 3.010 10.468 0.288 0.775 Age 0.052 0.330 0.159 0.875 Gender 0.092 1.613 0.057 0.955 Religion -0.291 0.666 -0.437 0.664 Income level -0.200 0.540 -0.370 0.713 Discussion This study indicated that after completing the course, medical students changed their knowledge of cultural diversity, with the average score on the posttest being higher than that on the pretest. First, the categorization of the first 6 questions focused primarily on achieving cultural balance and recognizing and appreciating diversity in oneself and others. Although there was a significant difference between the pretest and posttest mean scores of these questions, we observed that the p values from the paired-sample t test for questions 2, 3, and 4 did not reach statistical significance. This indicated that, after completing the course, students' perspectives on these 3 questions did not undergo significant changes. This may be influenced by family and societal factors [ 15 , 16 ]. Families, as the initial environment of human interaction, often serve as the foundation for cultural values and norms. By receiving education and spending time alongside their parents, students can develop values of respect, understanding, and acceptance toward cultural differences. On the other hand, society plays a role in expanding students' perspectives and cultural diversity. From interacting with peers to participating in community activities, students have the opportunity to experience and learn from individuals with different cultural backgrounds. These activities help students develop the ability to perceive and evaluate situations from multiple perspectives, as well as hone communication skills and the ability to work in diverse environments. Consequently, students have already formed an attitude toward cultural balance and diversity. Second, the next three questions focused on articulating the meaning and significance of cultural diversity in healthcare. There was no change for question number 9: “Just like many others, healthcare workers are not immune to harboring biases. Stability in students' preexisting views on doctors and cultural diversity potentially indicate that these views existed prior to their participation in the program and were not strongly influenced by the new learning experience [ 17 – 19 ]. In a setting where cultural values and societal norms play a significant role, [ 20 ] integrating DEI principles becomes crucial for addressing biases and ensuring equitable healthcare practices, and medical students may develop a set of culturally influenced beliefs about the practice of medicine and the role of healthcare professionals. Moreover, the complexity of the question of whether healthcare workers are immune to biases is emphasized. It extends beyond theoretical understanding, encompassing the practical application of these concepts in real-world healthcare settings. This becomes particularly evident when first-year medical students, who might not yet fully grasp the intricacies of healthcare practices and cultural dynamics, are considered. Finally, the final set of 5 questions focused on students' perceptions of CD activities. The results indicated that upon completing the course, students became more aware of the importance of extracurricular activities and academic programs related to cultural diversity. These programs are attributed to the benefits of skill development, academic improvement, social skills, and personal growth for every individual [ 21 ]. DEI principles play a crucial role in constructing these programs to celebrate different ethnicities, traditions, languages, and perspectives [ 22 ]. Although there has been a generally positive change in students' perception of cultural diversity after completing the course, it is still insufficient to conclude that this program effectively contributes to students' development of cultural competency in healthcare. Therefore, we will further expand our research by including not only students who have completed the course and are currently undergoing hospital clerkship but also those who have graduated and are now working in hospitals. This comprehensive approach allows us to observe changes at different stages and discern the benefits it brings to students during clerkship and their subsequent professional roles. Consequently, we can draw more robust conclusions regarding the effectiveness of the cultural diversity course. Our study also revealed that the regression model did not produce statistically significant results. This lack of significance may be related to the nature of the variables examined—such as age, gender, religion, and income level—which might not strongly predict changes in attitudes toward cultural diversity. Research indicates that demographic variables alone often do not have a significant effect on attitudes toward cultural diversity. For example, studies have shown that these demographic factors frequently do not robustly predict individuals' preconceptions or attitudes, suggesting that these variables may not be direct predictors of specific attitudes or outcomes [ 23 ]. Furthermore, the influence of background variables such as age, gender, religion, and income on changes in cultural attitudes might be limited due to their inherent stability and their lesser impact on immediate educational or cultural environments. The evidence suggests that while these demographic factors are important, their direct effect on the success of diversity and inclusion programs might be less significant than other influencing factors [ 24 ]. Similarly, research in educational settings has highlighted that demographic variables alone are insufficient to account for shifts in attitudes, indicating a need for more complex models to capture these dynamics effectively [ 25 ]. Strength This study represents a significant contribution to the field of medical education by offering a structured and comprehensive cultural diversity course to first-year medical students. The course content and structure were based on the cultural competence model, ensuring alignment with established frameworks in medical education. By utilizing the LEARN model as a foundational framework, the course provided students with a systematic guide to enhance their cultural competence and communication skills within healthcare settings. Additionally, the study employed a