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2.2.4 Focus examination on high risk areas pertaining to functional capacity, specifically visual acuity:
a) List the licensing authority’s requirements for testing distance and near vision.
b) Demonstrate or describe the process for testing and recording distance and near visual acuity,
corrected and uncorrected.
c) Identify potential errors in the process and how to avoid them.
d) Describe the actions to be taken following an abnormal result.
In terms of the special senses, vision (including colour vision) and hearing warrant being highlighted, both in
the examination and in the training of examiners.
2.2.5 Focus examination on high risk areas pertaining to functional capacity, specifically colour vision:
a) List the licensing authority’s requirements for testing color vision.
b) Demonstrate or describe the process for color vision screening using pseudoisochromatic plates or
other suitable alternatives.
c) Identify potential errors in the process and how to avoid them.
d) Describe the actions to be taken following an abnormal result.
ICAO Preliminary Unedited Version — May 2010 V-1-16
Pseudoisochromatic plates are mentioned specifically because of their prominence in colour vision
assessment. However if new technologies which supersede them are developed and introduced, medical
examiners will need to be competent with their use.
2.2.6 Focus examination on high risk areas pertaining to functional capacity, specifically hearing:
a) Demonstrate the whispered voice test.
b) Describe techniques using a tuning fork or other suitable alternatives to distinguish conductive from
sensorineural hearing loss.
While many States use audiometry routinely, there is still a need to employ clinical techniques in the
assessment of hearing.
2.2.7 Focus examination on high risk areas relating to behaviour, specifically evaluating psychiatric and
psychosocial factors:
a) Describe methods for assessing psychiatric function in an aviation medical setting.
b) Identify important clues as to abnormal psychiatric function.
c) Describe methods for further evaluating these clues.
d) Explain the importance of current psychosocial factors.
e) Describe methods for gaining insight into psychosocial factors.
f) Describe methods for further evaluating the severity and impact of these factors.
Perhaps the most important areas of the examination relate to behaviour. An important competency in this
regard is the evaluation of psychiatric and psychosocial factors. This phrase may appear to confuse different
elements, but is chosen deliberately. A full psychiatric examination would not normally be conducted by an
aviation medical examiner, however it should be normal in the course of an assessment to undertake some
empirical evaluation of the features of psychiatric illness including behaviour, appearance, orientation,
memory, form and content of thought, mood and affect/emotion.
Similarly, although time precludes a full psychological evaluation, it would be valuable for medical
examiners to gain some degree of insight into the psychological milieu and social circumstances of the
applicant, in a discussion of such areas as domestic/family situation and work stresses, which is referred to in
1.2.2 above. It could be argued that this is at least as important as many other parts of the traditional physical
examination. Many of the conditions which could be contributory to an accident are not major medical
problems but situational i.e. dependent on the current circumstances in which an individual finds himself.
Current life events or concerns such as relationship worries, domestic strife, family stress, financial difficulty,
work challenges (including fatigue), or workplace conflict (or even positive events such as marriage, new
baby or promotion) have great potential to cause preoccupation and distraction of pilots or air traffic
controllers, and may thus have a major impact on flight safety, even if they do not constitute a medical
condition or diagnosis. The DME is well placed to identify such situations and discuss them with the
applicant to ensure that adequate professional support is provided, whether non-medical or medical, and also
that good judgement is exercised by the applicant as to temporarily avoiding flying where appropriate.
ICAO Preliminary Unedited Version — May 2010 V-1-17
2.2.8 Focus examination on high risk areas relating to behaviour, specifically identifying abnormal
cognitive functions:
a) List typical important causes of abnormal cognition in aviation applicants.
b) List clues as to abnormal cognitive function.
c) Identify available tools for further evaluating cognitive function.
A distinction is drawn between psychiatric and psychosocial factors, and cognitive function. While this has
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Manual of Civil Aviation Medicine 2(154)
