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flexibility for Class 3 applicants as compared to Class 1, air traffic controllers are professionals within the
same aviation system. Most of the medical considerations for Class 1 also apply to Class 3, and therefore the
same core set of competencies is likely to be required of their medical examiners. What follows in this
attachment is applicable to medical examiners who are designated to examine Class 3 applicants.
Other than the three ICAO classes of medical assessment are other aviation personnel such as recreational
pilots (operating under non-ICAO licences), tandem parachute instructors, and pilots of microlight or
ultralight aircraft: for these groups the level of legislation varies greatly from State to State, and the training
of medical examiners who may determine the medical fitness of individuals is outside the purview of ICAO.
This attachment does not attempt to encompass these groups.
Development of guidance material
A survey of several Contracting States was undertaken concerning existing training programmes and required
competencies and tasks of aviation medical examiners. The States that responded to the survey represented a
variety of geographical regions and regulatory approaches. The responses were highly diverse.
In some States all examiners were directly employed by the State. In some, the examiners were entitled or
required to issue the Medical Assessment (even if only as a temporary Medical Assessment) while in others
the examiner only performed examinations and the Assessment was issued remotely, based on examination
findings.
Few States had formal competencies established for their medical examiners, although many had established
goals and objectives for training. In terms of prerequisites to undergo training, some States required only
basic medical qualifications, while others required additional qualifications, skills or experience. In some
States, completion of the training allowed the doctor to commence working as a medical examiner but in
others, further requirements were added, sometimes including a probation period. In about half the States,
there was an established process for review or audit of examiner performance.
All States conducted medical examiner training, but the variation in size, duration and frequency of training
courses was wide. In some States the Licensing Authority itself provided the training, and in others this was
done by external organizations. The principal training method was by lectures, often with clinical
demonstrations and sometimes practical visits (to altitude chambers or aviation worksites, for example).
Computer-based training was mentioned by some States. A variety of written reference material was used
including textbooks, on-line resources and regulatory documents.
ICAO Preliminary Unedited Version — May 2010 V-1-5
In terms of assessment at the end of training, written examination was the commonest method, but other
methods included practical or oral examination, or none at all. The experience or training required of trainers
also varied greatly but in general, there were few explicit requirements.
This wide variety of approach to DME training confirmed the need to harmonize the outcomes of training
programmes for medical examiners, considering the different regulatory contexts in which they practice and
the different training environments in which they learn. The successful implementation of competency-based
training for medical examiners takes into account the variety of State-specific parameters while ensuring that
internationally agreed competency standards are met.
Formulation of the competency framework was achieved by an ICAO Medical Provisions Study Group,
composed of representatives from 12 States along with other invited participants (including the European
Aviation Safety Agency, the International Federation of Airline Pilots’ Associations, the International Air
Transport Association, the International Academy of Aviation and Space Medicine and the Aerospace
Medical Association) and external consultants, who corresponded initially by email. The MPSG met over a
three-day period and consulted further by e-mail to agree on the framework content.
The competency units and elements were derived from an analysis of the processes which occur during a
medical examination. Although the framework lists those units and elements sequentially, in reality they do
not necessarily occur in a specific order, or as individual units, with many functions being conducted
concurrently or iteratively.
The processes were grouped into three broad sections (units):
• facilitating communication;
• gathering and processing medical information; and
• utilizing that information to facilitate a medical assessment.
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Manual of Civil Aviation Medicine 2(146)
