Table 2.

Study outcomes and conclusions

Study	Outcome(s) measured	Result
Haack and Phillips, 2012 [19]	Cultural competency through the Inventory to Assess the Process of Cultural Competence-revised (IAPCC-R): a validated self-assessment tool.	Overall cultural competency did not differ between intervention and non-intervention groups, but cultural skills and cultural encounters scores were higher for the intervention group.
Lie et al., 2010 [17]	An assessment questionnaire to quantify the new course’s relevance in preparing students for a cross-cultural practice; a pre- and post-essay style test on cultural competency.	The students’responses were 83% positive for the course, and they showed a statistically significant score improvement on the post-test relative to the pre-test.
Lonie and Rahim, 2010 [18]	Objective Structure Clinical Examination (OSCE) scores and multiple choice examinations for a communications course.	A statistically significant increase in multiple choice scores was observed in the intervention group, with no change in OSCE scores.
Plake, 2010 [21]	After the elective, students completed retrospective surveys (5-point Likert scale) on their perceived functional empathy before and after the course.	Students showed statistically significant increases in self-assessed ability to complete empathy and compassion related tasks.
Roche, 2007 [20]	A post survey evaluation of course objectives, including empathy-related statements regarding underserved populations.	Researchers found significant improvements in students’“cultural appreciation and respect, awareness of health disparities and the need for social responsibility, appreciation for the spiritual aspect of wellness, and the positive impact of traditions on health, and a recognition of professionally rewarding practice opportunities.”
Shapiro et al., 2006 [22]	OSCE exams scores were compared.	The two groups did not differ on OSCE exam scores, but in the essay point-of-view writers were more likely to adopt the first person, to show empathy for the physician, and showed a higher score in overall empathy and insight.
Wallman et al., 2008 [24]	Essays were graded on a rubric of level of reflection with good inter-rater reliability (k5 = 0.63).	The levels of reflection scored in the essays pre- and post-course increased significantly.
Westmoreland et al., 2009 [23]	Reflective writing was analyzed for themes as a means of assessing changing attitudes and perceptions toward the elderly; a written pre- and post-survey on geriatric attitudes was administered; a learner satisfaction survey was administered.	Reflective writing analysis found a change in perception of elderly: 27% of participants changed their negative into positive or reinforced their pre-existing positive attitudes. 98% of students were also satisfied with the learning experience delivered by the sessions and writing exercises.