quasiexperimental design involving the entire group of first-year medical students, which enhances the reliability and generalizability of the findings. The survey questionnaire, developed through a rigorous review process by experts in medical education and international healthcare, ensured the validity and relevance of the data collected. Furthermore, the analysis of presurvey and postsurvey scores allowed for the assessment of changes in students' knowledge and perceptions of cultural diversity following the completion of the course. Limitations Despite its strengths, this study has several limitations that warrant consideration. First, the sample size of the completed surveys was relatively small, with only 51 out of 85 first-year medical students included in the analysis. This may limit the generalizability of the findings to the broader student population. Additionally, the study focused solely on first-year medical students at a single institution, which may restrict the applicability of the results to other medical education settings. Moreover, the survey questionnaire relied on self-reported responses from students, which may be subject to social desirability bias or inaccuracies in reporting. Furthermore, the study design did not include a control group or longitudinal follow-up, preventing the assessment of long-term outcomes or comparisons with students who did not participate in the cultural diversity course. Finally, while the course aimed to enhance students' cultural competency in healthcare, the study did not assess the impact of these changes on clinical practice or patient outcomes, which represents an important area for future research. Conclusion Following the course, the students demonstrated a positive shift in their understanding of the importance of cultural diversity. This highlights the importance of incorporating DEI principles into cultural diversity initiatives. Further studies targeting not only current hospital interns but also graduates in professional practice are needed to evaluate the program's effectiveness. Declarations Declaration of conflicting interests None of the authors have any potential conflicts of interest associated with this research. Funding This study was supported by the LJW Fellowship Program, KOFIH Acknowledgment None. Data availability The data that support the findings of this study are available from the corresponding authors and the Yonsei University Wonju College of Medicine, but restrictions apply to the availability of these data, which are not publicly available. Data are, however, available from the corresponding authors upon reasonable request and with permission from Yonsei University Wonju College of Medicine. Ethics approval and consent to participate The study was approved by the Ethics committee of Yonsei University Wonju Severance Christian Hospital (IRB No. CR324313). Informed consent was obtained from all individual participants included in the study. All methods were performed in accordance with the relevant guidelines and regulations in Ethics Approval and Consent to participate in Declarations. Consent for publication Not applicable. References L. DJ, Gilbert MJ, Malone B. Diversity and cultural competence in health care: A systems approach. 1st ed. San Francisco, CA: Jossey-Bass; 2012. Dogra N. Cultural diversity teaching in the medical undergraduate curriculum. Divers Equal Health Care. 2005;2(3):233-245. Larsen MA. Internationalization of higher education: An analysis through spatial, network, and mobilities theories. New York, NY: Palgrave Macmillan; 2016. Panthi S, Bhandari A, Acharya R, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5274777","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369583021,"identity":"6ede30be-8d87-4a71-80c1-3459897b5e7d","order_by":0,"name":"Hoang Minh Nguyen","email":"","orcid":"","institution":"Hue University of Medicine and Pharmacy","correspondingAuthor":false,"prefix":"","firstName":"Hoang","middleName":"Minh","lastName":"Nguyen","suffix":""},{"id":369583023,"identity":"483252d4-0443-473a-903e-47633acbb1c2","order_by":1,"name":"Yon Chul Park","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie2RMQrCMBRAP0TSJeoaEewVKgXBpWdJEdzq0r0OQtx07i0UoTgWAjrYA3QSXNyEuDj7FRUVGhwd8pa8BB4/IQAWyx9CH6sAh+RvJ/kvCaHit+QJJsx72xuShrMb8vM6GHmKXVCSTgPIQUOxr74Yi7JWWgxiT9VvonwK1OdQxoa3RFm7LvNwgcldJEAPQIvqpHl6JuyIkowlOBdzwl9TGEUhggLDKaUpOa36qRyEqaI+iupKwmIuiurEnUfL8iyDcLadHFAS151Ol1pvqhOkxj+FwO2bjBD9LRaLxWL54AqLc1CVst/EUAAAAABJRU5ErkJggg==","orcid":"","institution":"Yonsei University Wonju College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Yon","middleName":"Chul","lastName":"Park","suffix":""}],"badges":[],"createdAt":"2024-10-16 09:53:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5274777/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5274777/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67371976,"identity":"616d7011-7212-4b5d-a8d6-ccd3d3e5c155","added_by":"auto","created_at":"2024-10-24 08:02:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10268,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in the response of pre- and postsurveys tostudents' attitudes toward cultural diversity\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5274777/v1/938bdab6c04b6215942ddfe1.png"},{"id":104402439,"identity":"55d961ac-38bd-43e2-9cd1-b8207e99c784","added_by":"auto","created_at":"2026-03-11 12:15:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":739444,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5274777/v1/368d7d48-1c2a-45c2-b8af-7cfba71c8ad6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Culturally competent doctors start here: Investigating the impact of a cultural diversity course on Korean medical students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCultural diversity (CD) plays a pivotal role in healthcare, as it leads to improved patient outcomes, facilitates effective communication, and helps reduce health disparities among different demographic groups [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As the world becomes increasingly interconnected, the need for cultural competence and balance among medical professionals becomes increasingly imperative [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, the Diversity, equity, and inclusion (DEI) principle highlights the imperative of cultivating an environment