{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:47:43Z","timestamp":1787024863482,"version":"build-2736575974"},"reference-count":52,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Climate change is a pressing public health issue, with the US health care sector contributing about 479 million tons of carbon dioxide (CO\n 2<\/jats:sub>\n ) annually. Online continuing medical education offers an alternative solution to increase global education delivery while reducing CO\n 2<\/jats:sub>\n emissions associated with traditional teaching methods.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n This study aimed to evaluate the carbon dioxide equivalent (CO\n 2<\/jats:sub>\n e) emissions associated with different delivery methods of the CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and Injury) global critical care education program. Specifically, we aimed to compare the climate impact of local in-person courses in Rochester, MN, international in-person courses, and online courses to determine the potential environmental benefits of transitioning to digital education platforms.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A cross-sectional analysis of CO\n 2<\/jats:sub>\n e emissions linked to the CERTAIN program was conducted from 2016 to 2022. We compared the climate impact of 3 different course offerings: local in-person at Rochester, MN, international in-person courses, and online courses. The international conferences were conducted in the host country with faculty traveling there to provide the educational content. CO\n 2<\/jats:sub>\n e emissions were calculated using the \u201cMy Climate Flight Calculator\u201d and \u201cEnvironmental Protection Agency Emission Factors\u201d formulas for travel, conference venues, and online course\u2013related emissions. Learner satisfaction was assessed via validated 5-point Likert surveys.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Local courses had the highest emissions: 52.7 tons\/course (2.5 tons\/participant), 96% from air travel (\n 50.6tons, P<\/jats:italic>\n <.001), versus other formats. International courses showed 20.2 tons\/course (0.4 tons\/participant), of which 93%(18.8 tons) were travel-related. Online courses reduced emissions by 96% per capita (0.1 tons\/participant,\n P<\/jats:italic>\n <.001) and 89% per course (5.6 tons,\n P<\/jats:italic>\n <.001) versus local format. Overall course ratings were either excellent (live 50%, n=136) vs online 44%, n=11) or very good (live 30.9%, n=84 vs online 53%, n=12) for both live and online courses.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The transition to online delivery of our CERTAIN global education program has led to a substantial reduction in CO\n 2<\/jats:sub>\n emissions, mainly by eliminating travel, with similar levels of learner satisfaction. These findings support a strategic shift toward digital medical education platforms to promote environmental responsibility and broaden global educational access.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/63524","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T22:51:17Z","timestamp":1754002277000},"page":"e63524-e63524","source":"Crossref","is-referenced-by-count":2,"title":["Environmental Impact of Online Versus in-Person Critical Care Education Through the Carbon Footprint Analysis of the CERTAIN Program: Cross-Sectional Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7704-9817","authenticated-orcid":false,"given":"Baiyong","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9469-6656","authenticated-orcid":false,"given":"Claudia Castillo","family":"Zambrano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1362-6769","authenticated-orcid":false,"given":"Nasrin","family":"Nikravangolsefid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8022-9029","authenticated-orcid":false,"given":"Ricardo Machado","family":"Carvalhais","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0891-9495","authenticated-orcid":false,"given":"Alexander","family":"Niven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-0890","authenticated-orcid":false,"given":"Ognjen","family":"Gajic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1737-6536","authenticated-orcid":false,"given":"Yue","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"issue":"24","key":"R1","doi-asserted-by":"publisher","first-page":"2234","DOI":"10.1056\/NEJMp2402018","article-title":"Carbon-footprint analyses in RCTs - toward sustainable clinical practice","volume":"390","author":"Nordberg","journal-title":"N Engl J Med"},{"key":"R2","unstructured":"Climate change. 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