The McKenzie Institute International provides a postgraduate series of courses to musculoskeletal physiotherapists, chiropractors, and other health care practitioners around the globe. The Institute has Branches in 29 countries and has close to 100 faculty worldwide providing approximately 500 courses per year to roughly 10,000 participants. The Institute also provides courses in 15+ countries that have no Branches.

Natural alignment

In itself, the McKenzie approach seems fortuitously aligned with environmental objectives: It is primarily focused on what the person can do for themselves rather than what the clinician can do to them to help manage their symptoms and distress, thus minimising clinic visits and associated travel. The focus of the assessment on exploring the person’s own ability to move and affect their symptoms also makes it a natural fit for telehealth and it is well utilised in this capacity, with the associated environmental benefits. There is no use of electrical modalities, no expensive equipment, no heating up or cooling down of tissues, just education, exercise and / or positioning. The natural history of most MSK conditions is persistent and recurrent, the accompanying obligation is to provide the patient with the tools to manage these persistent symptoms and future episodes over their lifetime. As a consequence of this exploration of the person’s own generated management, the system is geared towards less future healthcare utilisation.

Easy choices

First, a full disclosure, the path to the McKenzie Institute becoming more environmentally adherent was initiated for primarily non-environmental reasons: reducing face-to-face course length to decrease the burden on course venues, allowing the live educational experience to be less didactic and more interactive (with much background information provided upfront online), allowing participants to need less time off work and thus decrease the barriers to attendance etc. Covid brought other more pressing considerations: how to keep providing courses when people could not travel and thus how to keep the branches functioning and afloat. 

Helping the environment was therefore not the initial motivating factor but has become an increasing central consideration as we plan our future strategies in the provision of our educational offerings. The development of a McKenzie Institute International environmental policy is currently in process.

Richard Rosedale (PT, Dip MDT)

Richard Rosedale (PT, Dip MDT)

Director of Education and the Diploma Coordinator for the McKenzie Institute International

Richard Rosedale lives in Canada where he works part-time as an MSK clinician next to his position with the McKenzie Institute. He has a keen interest and involvement in MSK research, and loves his teaching assignments for the Institute within Canada, online and abroad.

Photo by Windows on Unsplash

Accelerated transition

It is clear that compared to undergraduate programs where students and educators are in close proximity to their site of study, the environmental cost of providing post-graduate education can be significantly greater: Educators and participants may travel considerable distances, in larger countries up to thousands of kilometers, to teach and to participate. With a potentially greater environmental impact that other educational offerings, there can of course be relatively greater reductions with ameliorating strategies. 

We had dipped our toes into the online provision of courses with many of our Branches providing a ‘Day 1’ online from our A and B courses. This was pre-Covid, and the impact would have been minimal with a reduction in a single day travel for those local clinicians and non-local clinicians still having to drive or fly, whether it be for 3 or 4 days away from home. Covid accelerated this transition considerably, with much hurried preparation some branches were soon providing complete courses online and in the case of Canada, an online credentialing examination.

Increasing efforts and impact

Of course, the rationale was not initially environmental, but a means through which we could continue to provide education to interested clinicians and keep our Branches afloat and functioning. However, the impact of full online courses was more significant with no course participants or instructors flying or driving. This was especially apparent in larger countries such as Canada, the US and Australia, where a flight of 5-6 hours to attend a course would not be unusual. Time zones were of course accounted for, making an early start for some and a late finish for others, but people were prepared to be flexible in exchange for the much greater convenience and considerable reduction in cost of taking the course from home.

Our Diploma Program is the highest level of education we provide. It consists of a 12 week fully online theoretical and a 9-week face-to-face clinical. We currently have 11 clinical sites, but still have many candidates who need to travel internationally for this component of their education. Over the past few years, we have been able to provide sites in new countries to accommodate the needs of candidates and reduce the cost, impact, and burden of international travel. We have also initiated a pilot program of online mentoring for those candidates needing additional time and guidance, which allows them to attempt to successfully complete their clinicals without having to travel back to their original clinical site. The final component of the Diploma Program is the examination. In the past this usually entailed a separate trip, often international, now we have transitioned to a fully online format, no travel necessary

The new norm

As Covid’s compelling influence on our education provision faded, it was clear that we would not be returning to ‘normal’. Many faculty had become confident and proficient at online education and felt that an engaging and interactive learning environment could be achieved. Hence, the Institute would be further developing online content and exploring ways in which we could maintain high standards in our education provision, convenience to learners and keep environmental impacts minimised. Though acknowledging, that in some countries and cultures, there is still considerable resistance to online learning as a viable alternative to face-to-face courses and thus the transition would not be uniform worldwide.

We are currently in discussion regarding the provision of our full course series online for non-Branch countries and regions. This would eliminate the need for travel and help provide educational opportunities for clinicians in countries where live courses could not logistically be provided or would be prohibitively expensive.

Our international conference has traditionally been an occasion to get together with old colleagues, meet new colleagues, and socialize and learn together. However, we are now trying to accommodate the needs of those who choose not to travel, providing access to the recorded sessions online post-conference, along with the consideration of live streaming and a hybrid conference.

A team effort

Some McKenzie Institute Branches have independently made other changes that are worth noting:

  • Allocating faculty to courses closest to them to reduce travel distance.
  • Providing course manuals in PDF rather than paper format to save resources.
  • Locating courses for maximum accessibility to public transport and at the shortest possible. distances to the maximum number of participants.
  • Conducting Board / faculty meeting online and reducing the frequency of face-to-face gatherings.
  • Reducing food waste on courses through self-catering.
  • Ensuring recycling available at course venues.
  • Requesting participants bring their own water and not providing bottled water.
  • Our Swedish Branch have had an environmental policy since 2018.

Clearly, it is essential in the future to ensure the environment is a prime consideration in our decision making at a local and international level regarding our provision of education throughout the world. We have made some small steps in the right direction, but I am sure that we can and will do more.


Header image by Sam Mgrdichian on Unsplash