that embraces differences in race, ethnicity, gender, sexual orientation, and various other characteristics [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The DEI principle is gaining prominence as a guiding framework in various sectors, including education, [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] business, [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and healthcare [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In medical education, equity, diversity, and inclusion emerge as outcomes when addressing discrimination [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. By removing barriers and promoting inclusivity, medical education evolves into an environment characterized by prevailing equity, active encouragement of varied viewpoints, and a sense of value and support for individuals from all backgrounds [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In recent years, Korea has experienced a significant shift from ethnic homogeneity to increased CD [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Medical schools are pursuing internationalization efforts by recruiting foreign students with diverse ethnic backgrounds [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and medical students are provided with increased opportunities to interact with multicultural patients to foster the recognition of the importance of CD in healthcare delivery [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Consequently, CDs have been incorporated into the curriculum of medical schools. However, variations exist in the delivery methods of cultural diversity education among medical schools, and the emphasis on the DEI principle varies across institutions. This study aims to examine the changes in understanding cultural diversity after the course was completed at a medical school in Korea.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe cultural diversity course\u003c/h2\u003e \u003cp\u003eThe course was developed to provide medical students with an understanding of cultural diversity. Its outcomes were designed and adjusted on the basis of the cultural competence model [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], with the key objectives of enabling students to recognize and appreciate diversity in themselves and others, as well as to articulate the meaning and significance of cultural diversity in healthcare. This course is compulsory for first-year medical students at Yonsei University Wonju College of Medicine (YUWCM). In delivering this 3-hour course, we utilized the LEARN model [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] as a foundational framework, offering a systematic and effective guide for students to enhance their cultural competence and communication within healthcare settings.\u003c/p\u003e \u003cp\u003eThe course was divided into three main parts: an introduction, main instructions, and a conclusion and recap (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the introduction phase, we spent 15 minutes assessing students' grasp of cultural diversity, followed by a 15-minute orientation session.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStructure of the cultural diversity course\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcess\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eActivities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDelivering methods\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIntroduction Phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChecking student understading about CD before starting the class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePresurvey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuestionnaire\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eIce breaking\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMain Instruction Phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCD introduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLecture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePresentation\u003c/p\u003e \u003cp\u003eCase studies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudent activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGroup discussion\u003c/p\u003e \u003cp\u003eAnd feedback\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConducting patient interviews with an emphasis on embracing cultural diversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLecture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePresentation\u003c/p\u003e \u003cp\u003eCase studies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudent activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRole-playing and feedback\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConclusion and Recap Phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChecking student understading about CD after completing the class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostsurvey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuestionnaire\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClosing the class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSummarize\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the main instruction phase, we started with a 30-minute introductory session on cultural diversity, using presentations and case studies. This approach aims to explain the importance of cultural beliefs and practices, help students understand diversity in themselves and others, and encourage empathy toward patients' cultural backgrounds during medical interactions. We emphasized the need to address biases, prejudices, and stereotypes to provide fair and respectful healthcare. Effective communication across different cultures and social contexts was stressed, along with careful handling of sensitive issues. Afterward, we held a 30-minute group discussion in which the students received feedback from peers and lecturers.