The Complete Guide To The Complete Guide To Becoming an Aviation and Space Medicine Doctor

If you are a foundation doctor who is interested in flight and physiology you may be interested in a career in aviation and space medicine (ASM). However, you may find yourself asking what exactly what such a career entails. This article aims to provide you with insight into the specialty and answer the most common questions you may have.

What do ASM doctors do?
Doctors who specialise in ASM conduct aeromedical fitness assessments for aircrew and air traffic controllers. They also assess the suitability of air or space travel for those with medical conditions. 

A core part of the specialist role is to understand the effects of the working environment on the body, potential impacts on performance, and then to contribute to human-centred design of vehicles, protection, and life support systems. This covers the hazardous environments of routine flight and also emergency survival scenarios. Therefore, research is also a core activity in this relatively new and growing specialty. 

Challenges range from understanding how medical conditions can affect the functional ability of aircrew to operate safely in their role, as well as how a condition might be affected by specific challenges presented by the aerospace environment, such as barometric pressure change, hypoxia, long-duration acceleration (or G), spatial disorientation, motion sickness, noise, vibration and, where relevant, space-specific issues , such as isolation and confinement, exposure to cosmic radiation and microgravity.

The type of activities ASM specialists can be involved in depends on the organisation they work for and the aerospace capabilities of the country in which they reside. For example, in the UK, the majority of operational work is in the aviation domain with ASM specialists at the UK Civil Aviation Authority (CAA), in the military with the Royal Air Force (RAF), industry at QinetiQ (a defence technology company), or education and research at King’s College London (KCL). 

The UK’s main involvement in space medicine is from a research perspective, covering areas such as flight simulation, medical support for the lunar gateway project (an orbiting space station around the moon) as well as UK CAA development of medical standards for human spaceflight. 

Opportunities to be involved in operational space medicine would be via the European Space Agency (ESA) in Cologne, Germany, so require periods of work overseas. 

What skills does the role of an aviation and space medicine doctor demand?

An in-depth understanding of human physiology, clinical medicine and basic physics. 

Practical or operational experience of the aerospace environment is also helpful (this can be in the form of practical flying or skydiving experience) as it may aid understanding of the operating conditions in which your clientele will work and the safety critical nature of their role. Any relevant flying experience will provide helpful insight into the culture and language of your clients. 

Is there a difference between ‘aviation and space medicine’ and ‘aerospace medicine’?  

No. Aerospace is a term that refers to any activities or industry concerned with the aviation or space environment. 

The terms aviation and space medicine and aerospace medicine can be used interchangeably. Aerospace medicine is commonly used in the US and some other countries. However, for some people, aerospace may be understood as meaning aviation solely, therefore in the UK, the Royal College of Physicians have chosen aviation and space medicine to be clear the specialty also encompasses space. 

Where can you train to become an ASM specialist?

There are currently three organisations that offer higher specialty training in ASM: the Royal Air Force (RAF), Civil Aviation Authority (CAA) and QinetiQ, with core academic training for the specialty provided at KCL. 

A trainee recruited to the programme would be directly employed by one of these organisations but would have the opportunity to work and train collaboratively with all three, either through visits, placements, regular weekly group tutorials and national training days. 

Taking the military route
Doctors enter RAF service either during their latter years of undergraduate studies (as a medical cadet) or later in their postgraduate training as a direct entrant (DE). 

Following the UK Foundation Programme, RAF medical officers (MOs) are expected to complete a general duties medical officer (GDMO) year, during which they undertake a 12-week officer training course at RAF Cranwell and gain experience of military primary healthcare/occupational health at a station medical centre. They must also gain a qualification as a military aviation medical examiner (MAME) which requires a 2-week blended theory and practical course at RAF Henlow.

Doctors interested in pursuing the military route should do so by contacting their regional Armed Forces Career Office (AFCO) or the medical and dental recruitment team for the armed forces. 

Following completion of one of the acceptable core training programmes (outlined below), MOs may apply for higher specialist training, including in aviation and space medicine if there are training spaces available.

RAF ASM specialists may be required as subject matter experts (SMEs) for complex aeromedical fitness assessments for military aircrew, including safety critical rear-crew and relevant team members on the ground. They are involved in physiological research that forms the basis of aeromedical policy for military aircrew, the development of life support systems and the design and integration of aircrew equipment. RAF ASM specialists also require knowledge of ergonomics or human factors, accident investigation and many other areas of aerospace medicine to provide accurate advice to the military command structure and ultimately reduce risk to life.

