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and applicant (a factor addressed in 1.1.4.1 above), there is potentially a greater risk in the examiner not being
provided with important safety-related information. Therefore, through the creation of an environment where
open disclosure is encouraged, the medical examiner may potentially have a great impact on flight safety.
Contact between examiner and applicant is typically infrequent and brief; it is therefore suggested that
medical examiners should be encouraged to put effort into building rapport with the applicant as far as is
possible within these constraints. Many factors in the environment and the interaction of the medical
examination can contribute to such rapport.
1.2.1 Initiate interaction and discussion about general issues in such a way as to promote a non-threatening
environment:
a) Explain the importance of the initial moments of interaction.
b) List aspects of design/setup of the office or consulting room likely to help put applicants at ease.
c) List factors in the aviation medical process that may create a threatening environment.
d) List opening questions and comments appropriate for an aviation medical examination.
e) List aspects of body language that facilitate rapport.
1.2.2 Enquire about work and home situations and challenges:
a) Explain the importance of domestic and professional stressors on aviation performance and
safety.
b) List areas of home and work life which may be appropriate to discuss.
c) Identify suitable times in the encounter to enquire about work and home situations.
d) Describe an open-ended question and explain the value of such questions and follow-up
questions.
e) List typical work and home challenges faced by aviation professionals.
If appropriately timed and executed, this discussion of work and home life has the dual benefit of promoting
rapport, and providing insight into the current circumstances of the applicant (item 2.2.7 below refers).
1.2.3 Demonstrate familiarity with typical aviation workplaces:
a) Demonstrate familiarity with the workplaces of professional pilots and air traffic controllers.
b) Provide evidence of having visited a range of such workplaces (such as airliner flight decks,
aircraft/air traffic control simulators, flying schools, control towers, radar centres).
An examiner who has a familiarity with the work and workplace of an applicant is more likely to be trusted to
understand the information provided by the applicant. An effective medical examiner will understand the
flight environment and processes, and the roles of pilots and air traffic controllers, and will have gained
familiarity with their workplaces; knowledge and experience of those workplaces is a requirement of medical
examiners under ICAO Annex 1 which states:
ICAO Preliminary Unedited Version — May 2010 V-1-13
“medical examiners shall have practical knowledge and experience of the conditions in which the
holders of licences and ratings carry out their duties” (Annex 1, 1.2.4.4.2).
When unfamiliar with the applicant’s particular workplace, the examiner should at least display an interest in
learning more.
1.2.4 Show interest in the applicant’s general health and well-being:
a) Explain the importance and relevance of discussing lifestyle/wellness characteristics and behaviours
such as exercise, diet, alcohol and drug use, smoking and sleep during the consultation
b) Describe typical health queries that may arise in discussion.
c) Explain the importance of addressing these queries when they arise and providing advice.
d) Explain the process for dealing with health issues beyond the scope of the aviation medical
examination.
The examiner is not normally in the role of treating physician and, traditionally, the formal regulatory
approach considers only the Medical Assessment which may not appear to require evaluating lifestyle or
providing preventive advice. However these issues have potential long-term implications for the applicant’s
health (Feig, 2005; About USPSTF, 2010) and also may provide an opportunity to engage in discussion about
important health related issues, as well as building trust. For some conditions, it may be that efforts to
encourage interventions which prevent illness are of greater long-term safety benefit than efforts to detect
such illness once they have developed. For example, the US preventive services task force found better
evidence for benefit to health from advice on stopping smoking than from routine screening for coronary
heart disease.
2. GATHER AND PROCESS RELEVANT INFORMATION ON THE
APPLICANT’S HEALTH STATUS
2.1 Elicit and evaluate medical history
As outlined above, a large number of the medical conditions which are relevant to safety will be identified
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Manual of Civil Aviation Medicine 2(152)
