ICAO Preliminary Unedited Version — May 2010 V-1-1
Chapter 1. AEROMEDICAL TRAINING FOR
MEDICAL EXAMINERS
INTRODUCTION
“Medical examiner. A physician with training in aviation medicine and practical knowledge and
experience of the aviation environment, who is designated by the Licensing Authority to conduct
medical examinations of fitness of applicants for licences or ratings for which medical requirements
are prescribed.
1.2.4.4 Contracting States shall designate medical examiners, qualified and licensed in the practice
of medicine, to conduct medical examinations of fitness of applicants for the issue or renewal of the
licences or ratings specified in Chapters 2 and 3, and of the appropriate licences specified in Chapter 4.
1.2.4.4.1 Medical examiners shall have received training in aviation medicine and shall receive
refresher training at regular intervals. Before designation, medical examiners shall demonstrate adequate
competency in aviation medicine.
1.2.4.4.2 Medical examiners shall have practical knowledge and experience of the conditions in
which the holders of licences and ratings carry out their duties.
Note.— Examples of practical knowledge and experience are flight experience, simulator experience,
on-site observation or any other hands-on experience deemed by the Licensing Authority to meet this
requirement.”
A designated medical examiner as specified in Annex 1, 1.2.4.4 (see above), is a physician who is authorized
by the appropriate national authority to carry out clinical examinations as required for issue of aviation
licences. Usually such physicians are engaged primarily in some other field of medical practice in the course
of which they also act as designated medical examiners on request. They may occasionally be part- or
full-time employees of an airline, but only infrequently are they part- or full-time employees of a Civil
Aviation Administration.
The aviation medical examiners should fully understand the importance of the authority and responsibility
vested in them. Incompetence in the medical fitness evaluation of an applicant might permit a physically or
mentally unfit person to exercise the privileges of a licence which can have serious implications for flight
safety, for the Administration and indeed also for the examiner him- or herself. However, an overly stringent
approach by the examiner without due consideration of the needs and wishes of the applicant should be
avoided, since this is likely to adversely affect the relationship between examiner and applicant. As most
conditions of relevance to flight safety will be elicited from the history, a relationship of trust must be fostered
by the examiner. Adequate aeromedical training for potential examiners and recurrent training for those
designated as medical examiners is necessary but the examiner must also develop the skills needed to conduct
a thorough examination in an atmosphere of trust.
The appropriate environment for the medical examination can be fostered by the medical department of the
Licensing Authority, which should strive for a certification process that is transparent and based as far as
possible on scientific evidence. Applicants are more likely to be forthcoming with personal information if
they believe that, should they declare a condition that could have aeromedical significance, they will be
treated fairly by the Authority, and that efforts to keep the applicant operating will be made wherever possible
by those having decision-making authority over the issuance of Medical Assessments.
A need for special post-graduate aviation medical training has been recognized by responsible authorities in
ICAO Preliminary Unedited Version — May 2010 V-1-2
most countries with significant civil aviation activities. No basic medical curriculum or post-graduate training
in a speciality other than aviation medicine provides the specific instruction desirable for a designated medical
examiner. Improving the quality of aviation medical examinations in a State will result in a more rational and
uniform application of the medical provisions of Annex 1. This in turn may not only positively affect the
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