A total of 333 (91.0%) questionnaires (111 for three times) were effective and used for analyses (Fig. 1). The remaining 11 (9.0%) respondents were excluded for refusing to participate or incomplete information. There were 66 (59.5%) males and 45 females (40.5%) among the effective respondents.

The flowchart of participants recruitment. A total of 111 students with their questionnaires eligible for analyses

As illustrated in Fig. 2, the majority of students were afraid of X-rays before taking the course. The number of students with mild, moderate, and severe fear was 12 (10.8%), 30 (27.0%), and 65 (58.6%), respectively. After the curriculum, the degree of fear decreased. After on-site viewing of IR operations, it was further decreased to 32 (28.8%), 51 (45.9%), and 20 (18.0%), respectively. The difference among the three groups was statistically significant (p < 0.001). In the gender-specific subgroup analyses, the results (Fig. 3) showed that the difference among males was also statistically significant (p < 0.001), and so was it among the females’ subgroup (p < 0.001).

Changes in undergraduates’ radiation anxiety, perception of IR operation, and career pursuing intention. A The fear degree of X-ray pre- and post-applying for curriculum, and after on-site viewing of IR operations. The difference was significant (p < 0.001). B The fear degree of radiation exposure during IR surgery procedures (p < 0.001). C The perception of IR before and after applying for curriculum, and after on-site viewing of IR operations (p < 0.001). D The change of career pursuing intention pre- and post-applying for curriculum, and after on-site viewing of IR operations (p < 0.001). IR, interventional radiology

Changes in radiation anxiety, perception of interventional radiology (IR) operations, and career pursuit intentions among male and female undergraduates. A–D Improvement in the attitudes of male undergraduates towards radiation anxiety, IR profession, and career pursuit intentions. E–H Changes in the attitudes of female undergraduates towards radiation anxiety, IR profession, and career pursuit intentions. IR, interventional radiology

Regarding radiation exposure during IR surgery procedures, 5 (4.5%), 11 (9.9%), and 22 (19.8%) students expressed fearlessness in the pre-curriculum, post-curriculum, and post-on-site view groups, respectively. The mild degree increased, and the severe degree decreased after taking courses in school and observing IR operations on-site. These changes presented statistically significant differences among these groups (p < 0.001). In gender-specific subgroup analyses (Fig. 3), statistically significant differences were observed among males (p < 0.001), as well as among females (p < 0.001).

There were 42 (37.8%) students blind to IR before applying for the curriculum, while almost all of them understood what it was after taking school courses. There were 19 (17.1%), 27 (24.3%), and 15 (13.5%) students who had no interest in IR pre-curriculum in the three groups, respectively. The number of undergraduates who expressed interest post-curriculum in the three groups was 50 (45.0%), 79 (71.2%), and 84 (75.7%), respectively. Furthermore, 4 (3.6%) and 12 (10.8%) students expressed a sense of achievement after applying for courses and observing the IR surgeries on-site, respectively. The change of interest was significantly different among the three groups (p < 0.001). In the gender-specific subgroup analyses, there were 25 (55.6%), 34 (75.6%), and 34 (75.6%) male undergraduates expressed interest in the three groups, respectively. The number of male students expressing a sense of achievement also increased in these groups from 0 (0%), to 3 (6.7%), and then to 7 (15.6%) respectively (p < 0.001). The number of female students who expressed interest in IR was also increased from 13 (19.7%), 19 (28.8%), and 11 (16.7%) to 25 (37.9%), 45 (68.2%), 50 (75.8%), respectively. Additionally, five females showed a sense of achievement after on-site viewing of IR operations. The difference among the female subgroup was statistically significant (p < 0.001).

Regarding career intention, 55 (49.5%) undergraduates did not want to pursue a career in IR prior to the curriculum. Fifty-five (47.7%) had the same attitude after taking courses in school, and the number dropped to 42 (37.8%) after watching operations in the clinic. There were 48 (43.2%), 41 (36.9%), and 33 (29.7%) students would consider IR as an alternative career in the three groups, respectively. In addition, 8 (7.2%), 17 (15.3%), and 36 (32.4%) students chose IR as their preferred career path, respectively. The difference was statistically significant among the three groups (p < 0.001). However, after on-site viewing, the majority of undergraduates who chose IR as their preferred career path were males (n = 32, 88.9%), while only four females did so (11.1%). Additionally, the difference among the three male subgroups was statistically significant (p < 0.001), but not among female subgroups (p = 0.397).

To further investigate whether these significant changes were related to the course taken in school and the on-site clinical exposure, the associations between them were evaluated. As shown in Fig. 4, students with a mild fear of X-ray increased significantly after on-site viewing compared to that of before taking courses, while it was nonsignificant only after curriculum. However, after applying for curriculum in school, the number of students with moderate fear increased significantly, while the number with severe fear was significantly reduced. In addition, the number of severe fear students was further significantly reduced after watching IR operations. The association value among these groups was 33.8% (The larger values indicate closer relevance between changes in undergraduates’ attitudes and educational interventions through curriculum and on-site view).

Correlation between the changes in undergraduates’ attitude and the intervention of curriculum or on-site view of IR surgeries. A Group comparation of the undergraduates’ anxiety to X-ray before and after applying for curriculum, and after on-site viewing of IR operations. The association value was 33.8%. B Group comparation of the undergraduates’ fear to IR operation. The association value was 41.9%. C Group comparation of the undergraduates’ perception of IR operation. The association value was 49.4%. D Group comparation of the career pursuing intention. The association value was 26.3%. Note: The distinct capital on the bar graph (different group) indicated the difference was significant. For example, the difference in the sense of achievement was significant in the post-on-site view group compared with the pre-curriculum group (A vs B). However, it was not significant compared the pre-curriculum group to the post-curriculum group (A vs A, B). In addition, the association value refers to the strength of the relationship between educational interventions and changes in attitudes. A larger value indicates a closer relevance between changes in undergraduates’ attitudes and educational interventions in curriculum and on-site view

The number of undergraduates who did not fear IR operation after on-site viewing was significantly improved compared to the pre-curriculum group, while it was not statistically significant after taking school courses. Following the IR surgeries, a statistically significant increase in the number of students with mild fear was also observed. The number of moderate fear students significantly increased after applying for courses, while it was decreased for severe fear students. Additionally, the number of students with severe fear further decreased after on-site viewing. The association value among these groups was 41.9%.

After completing the curriculum, the students sharply enhanced their knowledge of IR surgery, as was their interest. In particular, the sense of achievement was significantly improved after on-site viewing of IR operations. The association value between these groups was 49.4%.

As for career intention, the number of undergraduates who chose IR as their preferred career was significantly increased after on-site viewing compared to before and after taking courses. The students who did not want to pursue a career or who considered IR as an alternative career did not change significantly. The association value between these groups was 26.3%.