\u003c/p\u003e \u003cp\u003eNext, we dedicated 30 minutes to conducting patient interviews, focusing on embracing cultural diversity, using presentations and more case studies. We highlighted the importance of effective communication in medical settings, especially with foreign patients, and the need to understand verbal and nonverbal cues. Confirming patients' preferred language and being sensitive to their cultural backgrounds were essential to overcoming communication barriers. We encouraged strategies such as offering free interpretation services and personalized patient support to create a welcoming environment. Furthermore, we emphasized recognizing cultural differences and catering to the specific needs of various patient groups, including English-speaking, former Soviet Union, Southeast Asian, or Arab populations, to ensure an inclusive and patient-centered approach. This segment included a 30-minute activity involving role-playing exercises and feedback.\u003c/p\u003e \u003cp\u003eFinally, in the conclusion and recap phases, we spent 15 minutes evaluating students' understanding of cultural diversity. The session ended with a 15-minute summary, summarizing the key points and insights gained during the course.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy methods\u003c/h3\u003e\n\u003cp\u003eThe research was carried out at YUWCM in Wonju, Korea. Ethical approval for the study was obtained from the Institutional Review Board (IRB) at YUWCM (IRB number: CR324313). This quasiexperimental study involved an entire group of first-year medical students who participated in a cultural diversity course during the academic year 2023\u0026ndash;2024.\u003c/p\u003e \u003cp\u003eEighty-five first-year medical students who completed the CD course were surveyed via a 14-question questionnaire with a 5-point Likert scale. This survey was conducted two times (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): prior to the commencement of the course (presurvey) and upon the completion of the course (postsurvey). The presurvey were distributed during the first 15 minutes before the course started by sending a questionnaire. Postsurvey were administered immediately after the students completed the main instruction phase, allowing for a response period of 15 minutes to answer the same questionnaire. Only students who completed all questions in the questionnaire were included in the study, while those who left any questions unanswered were excluded.\u003c/p\u003e \u003cp\u003eThe survey questionnaire was developed by reviewing and adapting literature and was reviewed by two experts. One expert specialized in medical education, while the other had expertise in international healthcare. The questionnaire consisted of 14 questions (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), each answered via a 5-point Likert scale. The respondents indicated their level of agreement on a scale from \"1\" for \"strongly disagree\" to \"5\" for \"strongly agree.\" For the statement \"3. International students should abandon their own customs and values while studying,\" and a rating of \"5\" indicates strong disagreement, whereas a rating of \"1\" signifies strong agreement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurvey questions on students\u0026rsquo; attitudes toward cultural diversity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Every individual should take responsibility for acquiring knowledge about different ethnicities and cultures.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Minorities should embrace the values and customs of the majority.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. International students should abandon their own customs and values while studying.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. International students pursuing studies in a foreign country should adapt to the customs and values of the new country while preserving their own.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Empathy and open-mindedness are essential in achieving cultural balance.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Cultural balance is important in today's society.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Cultural diversity among healthcare workers can enhance the overall quality of healthcare services provided.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. It is essential for healthcare professionals to acquaint themselves with the customs of diverse ethnicities and cultures within a multicultural context.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Just like many others, healthcare workers are not immune to harboring biases.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. I feel comfortable expressing my culture at the university.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. The course provides opportunities for students to engage in diverse cultural activities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. The university administration should address cultural issues affecting students, such as providing an adequate number of holidays for major festivals ensuring equal consideration for all.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. The curriculum should incorporate the concept of multicultural awareness and sensitivity, fostering a more inclusive educational environment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Student clubs within our college should actively promote and encourage the proportional involvement and participation of students from diverse cultures and nationalities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe collected data were analyzed via IBM SPSS Statistics Version 27. The average score for each question and the overall average score were computed and rounded to one decimal place. Descriptive statistics were used to analyze the sociodemographic characteristics of the students, whereas a paired-sample t test was used to determine significant differences between presurvey scores and postsurvey scores. Additionally, multiple linear regression was performed to examine the statistical significance between the dependent variable (the change in pre- and posttest data) and the independent variables (age, gender, religion, and income level).\u003c/p\u003e\n\u003ch3\u003eEthic approval\u003c/h3\u003e\n\u003cp\u003e The study was approved by the Yonsei University Wonju Severance Christian Hospital. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], as reflected in prior approval by the Institutional Review Board of the Yonsei University Wonju College of Medicine (IRB No. CR324313). Informed consent was obtained from all research participants.