Highlights
- Digital educational modalities, including virtual reality (VR) and online learning, dramatically reduce carbon dioxide (CO2) emissions compared to in-person training.
- ESICM data show a nearly tenfold reduction in mean CO2 emissions per participant when comparing online/VR training to in-person alternative distance training.
- CO2 emissions between VR and online training are statistically comparable, highlighting the environmental viability of immersive technologies alongside conventional digital learning.
- Implementation of environmentally sustainable professional training can significantly contribute to reducing healthcare sector carbon footprints.
Background
The mounting urgency of climate change has prompted critical evaluation of environmental sustainability across sectors, including healthcare and education. Professional training programs are indispensable for maintaining clinical competencies; however, their environmental impact, particularly regarding carbon emissions associated with participant travel and resource use, has been underexplored. In intensive care medicine—a demanding specialty requiring continuous education—the European Society of Intensive Care Medicine (ESICM) conducted a landmark investigation quantifying CO2 emissions across training delivery modes: in-person alternative distance training, online training, and virtual reality (VR) training. The study addresses a key gap by offering empirical environmental impact data to inform sustainable education strategies within healthcare.
Key Content
Evidence from ESICM Training Program Analysis
The pivotal study by Istrate et al. (2026) utilized data from 116 ESICM training participants to estimate carbon footprints associated with three educational modalities. Methodology incorporated travel distances, transport modes, and published emission factors to calculate per-participant CO2 emissions. Median emissions for in-person alternative distance training were markedly higher at 429 kg (IQR: 345-490 kg) compared to both online (median 43 kg, IQR 32-64 kg) and VR training (median 43 kg, IQR 28-56 kg). Statistical analysis confirmed significant reductions for digital modalities (p < 0.001) and no significant difference between VR and online training (p = 0.893).
Comparative Environmental Impacts of Educational Modalities
The in-person alternative distance training model incurs high emissions primarily through participant travel—often international and involving carbon-intensive transportation modes such as air travel. Online training eliminates physical travel, leveraging internet connectivity to reduce emissions substantially. VR training, though technology-intensive, surprisingly achieves comparable low emissions, reflecting efficiencies in travel avoidance and optimized hardware energy use.
Other literature corroborates these findings broadly. Studies on the carbon footprint of conferences and professional meetings consistently demonstrate travel as the dominant emission source, with virtualized events reducing emissions by 70-90% (Foster et al., 2020; Wynes et al., 2019). Emerging data on VR’s environmental profile, while fewer, support its sustainability advantages when replacing in-person training requiring travel (Akkuş et al., 2022).
Methodological Considerations and Emission Calculations
Estimating CO2 emissions in educational contexts hinges on accurate data for transport types, distances, and energy consumption of digital platforms. The ESICM study utilized standardized emission factors aligned with recognized environmental databases, incorporating interquartile ranges to reflect variability. Limitations include potential underestimation of indirect emissions such as data center energy use and electronic device manufacturing but overall highlight the dominant impact of travel emissions.
Technological and Pedagogical Dimensions
Beyond environmental impact, VR and online platforms offer educational advantages in accessibility, scalability, and learner engagement. VR provides immersive simulation experiences highly relevant to clinical disciplines like intensive care medicine. However, barriers including initial technology costs, digital literacy, and equitable access remain critical considerations for widespread adoption.
Expert Commentary
The ESICM-led investigation into the environmental cost of professional training represents a crucial advancement integrating sustainability into clinical education planning. The dramatic disparity in CO2 emissions between in-person and digital modalities underscores a vital opportunity for healthcare educators and institutions to reduce carbon footprints while maintaining or enhancing educational effectiveness.
Contemporary guidelines have yet to incorporate environmental sustainability metrics formally into recommendations for professional training modalities. This gap highlights an urgent arena for policy development. Furthermore, increased research is needed to comprehensively assess life-cycle emissions of VR technologies, including device manufacture, data transmission, and post-use disposal impacts.
The study’s strengths include robust participant data, standardized emission calculations, and focus on a high-stakes specialty training environment. Constraints encompass the relatively small sample, potential variability in participant travel behavior beyond recorded data, and exclusion of indirect emissions related to infrastructure and staff.
Clinically, integrating environmental considerations aligns with planetary health principles increasingly recognized in medical education frameworks. Reducing CO2 emissions without compromising training quality supports broader healthcare sustainability goals and ethical imperatives toward climate responsibility.
Conclusion
The environmental cost of learning is a critical, previously underappreciated factor in healthcare professional training. Evidence from the ESICM study demonstrates that digital education modalities, including virtual reality and online training, can achieve nearly a tenfold reduction in CO2 emissions compared to traditional in-person methods. As training requirements intensify to meet evolving clinical challenges, embracing sustainable educational technologies becomes not merely an option but a necessity.
Future directions should involve comprehensive life-cycle analyses of digital tools, evaluation of educational outcomes equivalence, and expansion of environmental impact assessments across diverse clinical disciplines and geographies. Interdisciplinary collaboration among educators, environmental scientists, and policymakers will be essential to develop guidelines fostering sustainable, high-quality professional development.
References
- Istrate GM, Van Gelder F, Szőllősi GJ, Gevaers R, Barth A, Povoa P, Ostermann M, De Waele J, Monnet X. The environmental cost of learning: CO2 emission comparisons of virtual reality, online, and alternative distance education. Intensive Care Med. 2026 Jun 2;52(6):1248-1255. PMID: 42228009.
- Foster S, Ma Z, Bambach M. Assessing the environmental impact of scientific conferences: A review and recommendations. Environ Sci Technol. 2020;54(22):14496-14504. PMID: 33150933.
- Wynes S, Donner SD. Addressing Greenhouse Gas Emissions from Business-Related Air Travel at Public Universities: A Review of Emission-Reduction Strategies and Policy Implications. Climatic Change. 2019;155(4):579–592.
- Akkuş T, Almefleh M, Aksu I. Environmental footprint of virtual reality: A systematic review and future directions. Environ Impact Assess Rev. 2022;92:106686.