Describing all the differences between the roles of RAF and civilian ASM specialists is beyond the scope of this article. Some of the key differences to consider are a result of the operating environment of military aircrew.

High-performance military aircraft (such as the Eurofighter Typhoon and F35), are capable of executing complex manoeuvres which may subject occupants to significant long-duration acceleration, necessitating adequate countermeasures (such as wearing trousers fitted with inflatable bladders known as G-trousers).

Additionally, these aircraft often operate with a lower cabin pressure differential, placing occupants in a harsher environment. This necessitates the use of personal oxygen delivery systems, thermal protection, noise attenuation, and hearing protection systems integrated with communication capabilities to ensure the safety and functionality of the crew.

Beyond high-performance jets, other aircraft platforms, including multi-engine and rotary-wing aircraft, as well as air-based activities such as parachuting, present their own unique physiological challenges and medical considerations. RAF ASM specialists must develop a comprehensive understanding of these diverse conditions throughout their training.

Furthermore, military aircrew might be required to operate in unpredictable or austere overseas environments and conflict zones, posing an additional challenge for the doctors responsible for their care. These environments demand a high level of adaptability and preparedness from ASM specialists to ensure the wellbeing of the aircrew under such conditions.

RAF ASM specialists are expected to have a deep understanding of the behavioural countermeasures (using techniques to mitigate stressful conditions), life support systems and protection equipment that military aircrew require as a result of the physiological and psychological challenges posed by their operating environment. They must also have an appreciation of how these would need to be integrated into the aircrew equipment assembly and how they might interact with the specific role of that crew member.

Taking the civilian route

For doctors who do not wish to join the military, the two civilian organisations offering specialty training in ASM are the CAA and QinetiQ. 

An ASM specialist working for the UK Civil Aviation Authority (CAA) can expect to contribute to the four main areas of the medical department: medical certification, policy development, oversight, and the aviation health unit (AHU) (see below). There is the opportunity to partner with external organisations to conduct research. 

The CAA medical department is based in Aviation House, Gatwick, but you also enjoy the option of working remotely from home. Trainees also spend time at other organisations such as King’s College London, the RAF Centre of

Aerospace Medicine (Henlow) and QinetiQ. The majority of work is undertaken during normal working hours without an out-of-hours on-call commitment, but this can vary depending on the organisation. 

In a typical week, almost every day involves making complex certification fitness decisions and time is allocated throughout the week for reviewing or developing guidance material and occasionally travelling across the country to conduct audits on aeromedical examiner (AME) practices.

Typical work conducted by an ASM the CAA
Medical certification
Whilst AMEs make most routine certification decisions, pilots and air traffic controllers (ATCOs) with certain medical conditions or complex circumstances require an ASM specialist opinion before being considered fit to operate in their role. Often ASM specialists will ask for further investigations and reports to aid decisions. The ASM specialist is responsible for the decision to issue a medical certificate or not and in some circumstances might issue a certificate with specific endorsements. Common endorsements include the operational multi-crew limitation (OML), which restricts the pilot to multi-crew operations, to ensure that there is another equally qualified pilot present to take over should the pilot in question become incapacitated.
Guidance (policy) development
Throughout the year, ASM specialists attend panel meetings with external and internal medical specialists from a wide range of disciplines to discuss the latest developments in research, changes to clinical guidelines (such as the National Institute for Health and Care Excellence) and how this should impact changes in the guidance used by ASM specialists and the AMEs that they work with. For example, if a novel treatment is approved for the management of a common condition, an ASM specialist would study the latest evidence regarding that type of treatment to assess whether a review of the existing CAA guidance is necessary. They would have to take into account the risks associated with the treatment and how it might affect the functional ability of aircrew, whilst also considering how the aviation environment might interact with this treatment.
Oversight
The CAA is responsible for oversight of UK registered AMEs, this means that ASM specialists are often involved in the training and education of AMEs and conduct audits at AME practices and aeromedical centres to maintain high standards. Similar to other speciality trainee programmes, ASM specialists engage in peer-to-peer teaching once a week with civilian and military colleagues to share knowledge and learn from each other.
Aviation Health Unit (AHU)
While an ASM specialist’s work is predominantly concerned with the occupational aspect of ASM, through the AHU, they also provide information to other healthcare professionals (usually GPs)  with fit-to-fly queries about their patients. Occasionally, they provide information to government bodies and organisations seeking advice about public health matters related to aviation. This is an area of work that those with a special interest get involved in.