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic data\u003c/h2\u003e \u003cp\u003eAmong 85 first-year medical students, 51 completed the survey without omitting any information (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The mean age was 22.75 years. In terms of gender distribution, 64.7% were males, whereas 35.3% were females. Regarding religious affiliation, a significant majority (72.5%) identified as atheists, with smaller percentages for Catholics (3.9%), Christians (15.7%), Protestants (3.9%), and Buddhism (3.9%). Income levels exhibited variability, with 43.1% earning 25% or less of the average income, 2.0% falling within the 25% \u0026minus;\u0026thinsp;50% range, 13.7% within the 50% \u0026minus;\u0026thinsp;75% range, and 41.2% reporting an income exceeding 75% of the average.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e22.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (64.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAtheism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (72.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBuddhism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIncome level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25% or less of average income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (43.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25% \u0026minus;\u0026thinsp;50% of average income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50% \u0026minus;\u0026thinsp;75% of average income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (13.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 25% of average income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe average scores of the presurvey and postsurvey\u003c/h2\u003e \u003cp\u003eThe average score of the postsurvey was higher than that of the presurvey, at 57.27, whereas it was 51.77 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe average scores of pre- and postsurveys on students' attitudes toward cultural diversity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresurvey\u003c/p\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostsurvey\u003c/p\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 1 (Q1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.62 (\u0026plusmn;\u0026thinsp;1.051)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.25 (\u0026plusmn;\u0026thinsp;0.905)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 2 (Q2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.88 (\u0026plusmn;\u0026thinsp;1.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.02 (\u0026plusmn;\u0026thinsp;1.365)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.341\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 3 (Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.48 (\u0026plusmn;\u0026thinsp;1.129)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.50 (\u0026plusmn;\u0026thinsp;1.336)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 4 (Q4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.06 (\u0026plusmn;\u0026thinsp;0.873)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.21 (\u0026plusmn;\u0026thinsp;0.977)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 5 (Q5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.31 (\u0026plusmn;\u0026thinsp;0.805)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.56 (\u0026plusmn;\u0026thinsp;0.669)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 6 (Q6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.10 (\u0026plusmn;\u0026thinsp;0.823)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.56 (\u0026plusmn;\u0026thinsp;0.639)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 7 (Q7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.83 (\u0026plusmn;\u0026thinsp;1.061)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.56 (\u0026plusmn;\u0026thinsp;0.725)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 8 (Q8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.83 (\u0026plusmn;\u0026thinsp;0.857)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.40 (\u0026plusmn;\u0026thinsp;0.721)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 9 (Q9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.15 (\u0026plusmn;\u0026thinsp;0.668)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.15 (\u0026plusmn;\u0026thinsp;0.826)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 10 (Q10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.63 (\u0026plusmn;\u0026thinsp;1.121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00 (\u0026plusmn;\u0026thinsp;0.929)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 11 (Q11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.62 (\u0026plusmn;\u0026thinsp;0.932)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.10 (\u0026plusmn;\u0026thinsp;0.153)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 12 (Q12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.81 (\u0026plusmn;\u0026thinsp;0.951)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.25 (\u0026plusmn;\u0026thinsp;0.905)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 13 (Q13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.87 (\u0026plusmn;\u0026thinsp;0.768)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.37 (\u0026plusmn;\u0026thinsp;0.768)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 14 (Q14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.56 (\u0026plusmn;\u0026thinsp;1.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.35 (\u0026plusmn;\u0026thinsp;0.764)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e51.77 (\u0026plusmn;\u0026thinsp;5.476)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e57.27 (\u0026plusmn;\u0026thinsp;6.142)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eChanges in the question response\u003c/h3\u003e\n\u003cp\u003eIn general, a positive trend was observed, with the average score increasing from 51.77 (\u0026plusmn;\u0026thinsp;5.476) in the presurvey to 57.27 (\u0026plusmn;\u0026thinsp;6.142) in the postsurvey (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Notably, there was a statistically significant improvement in the postsurvey scores for several questions. In particular, Questions 1, 5, 6, 7, 8, 10, 11, 12, 13, and 14 demonstrated significant increases, all with p values less than 0.05. However, Questions 2, 3, 4, and 9 did not exhibit statistically significant changes, as their p values exceeded 0.05 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eMultiple