The Aviation and Space Medicine Speciality

WHAT IS AVIATION AND SPACE MEDICINE?

Disclaimer: The information that follows is one person’s impression of the speciality. Whilst it is based on discussions with colleagues and the curriculum, the journey through ASM is quite often unique and differs from person to person. Whilst the factual material should all be correct, opinions such as the pros and cons sections are mine alone – JB

Aviation and Space Medicine (or ASM for short) is the GMC approved speciality for doctors in the UK who work full time as physicians in aerospace medicine (you can find out more about the wider field of aerospace medicine here).

Aviation and Space Medicine is the study of all factors affecting the human body in flight, in health as well as sickness and the means by which those flying may be protected against the potentially harmful effects of their abnormal environment.

Aviation and Space Medicine Curriculum, 2016

ASM is a small but vibrant speciality with a tight-knit and supportive community. There are a number of differences from other medical specialities, the most important being that it is not NHS funded. Due to this you can only embark on training alongside employment with a sponsoring organisation (currently only the CAA or the RAF). Perhaps unique to ASM this means you must be sucessful at both securing the job and benchmarking for higher training.

---

What DO ASM DOCTORS DO?

The work of an ASM doctor will vary considerably based on their employer but the fundamentals remain the same – filling the role as a Subject Matter Expert (SME) by applying knowledge of the aviation and space environments to a wide range of queries, from clinical, to operational or policy focused. To be able to achieve this, ASM doctors must be able to understand, critique and perform research across a range of fields from clinical medicine to physiology, equipment requirements to testing and aircraft design to human factors or ergonomics.

ASM doctors working for the CAA regularly make Fitness to Fly decisions for complex cases that don’t readily follow pre-existing guidance. They are also the ones responsible for drawing up that guidance in the first place and for deciding wider national policy in the civilian sector, including medical guidelines for commercial spaceflight.

Whilst ASM doctors in the RAF do tackle clinical issues, this forms a less regular part of the role than it does for those working in the civilian sector. Tasks in the RAF can include research into practical questions about aerospace physiology like assessing G tolerance on a human centrifuge, setting and testing requirements for vital equipment like oxygen systems or investigating the injuries caused by ejections or accidents with an aim to reduce injury in future.

For both settings work is predominately office based with a large proportion of time spent behind a computer. Regular meetings bring together the interdisciplinary team and travel across the country (and globe!) is not uncommon. All this background work may lead to practical task such as an integration trial, a clinical review or human trial. On top of that, teaching and education is another key aspect of the job wherever you work!

Future blogs will look into the role of CAA and RAF trainees in more detail.

---

What are the Pre-REQUISITES TO APPLY FOR TRAINING?

ASM is a higher training pathway and hence requires a minimum of 4 years post-graduate training in approved pathways before you can apply. Currently the following requirements must be met before gaining a higher training number:

• Satisfactory completion of Foundation Training
• Satisfactory completion of Internal Medical Training (IMT) or Acute Care Common Stem (ACCS) in Acute Medicine
• Membership of the Royal College of Physicians [MRCP (UK)]

Alternative routes to ASM training are possible (as shown by a number of current ASM StRs). The most common of these routes is via completion of GP training including MRCGP board certification. Completion of Core Anaesthetics (with success in FRCA) is another potential pathway. According to the curriculum, applicants with these backgrounds will need a ‘training needs analysis’, however.

Previous flying experience is not necessary but is highly desirable.

---

WHAT DOES TRAINING INVOLVE?

ASM training is a true apprenticeship and involves gaining experience in the wide range of the field (see above). The first 6 months tends to be spent on the King’s College London PGDip in Aerospace Medicine course where you will gain the baseline understanding which you will build upon for the next 4 years.

Following this, training will vary based on where you work, but the whole curriculum must be covered by all trainees. This includes research skills and a number of trainees extend their training by undertaking a PhD, looking into a specific issue in more depth. The best way to get an idea of the areas you will cover in your training is to take a look at the current curriculum here.

---

ARE THERE ANY SPONSORS THAT FOCUS ON SPACE MEDICINE ONLY?