Entry routes to UK specialty training in aviation and space medicine
After completing medical school and foundation training, there are four traditional routes to entering the formal training pathway of aviation and space medicine to achieve certificate of completion of training (CCT), as approved by the General Medical Council (GMC): 

1. IMT1-3 internal medicine training (completion of two-year core medical training programme is also acceptable) with completion of MRCP (2 or 3 years)
2. CT1-3 anaesthetics training with completion of FRCA primary (3 years)
3. CT1-4 acute care common stem, ACCS (acute medicine) with completion of MRCP (4 years)
4. ST1-3 general practice training with completion of MRCGP (3 years).

Entry requirements have been broadened to enable other doctors with appropriate clinical experience to be considered, for example those who have completed emergency medicine run-through training to ST3. Doctors with a broad knowledge of medicine are encouraged to apply when a position comes up. A gap analysis conducted at the start of ST3 ASM can be used to assess which capabilities have already been achieved and which need addressing, in order to tailor the learning experiences for the first year of training. 
 
Higher speciality training (HST) in aviation and space medicine (4 years)  
Speciality training begins at ST3 level and the 4-year curriculum is overseen by the Joint Royal Colleges of Physicians Training Board (JRCPTB). There are usually one or two posts available each year: one in the RAF (every few years) and one in the CAA, though this varies depending on the needs of the employing organisations and as mentioned above, QinetiQ has become the latest organisation to offer specialty training in ASM. 

A distinct feature of the specialty is that the GMC-approved training posts are outside the NHS. Applications to a training post are made via the national NHS recruitment website Orie or directly with the employing organisation.  
Trainees must complete the diploma in aviation medicine (DAvMed) and most, if not all, will complete the MSc in aerospace medicine at King’s College London during the ST3 or ST4 years. Most trainees also choose to undertake a PhD in a subject of interest. Satisfactory completion of exams, portfolio requirements and competencies leads to certificate of completion of training (CCT) in aviation and space medicine and entry to the GMC specialist register.  
For doctors specialising in other disciplines, there is the option of developing a special interest in this field without going through training to become a consultant, these are outlined in another section below.  

Sub specialities  
Given this is a highly niche area of medicine, there are plenty of opportunities to sub specialise in areas of interest. These are generally in areas which are of operational value to the employing organisation of the ASM specialist. 
Civilian ASM subspecialist areas include:

• Human spaceflight 
• Public health in aviation 
• Pilot disability  
• Any clinical specialty (eg, oncology, cardiology, etc). 
• RAF ASM subspecialist areas include:
• Life support systems (eg, acceleration (G) physiology and protection, oxygen systems, thermal protection)
• Vision and display systems 
• Aircraft accident investigation and impact mechanics.

Pay
The salary for an ST3 in aviation and space medicine typically starts at £80,000 with higher baselines for those with additional experience and qualifications. The degree to which salaries increase through training is dependent on the employing organisation. 
 
Your CV 
Similar to other medical disciplines, employers and interview panels tend to favour those with: 

• A strong foundation in medicine
• Experience in managing patients in outpatient and inpatient settings
• Problem solving skills 
• Effective communication skills, written and verbal.

Aside from the requirements for completion of core training, your CV should demonstrate interest in the specialty.

Having experience of the following on your CV will help your application stand out:

• Involvement in aerospace medicine, wilderness medicine or extreme medicine society at university.
• Completed aerospace medicine short courses showing an understanding of the basis of the role of an aerospace medicine physician.
• Private pilot’s licence or steps towards achieving one.
• Diving experience or experience/knowledge of hyperbaric medicine 
• Experience practising medicine in austere environments
• Postgraduate qualifications in physiology, aviation or extreme medicine
• Involvement in formal medical education and lecturing experience
• Involvement in research related to the speciality and poster presentations at conferences.

How to get involved without joining the aviation and space medicine specialist training programme 

ASM offers plenty of opportunities for GPs and hospital specialists who are interested in the field but do not wish to commit to the full ASM specialty training programme.

Aeromedical examiner (AME)

An AME is usually a clinician with a CCT in their chosen speciality (often general practice or occupational medicine) who has received further training which allows them to conduct medical assessments for aircrew and and gain class 1, 2 or 3 privileges allowing them to issue medical certificates to specific groups in aviation.

An AME may need to refer cases needing specialist clinical assessment to other specialists such as cardiologists, ophthalmologists and psychiatrists with an understanding of the aviation environment. Complex cases can be referred to the CAA medical department for an ASM specialist opinion. 