regression\u003c/h3\u003e\n\u003cp\u003eThe regression model yields an intercept coefficient (B) of 3.010 (SE\u0026thinsp;=\u0026thinsp;10.468), with a t value of 0.288 and a p value of 0.775 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This result suggests that the intercept is not statistically significant. None of the independent variables reached statistical significance (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that age, gender, religion, and income level do not have a significant predictive relationship with the dependent variable (the change in pre- and posttest data) in this model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis of the effects of changes in the average presurvey and postsurvey scores on students' attitudes toward cultural diversity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e(Intercept)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e3.010\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e10.468\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.288\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.775\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study indicated that after completing the course, medical students changed their knowledge of cultural diversity, with the average score on the posttest being higher than that on the pretest.\u003c/p\u003e \u003cp\u003eFirst, the categorization of the first 6 questions focused primarily on achieving cultural balance and recognizing and appreciating diversity in oneself and others. Although there was a significant difference between the pretest and posttest mean scores of these questions, we observed that the p values from the paired-sample t test for questions 2, 3, and 4 did not reach statistical significance. This indicated that, after completing the course, students' perspectives on these 3 questions did not undergo significant changes. This may be influenced by family and societal factors [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Families, as the initial environment of human interaction, often serve as the foundation for cultural values and norms. By receiving education and spending time alongside their parents, students can develop values of respect, understanding, and acceptance toward cultural differences. On the other hand, society plays a role in expanding students' perspectives and cultural diversity. From interacting with peers to participating in community activities, students have the opportunity to experience and learn from individuals with different cultural backgrounds. These activities help students develop the ability to perceive and evaluate situations from multiple perspectives, as well as hone communication skills and the ability to work in diverse environments. Consequently, students have already formed an attitude toward cultural balance and diversity.\u003c/p\u003e \u003cp\u003eSecond, the next three questions focused on articulating the meaning and significance of cultural diversity in healthcare. There was no change for question number 9: \u0026ldquo;Just like many others, healthcare workers are not immune to harboring biases. Stability in students' preexisting views on doctors and cultural diversity potentially indicate that these views existed prior to their participation in the program and were not strongly influenced by the new learning experience [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In a setting where cultural values and societal norms play a significant role, [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] integrating DEI principles becomes crucial for addressing biases and ensuring equitable healthcare practices, and medical students may develop a set of culturally influenced beliefs about the practice of medicine and the role of healthcare professionals. Moreover, the complexity of the question of whether healthcare workers are immune to biases is emphasized. It extends beyond theoretical understanding, encompassing the practical application of these concepts in real-world healthcare settings. This becomes particularly evident when first-year medical students, who might not yet fully grasp the intricacies of healthcare practices and cultural dynamics, are considered.\u003c/p\u003e \u003cp\u003eFinally, the final set of 5 questions focused on students' perceptions of CD activities. The results indicated that upon completing the course, students became more aware of the importance of extracurricular activities and academic programs related to cultural diversity. These programs are attributed to the benefits of skill development, academic improvement, social skills, and personal growth for every individual [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. DEI principles play a crucial role in constructing these programs to celebrate different ethnicities, traditions, languages, and perspectives [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Although there has been a generally positive change in students' perception of cultural diversity after completing the course, it is still insufficient to conclude that this program effectively contributes to students' development of cultural competency in healthcare. Therefore, we will further expand our research by including not only students who have completed the course and are currently undergoing hospital clerkship but also those who have graduated and are now working in hospitals. This comprehensive approach allows us to observe changes at different stages and discern the benefits it brings to students during clerkship and their subsequent professional roles. Consequently, we can draw more robust conclusions regarding the effectiveness of the cultural diversity course.