We have all come across learning outcomes (LOs) that form the backbone of accredited physiotherapy programmes and standards of practice. Physiotherapy academics spend hours developing LOs, a task where you try to find the balance between Oracle-of-Delphi-ambiguity and useful physiotherapy stuff. Developing LOs is a privilege, they outline what it is we want students to learn, to be able to do, they guide our practice. But we also need to understand the requirements of the powers that be, including educational institutions, regulatory authorities, and professional bodies. This can be a balancing act and at times requires diplomacy, pragmatism, and tireless efforts to eventually get the LOs across the line.

The United Kingdom Musculoskeletal Advanced Practice (UK MSK AP) Standards (ARMA n.d.) were published in September 2022 and include these LOs:

By the end of the programme of study, the successful student will be able to:

  • Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems, and describe how the environment and human health interact at different levels (E2.K14)
  • Discuss how the duty of a health professional to protect and promote health is shaped by the dependence of human health on the local and global environment (E2.S10)

Real, tangible LOs that highlight the need to consider planetary health and sustainable healthcare, in a standards document for advanced musculoskeletal practice!

The starting point for the development of the UK MSK AP Standards was the IFOMPT Educational Standards Document 2016 and IFOMPT granted permission to use words and illustrations from their publication. However, these do not contain LOs about environmental sustainability.

Kenneth Chance-Larsen

Kenneth Chance-Larsen

Associate Professor, Western Norway University of Applied Sciences

Kenneth Chance-Larsen is an Associate Professor at Western Norway University of Applied Sciences in Bergen, Norway. He normally teaches undergraduate physiotherapy students, but is currently undertaking a PhD project on how skill mix / task shifting / task sharing in primary care can benefit patients with musculoskeletal conditions.

ARMA. (2022). U.K. Musculoskeletal Advanced Practice Standards.

A project management group, which included Amanda Hensman-Crook, Helen Welch, Dr Tim Noblet, Dr Neil Langridge, Dr Elaine Atkins MBE, Dr Colette Ridehalgh, Diarmuid Denneny, and Kenneth Chance-Larsen, undertook an extensive mapping and governance alignment exercise. The idea of adding environmental sustainability learning outcomes emerged during this work, and we ended up with a draft that included planetary health and sustainable healthcare LOs. This was in alignment with the Greener NHS initiative, which seeks to “…deliver a net zero health service and respond to climate change, improving health now and for future generations.” (NHS England 2020). We felt it was important to ensure that the MSK AP Framework alignment with this initiative. In addition, we used the AMEE consensus statement on planetary health and education for sustainable healthcare (Shaw et al. 2021) to make it clear that to meet the 2030 Sustainable Development Goals, health professions education must equip students with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights, and well-being of current and future generations, while protecting the health of the planet.

And so, another important step in the right direction has been made. By having these LOs in the standards, students and education providers in the UK now must talk about them and consider how they should influence practice as we go forward.


ARMA. (2022). ‘U.K. Musculoskeletal Advanced Practice Standards, Sept 2022’. Retrieved 17 October 2022 (http://arma.uk.net/msk-advanced-practice/).

NHS England. 2020. ‘Greener NHS’. Retrieved 17 October 2022 (https://www.england.nhs.uk/greenernhs/).

Shaw, Emily, Sarah Walpole, Michelle McLean, Carmen Alvarez-Nieto, Stefi Barna, Kate Bazin (…) and Robert Woollard. 2021. ‘AMEE Consensus Statement: Planetary Health and Education for Sustainable Healthcare’. Medical Teacher 43(3):272–86. https 10.1080/0142159X.2020.1860207.

Thompson, Trevor, Sarah Walpole, Isobel Braithwaite, Alice Inman, Stefi Barna, and Frances Mortimer. 2014. ‘Learning Objectives for Sustainable Health Care’. The Lancet 384(9958):1924–25. https://doi.org/10.1016/S0140-6736(14)62274-1