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 focus on aeromedical fitness assessments for aircrew, air traffic controllers as well as medical considerations for passengers of air and space vehicles. Research is also a core activity in this relatively new and growing specialty.
Challenges range from understanding how health issues interact with features of the aviation environment, such as barometric pressure change, hypoxia, spatial disorientation, motion sickness, vibration and many others, including space- specific considerations, such as isolation, exposure to excess radiation and physiological changes resulting from microgravity (1).
What does the role demand?
You need an in-depth understanding of human physiology, clinical medicine and basic physics. Additionally, knowledge of how to maximise the limited resources of an aviation or space environment are key for an aerospace physician.
Practitioners strive for optimal standards for staff, in order to combat the occupational environmental hazards and engineering countermeasures (2).
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 more commonly used in the US and some other countries, whereas in the UK, the Royal College of Physicians have chosen Aviation and Space Medicine.
The type of activities ASM specialists can be involved in depends on which country they are based in, which organisation they work for and what the aerospace capabilities of that country are.
For example, in the UK, the majority of operational work ASM specialists are involved in, is in the aviation industry as there is currently no human spaceflight capability in the UK. UK ASM specialist’s involvement in space medicine is only through academic research.
Roles within Aviation and Space Medicine
Aviation and Space Medicine offers an expansive array of career opportunities for medical professionals, encompassing a wide scope of practice within either a civilian or military capacity.
For those not wanting to enter specialty training in ASM but are interested in the field and wish to develop a special interest, there are plenty of opportunities:
1. Aviation Medical Examiner (AME)
An AME is usually a clinician with a CCT in their chosen speciality (often GP or Occupational Medicine) and further training which allows them to conduct medical assessments for aircrew and issue Class 1, 2 or 3 medical certificates.
For cases needing specialist clinical assessment they may need to refer to other specialists such as cardiologists, ophthalmologists and psychiatrists with an understanding of the aviation environment. They are also able to refer complex cases to the CAA medical department for an ASM specialist opinion.
Completion of the Basic Course in Aviation Medicine (BCAM) from King’s College London would allow an individual to apply to become an AME with Class 2 (mostly private pilots) privileges. Further study to complete the Advanced Course in Aviation Medicine (ACAM) allows an individual to apply to become an AME with Class 1 (commercial pilots) and 3 (air traffic controllers) privileges.
2. Specialist Medical Adviser
Medical advisors with a specialist interest in ASM are clinicians who have specialist knowledge in a particular field (such as cardiology, psychiatry, endocrinology or any other specialty) and have also completed further training which allows them to advise AMEs and ASM specialists regarding aeromedical assessment of aircrew. These specialists can be employed externally or by the CAA or RAF. They may also contribute to the specialty through academic research and help advise on guidance development.
3. Aeromedical Retrieval and Transfer Specialist
You can work as an Aeromedical Retrieval and Transfer Specialist, providing guidance and medical direction on the optimal and safe methods of retrieving and evacuating critically ill patients via air transport. This role requires an in-depth knowledge and understanding of the hypobaric, low humidity cabin environment and the detrimental effects of acceleration and deceleration G forces.
4. Air Accident Investigation specialist
The Air Accident Investigation Branch (AAIB) also 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.
Outside the UK, there are a number of government organisations and regulatory agencies that offer opportunities for medical practitioners to practise in the aviation and space industries.
Some of these include the US Federal Aviation Authority (FAA), European Union Aviation Safety Agency (EASA), National Aeronautics and Space Administration (NASA) and the European Space Agency (ESA).
For those wishing to become ASM specialists, there are currently two paths to certificate of completion of training (CCT): as a civilian with the UK Civil Aviation Authority (CAA) or with the military, specifically the Royal Air Force (RAF).
The military route
The primary place for aerospace physicians in the UK military remains with the Royal Air Force.
A career in the RAF has lots of similarities to an NHS career. After graduation, you complete F1/F2 in an NHS hospital with military links. After this you would undertake the General Duties Medical Officer year, in which you would complete the 12 week Initial Officer training to gain your commission, and spend time integrated into RAF medical centres at Ministry of Defence Bases.
You would then be selected for specialist training depending on service availability and your own preferences (3).
As an RAF doctor you have the opportunity to obtain specialist qualifications in aerospace Medicine, such as the Diploma of Aviation Medicine.
The main differences between NHS and RAF ASM specialists lie in the fact that RAF ASM specialists have to understand and deal with the intricacies of specific military aircraft and air crew. This may involve military air crew selection, equipment design, anthropometry and the clinical aspects of more extreme G forces in much faster and higher flying aircraft.
A typical week of a civilian ASM specialist
A civilian ASM specialist working for the CAA enjoys a varied and interesting working week.
You work in four main areas of the medical department: medical certification, policy development, oversight, and the aviation health unit (AHU). You also have the opportunity to partner with external organisations to conduct research.