\u003c/p\u003e \u003cp\u003eOur study also revealed that the regression model did not produce statistically significant results. This lack of significance may be related to the nature of the variables examined\u0026mdash;such as age, gender, religion, and income level\u0026mdash;which might not strongly predict changes in attitudes toward cultural diversity. Research indicates that demographic variables alone often do not have a significant effect on attitudes toward cultural diversity. For example, studies have shown that these demographic factors frequently do not robustly predict individuals' preconceptions or attitudes, suggesting that these variables may not be direct predictors of specific attitudes or outcomes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, the influence of background variables such as age, gender, religion, and income on changes in cultural attitudes might be limited due to their inherent stability and their lesser impact on immediate educational or cultural environments. The evidence suggests that while these demographic factors are important, their direct effect on the success of diversity and inclusion programs might be less significant than other influencing factors [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Similarly, research in educational settings has highlighted that demographic variables alone are insufficient to account for shifts in attitudes, indicating a need for more complex models to capture these dynamics effectively [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStrength\u003c/h2\u003e \u003cp\u003eThis study represents a significant contribution to the field of medical education by offering a structured and comprehensive cultural diversity course to first-year medical students. The course content and structure were based on the cultural competence model, ensuring alignment with established frameworks in medical education. By utilizing the LEARN model as a foundational framework, the course provided students with a systematic guide to enhance their cultural competence and communication skills within healthcare settings. Additionally, the study employed a quasiexperimental design involving the entire group of first-year medical students, which enhances the reliability and generalizability of the findings. The survey questionnaire, developed through a rigorous review process by experts in medical education and international healthcare, ensured the validity and relevance of the data collected. Furthermore, the analysis of presurvey and postsurvey scores allowed for the assessment of changes in students' knowledge and perceptions of cultural diversity following the completion of the course.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eDespite its strengths, this study has several limitations that warrant consideration. First, the sample size of the completed surveys was relatively small, with only 51 out of 85 first-year medical students included in the analysis. This may limit the generalizability of the findings to the broader student population. Additionally, the study focused solely on first-year medical students at a single institution, which may restrict the applicability of the results to other medical education settings. Moreover, the survey questionnaire relied on self-reported responses from students, which may be subject to social desirability bias or inaccuracies in reporting. Furthermore, the study design did not include a control group or longitudinal follow-up, preventing the assessment of long-term outcomes or comparisons with students who did not participate in the cultural diversity course. Finally, while the course aimed to enhance students' cultural competency in healthcare, the study did not assess the impact of these changes on clinical practice or patient outcomes, which represents an important area for future research.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFollowing the course, the students demonstrated a positive shift in their understanding of the importance of cultural diversity. This highlights the importance of incorporating DEI principles into cultural diversity initiatives. Further studies targeting not only current hospital interns but also graduates in professional practice are needed to evaluate the program\u0026apos;s effectiveness.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have any potential conflicts of interest associated with this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by\u0026nbsp;the\u0026nbsp;LJW Fellowship\u0026nbsp;Program, KOFIH\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eavailability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding authors and the Yonsei University Wonju College of Medicine, but restrictions apply to the availability of these data, which are not publicly available. Data are, however, available from the corresponding authors upon reasonable request and with permission from Yonsei University Wonju College of Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics committee of Yonsei University Wonju Severance Christian Hospital (IRB No. CR324313). Informed consent was obtained from all individual participants included in the study. All methods were performed in accordance with the relevant guidelines and regulations in Ethics Approval and Consent to participate in Declarations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eL. DJ, Gilbert MJ, Malone B. Diversity and cultural competence in health care: A systems approach. 1st ed. San Francisco, CA: Jossey-Bass; 2012.\u003c/li\u003e\n\u003cli\u003eDogra N. Cultural diversity teaching in the medical undergraduate curriculum. Divers Equal Health Care. 2005;2(3):233-245.\u003c/li\u003e\n\u003cli\u003eLarsen MA. Internationalization of higher education: An analysis through spatial, network, and mobilities theories. New York, NY: Palgrave Macmillan; 2016.\u003c/li\u003e\n\u003cli\u003ePanthi S, Bhandari A, Acharya R, et al. Medical students\u0026apos; attitude toward cultural diversity: a cross-sectional study at a health sciences university in eastern Nepal. BMJ Open. 2022 May;12(5):e057062.\u003c/li\u003e\n\u003cli\u003eRosenkranz KM, Arora TK, Termuhlen PM, et al. Diversity, equity and inclusion in medicine: Why it matters and how do we achieve it? J Surg Educ. 2021;78(4):1058-1065.\u003c/li\u003e\n\u003cli\u003eMuldoon KM. IMPROVing communication about diversity, equity, and inclusion in health professions education. Anat Rec (Hoboken). 2022;305(4):1000-1018.\u003c/li\u003e\n\u003cli\u003eIm J, Chung YK, Qin D. Exploring diversity, equity, and inclusion in hospitality and tourism firms through the organizational justice and stakeholder theories. Tour Manag. 2023;95:104662.\u003c/li\u003e\n\u003cli\u003eGill GK, McNally MJ, Berman V. Effective diversity, equity, and inclusion practices. Healthc Manage Forum. 2018 Sep;31(5):196-199.\u003c/li\u003e\n\u003cli\u003eBarnabe C, Osei-Tutu K, Maniate JM, et al. Equity, diversity, inclusion, and social justice in CanMEDS 2025. Can Med Educ J. 2023 Mar;14(1):27-32.