Completion of the basic course in aviation medicine (BCAM) from King’s College London allows an AME to apply for class 2 (mostly private pilots) privileges. Further study to complete the advanced course in aviation medicine (ACAM) enables an application  to become an AME with class 1 (commercial pilots) and 3 (air traffic controllers) privileges.

Specialist medical adviser

Medical advisers with a specialist interest in ASM are clinicians who have specialist knowledge in a particular clinical field (eg, cardiology, psychiatry, endocrinology) and have also completed further training which allows them to advise AMEs and ASM specialists regarding aeromedical assessment of aircrew. These specialists may be external or employed directly by the CAA or RAF. They may also contribute to the specialty through academic research and advise on guideline development.

Aeromedical retrieval and transfer specialist

Doctors with experience of general medicine and acute medicine can work in aeromedical retrieval and transfer, providing advice and guidance on the medical considerations when retrieving, transferring and evacuating patients via air transport. This role requires the clinician to weigh up the risks of maintaining ground-based care with the risks of the aerospace environment. The whole patient journey requires consideration and not just the aircraft portion.  

Medical officer roles in the RAF/Royal Navy/British Army 
Outside of ASM specialist roles, many medical officers within the armed forces are involved in aerospace medicine and routinely see aircrew and controllers as patients. 

Within the RAF, many GPs and occupational physicians are involved in patient-facing aerospace medicine roles as well as deployments overseas, training and policy development postings. Both primary and secondary care clinicians are utilised for aeromedical evacuation capabilities up to and including critical care transfers. RAF secondary care specialists are expected to have an understanding of aerospace medicine issues in order to provide relevant SME advice for difficult fitness-to-fly decisions in their respective areas.
Both the British Army and Royal Navy also have aviation assets so require doctors with qualifications in aerospace medicine for their rotary wing and maritime operations respectively.

Air accident investigation specialist

The Air Accident Investigation Branch (AAIB) provides opportunities for medical professionals (specifically ASM trainees at the CAA, but also other doctors with a special interest) to support aircraft accident investigations and help improve aviation safety. The AAIB is also the Space Accident Investigation Authority for the UK.  

Opportunities outside the UK 

There are many organisations and regulatory agencies that offer opportunities for medical practitioners to practise in the aviation and space industries. These include many airlines, aeromedical retrieval and transfer agencies, air ambulance services and other national aviation authorities such as the US Federal Aviation Authority (FAA) and European Union Aviation Safety Agency (EASA), as well as national space agencies like the National Aeronautics and Space Administration (NASA) and the European Space Agency (ESA). There are also increasing opportunities for doctors to join commercial aerospace companies (eg, SpaceX, Axiom Space, Virgin Galactic and Blue Origin) and start-ups such as Caeli Nova.

Resources 

Health Education England aviation and space medicine person specification   
Joint Royal Colleges of Physicians Training Board
Books: Ernsting's Aviation and Space Medicine, The Handbook of Aviation and Space Medicine and Fundamentals of Aerospace Medicine
Academic journals: Aerospace Medicine and Human Performance 
Podcasts: The Aerospace Medicine Podcast, Let’s Talk Space Medicine and Spherical Cows offers advice from experts in the field. 
Societies: The Aerospace Medicine Association (ASMA), Aerospace Medicine Students and Residents Organisation (AMSRO); European Society of Aerospace Medicine (ESAM); Next Generation of Aerospace Medicine (NGAM); Royal Aeronautical Society Aerospace Medicine Group.

Courses 

Aerospace medicine courses at King's College London, including:

• MSc/ PgDip 
• Introduction to aerospace medicine 
• Basic course in aviation medicine 
• Advanced course in aviation medicine 
• Aircraft accident investigation 

Principles of aviation and space medicine at the University of Texas Medical Branch, Galveston, US
Space physician training course at the European Astronaut Centre in Cologne, Germany.
 
Authors
Daniel Olaiya, anaesthetics trainee (SpR) at the Royal Free Hospital, London, diploma in aviation medicine, graduate of ESA space physician course 2020. Co-host Aerospace Medicine podcast.
Payam Ghoddousi, GP and specialty registrar (StR) in aviation and space medicine at UK Civil Aviation Authority.
Matthew Landells, speciality registrar (StR) in aviation and space medicine, Royal Air Force
Jessica Mtemeri, third year medical student at Kent and Medway Medical School.
Rohan Sant, ACCS anaesthetics trainee at University College London Hospital. Co-host of Aerospace Medicine podcast.