You spend most of your time based at Gatwick Airport, at the medical department based within Aviation House but you also enjoy the option of working remotely from home.
Trainees also spend time at King’s College, London but may be posted to RAF bases as well as other aerospace organisations.
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.
A typical week could involve the three days working in medical certification, with perhaps two days working on reviewing or developing guidance material and occasionally travelling across the country to conduct audits on AME practices.
Medical certification
Whilst AMEs make most routine certification decisions, pilots and 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 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 NICE) 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) regarding their patients with fit to fly queries.
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.
The route to becoming a consultant in Aviation and Space Medicine in the UK
After completion of medical school and foundation training, there are four main 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)
Speciality training 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 2 posts available each year: one in the RAF and one in the CAA.
A distinct feature of the specialty is that the GMC- approved training3 posts are outside the NHS. This means you train to become a consultant as part of the CAA or military. Applications to a training post are made via the national NHS recruitment website ‘Oriel’ 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 Aviation and Space Medicine. Many choose to contribute to the field through research and others study to obtain formal qualifications, such as DAvMed separately or MSc in Aerospace Medicine in order to practise as AMEs or specialist medical advisors.
Sub specialities
Given this is a highly niche area of medicine, there are plenty of opportunities to sub specialise in areas of interest. Preference is given to areas which are of operational value to the employing organisation of the ASM specialist.
Examples of civilian ASM subspecialist areas:
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Suborbital spaceflight
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Public health in aviation
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Aviation oncology
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Pilot disability
Examples of RAF ASM subspecialist areas:
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G physiology
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Oxygen systems
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Vision and helmet-mounted displays
Earnings
Salaries for Aviation and Space Medicine ST3 trainees typically start from £75,000 or more with added experience and qualifications and increase with time depending on the employing organisation.
Your CV
Similar to other medical disciplines, employers and interview panels tend to favour those with:
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A strong foundation in medicine
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Experience in managing patients in outpatient and inpatient settings,
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Problem solving skills
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The ability to reflect effectively.
Aside from the essential requirements for completion of core training, when preparing for a potential career in aviation and space medicine your CV should illustrate that you have genuine interest in the fundamentals of the speciality.
The benefit of ASM being a niche speciality is that passionate applicants can stand out from the crowd easily by being very intentional in their approach to their career.
Having these things on your CV will make you a very attractive applicant:
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Involvement in an aerospace medicine, wilderness medicine or extreme medicine society at university.
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Completing aerospace medicine short courses showing that understand the basis of the role of an Aerospace medicine physician.
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Private pilots licence or taking steps towards getting one and diving experience.
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Experience practising medicine in austere environments.
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Post graduate qualifications in physiology, aviation or extreme medicine related.
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Involvement in formal medical education and roles as a lecturer.
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Evidence of involvement in research related to the speciality. Poster presentations at conferences.
Resources:
There are many ways to find out more about Aerospace medicine.
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Podcasts: The Aerospace Medicine Podcast offers advice from experts in the field.
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Academic Journals: The Aerospace Medicine and Human Performance and
International Journal of Aviation, Aeronautics and Aerospace highlight the latest research in the field.
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Books: Ernsting's Aviation and Space medicine, The Handbook of Aviation and Space Medicine and Fundamentals of Aerospace Medicine4 offer a more detailed insight.
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Societies: The Aerospace Medicine Association (ASMA) holds an annual conference. Other societies include: 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.
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The key international courses that provide opportunities to study and meet like-minded people include: Aerospace Medicine MSc/ PgDip at King’s College London; Principles of Aviation and Space Medicine at the University of Texas Medical Branch, Galveston, US; the space physician course at the European Astronaut Centre in Cologne, Germany.
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This person specification sets out the requirements for an ASM career.
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, Aviation and Space Medicine trainee (SpR) at UK Civil Aviation Authority.
- Jessica Mtemeri, 3rd 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.
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References
1.Dehart, R, L. and Davis, R,J. (2002) Philadelphia: Fundamentals of Aerospace Medicine. Philadelphia: Lippincott Williams & Wilkins. Available at https://books.google.co.uk/books?hl=en&lr=&id=_6hymYAgC6MC&oi=fnd&pg=P R3&dq=Dehart,+R.+L.%3B+J.+R.+Davis+(2002).+Fundamentals+Of+Aerospace +Medicine:+Translating+Research+Into+Clinical+Applications&ots=Nz7aRULBZx &sig=J-9VHiQ-zJhnhr9DVoJ9Sr7WHmE#v=onepage&q&f=false ((Article ends))
2. Joint Royal Colleges of Physicians Training Board (2023)Aerospace Medicine. Available at:https://www.asma.org/about-asma/careers/aerospace-medicine
3. https://recruitment.raf.mod.uk/roles/roles-finder/medical-and-medical-support/medical-officer