\u003c/li\u003e\n\u003cli\u003ePowell C, Yemane L, Brooks M, et al. Outcomes from a novel graduate medical education leadership program in advancing diversity, equity, and inclusion. J Grad Med Educ. 2021 Dec;13(6):774-784.\u003c/li\u003e\n\u003cli\u003eRoh H, Nirta L. Medical students interact with multicultural patients to learn cultural diversity. Korean J Med Educ. 2018 Jun;30(2):161-166.\u003c/li\u003e\n\u003cli\u003eStatistics Korea. 2022 population and housing census (register-based census) [Internet]. Daejeon, Korea: Statistics Korea; 2023 [updated 2023 Jul 27; cited 2024 Mar 1]. Available from: https://kostat.go.kr/board.es?mid=a20108070000\u0026amp;bid=11747\u0026amp;act=view\u0026amp;list_no=426676\u003c/li\u003e\n\u003cli\u003eMoon RJ. Internationalization without cultural diversity? Higher education in Korea. Comp Educ. 2016;52(1):91-108.\u003c/li\u003e\n\u003cli\u003eWMA TWMai. WMA Declaration of Helsinki - ethical principles for medical research involving human subjects.: The World Medical association Inc; 2021 [Available from: https://www.wma.net/policies-post/wma-declaration-ofhelsinki-ethical principles-for-medical-research-involving-human-subjects/\u003c/li\u003e\n\u003cli\u003eJones RS. Changing student attitudes: The impact of community participation. Soc Sci Q. 1974;55(2):439-450.\u003c/li\u003e\n\u003cli\u003eDing X, LaBrenz CA, Nulu S, et al. Impact of Parents as Teachers on parenting-related protective factors: A pre- and post- evaluation. Child Youth Serv Rev. 2023 Apr;147:106834.\u003c/li\u003e\n\u003cli\u003ePark GM, Hong AJ. \u0026quot;Not yet a doctor\u0026quot;: medical student learning experiences and development of professional identity. BMC Med Educ. 2022 Mar 4;22(1):146.\u003c/li\u003e\n\u003cli\u003eLee SH, Kim KB, Kim MR, et al. Study on the awareness of school doctor of Korean medicine in Middle School. Society of Preventive Korean Medicine. 2017;21(3):51-63.\u003c/li\u003e\n\u003cli\u003eKang YJ, Hwang JS, Lin Y, et al. Exploring the preconception of the first year of medical students on medicine before entering medical school. Korean J Med Educ. 2021;33(4):369-379.\u003c/li\u003e\n\u003cli\u003eKim Y, Kim SY. The Influence of Cultural Values on Perceptions of Corporate Social Responsibility: Application of Hofstede\u0026apos;s Dimensions to Korean Public Relations Practitioners. J Bus Ethics. 2010 Feb;91(4):485-500.\u003c/li\u003e\n\u003cli\u003eOberle E, Ji XR, Guhn M, et al. Benefits of extracurricular participation in early adolescence: Associations with peer belonging and mental health. J Youth Adolesc. 2019 Nov;48(11):2255-2270.\u003c/li\u003e\n\u003cli\u003eBanks JA. Cultural diversity and education: Foundations, curriculum, and teaching. 6th ed. New York, NY: Routledge; 2016.\u003c/li\u003e\n\u003cli\u003eKang, Y. J., et al. (2021). \u0026quot;Exploring the preconception of the first year of medical students on medicine before entering medical school.\u0026quot; Korean Journal of Medical Education 33(4): 369.\u003c/li\u003e\n\u003cli\u003ePowell, C., et al. (2021). \u0026quot;Outcomes from a novel graduate medical education leadership program in advancing diversity, equity, and inclusion.\u0026quot; Journal of graduate medical education 13(6): 774-784.\u003c/li\u003e\n\u003cli\u003eMuldoon, K. M. (2022). \u0026quot;IMPROVing communication about diversity, equity, and inclusion in health professions education.\u0026quot; The Anatomical Record 305(4): 1000-1018.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cultural diversity, DEI, curriculum, ethics, undergraduate medical education, medical students","lastPublishedDoi":"10.21203/rs.3.rs-5274777/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5274777/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eCultural diversity (CD) plays a crucial role in healthcare, influencing patient outcomes and reducing health disparities. In regard to diversity, the Diversity, Equity, and Inclusion (DEI) principle is indispensable. This study examined the changes in understanding cultural diversity after a course was completed at a medical school in Korea.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA quasiexperimental study was employed to investigate the change in student attitudes toward cultural diversity after completing the Cultural Diversity (CD) course. A total of 85 first-year medical students were selected as the study participants and were surveyed via a 14-question survey at two points: before the commencement of the course and after its completion. The data were analyzed quantitatively via paired sample t tests to observe changes over time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe overall average scores for all the questions from all the students after completing the course were higher than those before the course. However, among the 14 questions, questions 2, 3, 4, and 9 showed statistically insignificant differences (p \u0026gt; 0.05). The overall average scores for all the questions from the students increased after they completed the course. However, for four specific questions—questions 2, 3, 4, and 9—the differences between the pre- and postcourse scores were not statistically significant (p \u0026gt; 0.05). Additionally, the independent variables, including age, gender, religion, and income level, did not have a statistically significant relationship with the dependent variable, which is the change in scores from pretest to posttest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eStudents demonstrated positive changes after completing the course, indicating a need for further research to assess the effectiveness of this class.\u003c/p\u003e","manuscriptTitle":"Culturally competent doctors start here: Investigating the impact of a cultural diversity course on Korean medical students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-24 08:02:30","doi":"10.21203/rs.3.rs-5274777/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1e2628a6-bebc-476a-96b6-db53e4d7874d","owner":[],"postedDate":"October 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-05T10:26:49+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-24 08:02:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5274777","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5274777","identity":"rs-5274777","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}