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Note that the medical examination is part of a wider process of medical evaluation for fitness, part of which
may be conducted after the examination by other parties; however, the purpose of the examination is to
facilitate the evaluation, and the two should be considered together rather than in isolation.
Assumptions
A series of assumptions underpin the formulation of the competency framework.
1. The goal of the examination process is to help optimise flight safety through managing aeromedical risk.
Whether or not the State requires the examiner to make certification decisions, the ultimate goal of the
examination process is to minimise the likelihood of safety being compromised as a result of aeromedical
factors. These factors include, but are not limited to, incapacitation of pilots or other applicants.
2. Competency-based aviation medical examiner training should contribute to achieving the goal in (1)
above.
In order to provide appropriately targeted evaluations, medical examiners should have a clear
understanding of the considerations which underlie aeromedical decisions.
ICAO Preliminary Unedited Version — May 2010 V-1-6
3. The periodic medical examination should use a risk-based approach.
Characteristics of the applicant will help determine the areas on which the examination should focus.
For example, in older applicants, cardiovascular risk becomes relatively more important as a potential
cause of incapacitation. In younger applicants, depression is relatively more common. Aside from age, a
number of demographic and other considerations may be important including gender, ethnic background,
culture, and type of flying.
4. Potential examiners are fully registered/licensed medical practitioners who already have acquired core
clinical skills (although they may require additional training in some specific areas).
Being registered to practice medicine is taken to denote an acceptable level of competence in foundation
skills of history-taking, physical examination, diagnosis and medical treatment. It is therefore assumed
that medical examiner training does not need or seek to ensure that all basic clinical skills or core
medical knowledge are in place. Rather, it is accepted that this has been verified within each State prior
to training commencement. The aim of medical examiner training, as addressed in this attachment, is to
build upon basic clinical skills and knowledge and provide additional, task-related knowledge and skills,
and to foster those attitudes, which are required to achieve competency in the specialised tasks of a
medical examiner. The training and its assessment should therefore be focused on developing and
verifying that such additional competencies have been achieved.
5. Potential examiners have currency in medical knowledge and practice
Ongoing education and clinical practice are essential to maintaining competency. States employ various
processes to ensure that examiners are receiving ongoing education and training, and are maintaining
currency in clinical practice. Verifying such currency is somewhat beyond the scope of the medical
examiner training, although it may reveal deficiencies if they are present. Nonetheless, it may be
necessary for States to verify that each applicant for medical examiner training remains fully conversant
with the foundation medical skills, especially if the applicant’s usual work does not include practising
such skills.
Background
1. Guiding Principles
The following premises provide background to the rationale behind the formulation of the competency
framework.
a) Physical incapacitation is a rare cause of fatal accidents in two-pilot aircraft undertaking commercial
flight operations.
b) Overall incidence of physical disease increases significantly with age.
c) In many States, the incidence of mental health problems, such as depression, and problematic
substance use is increasing, whilst cardiovascular disease is declining.
d) For some conditions, preventative strategies have been demonstrated to be effective in the general
population, e.g. depression, alcohol misuse.
e) The current periodic medical examination does not formally address mental health or behavioural
problems associated with ill health to the same extent as the detection of physical disease.
f) The periodic physical examination, as with all medical examinations, benefits from taking a thorough
history.
g) Current life events can adversely affect the performance of licence holders.
ICAO Preliminary Unedited Version — May 2010 V-1-7
2. Safety Context
Since soon after the birth of aviation, medical standards have been applied to aviators, with an overriding
focus on maintaining the safety of flight. In the 100 years since the first fatal aircraft accident involving
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Manual of Civil Aviation Medicine 2(147)