Not at present (and likely not any time soon). For the reasons discussed here, Aviation and Space Medicine should be seen as a single speciality, with understanding in each environment being symbiotic to the other. Due to the lack of human spaceflight capability in the UK, both sponsoring organisations are predominately focused on the aviation sector. However, each have strands of work targeting the growing commercial spaceflight sector and the training curriculum ensures experience is gained in the space arena.

---

HOW DO I KNOW IF ASM WOULD SUIT ME?

Gaining experience of the field to find out what it is about and what sort of role you would like is key before embarking on what can be a long and risky journey towards ASM. However, here’s my view on the qualities that will help you flourish in the speciality:

• Self-motivation– Training can be somewhat ad hoc at times and you need to be motivated and persistent to seek out opportunities. You will need to be good at keeping an ear out for training opportunities and be confident enough to ask to get involved.
• Organisation – In a small field it is often up to you to make sure you are on track for your ARCP or that you have placements arranged to cover the breadth of the field. Emails and tasks can stack up so keeping a good to do list (or rafts of post-it notes!) is vital.
• Passion – Once you get talking to anyone in the speciality their passion and excitement about their field is readily apparent. This is a speciality that people tend to take up because they love the subject matter. Prepare for some geeky chats about the specifics of oxygen regulators or about various experiments done in the 1950s!
• Patience – The work involves attending a lot of (often long!) meetings. Good listening skills are sometimes needed to make sure you don’t miss out anything as its often the throw-away sentence that comes back as a flash of inspiration some weeks later when a new challenge arises.
• An inquisitive nature – In this field you are often out on the edges of what people know. A lot of tasks involve digging through research papers, archive material and ringing up a range of specialists in all sorts of fields. Putting all the pieces of the puzzle together to give a balanced opinion on a clinical judgement or a operational question leads to some of the most challenging and rewarding moments in the job.
• Adaptability – Different tasks may see you working as part of a team or you may be working solo on a project for some time. Being able to work equally well in either manner will be hugely beneficial.

WHAT ARE THE BEST (AND WORST) THINGS ABOUT ASM?

There are lots of great things about this speciality:

• The people – ASM is a small, tight-knit community of passionate and like minded people. Everyone has their own sub-specialist interests so you can always learn from talking to colleagues and a lot of the work is a real team effort.
• The training – Training in this field is a true apprenticeship. You will learn directly from consultants, senior registrars and other experts in the field. One-on-one tutorials and mentoring are commonplace. Training is also hugely varied, ranging from academics or clinical work to practical matters such as performing an integration trial on a new airframe or training pilots how to withstand +Gz on a human centrifuge.
• The challenge – The varied training environments ensures there are frequent new challenges to face and to help you gain experience in the field. Even topics that may seem a bit dry on the outset tend to end up being interesting and enjoyable when studied in depth.
• The opportunities – Training and practice in ASM takes you to some interesting places! The first 6 months tends to be dedicated to the DAvMed course which alone includes visits to the European Space Agency, Martin Baker, BA training facilities, the RAF human centrifuge and much more. Your training will likely see you return to some of these places for longer placements and visiting many new locations in the UK and abroad. One StR even managed to get a placement at NASA (and wont’ stop telling us about it either!)
• The topic – This is the reason most people get interested in the speciality in the first place. How normal physiology, health and psychology is affected by hostile environments and how we can protect against this is a huge draw.

There are, of course, some downsides too:

• Travel – A bit of a double edged sword. It’s great to see new places, visit some amazing establishments and meet people across the aerospace sector, but there can be times when being on the road feels like the norm.
• Career options – There is not a huge range of flexibility in career options. By the time you are a consultant, the military and civilian paths look quite different. Whilst this doesn’t prevent moving across due to your broad training, you might not want to. There are limited opportunities outside of the sponsoring organisations as well, but this may grow as the speciality expands. This is why getting to know if it is the right job for you is vital early on.
• The “Dunning-Kruger roller-coaster” – ASM is often a ‘deep dive’ speciality. Just as you start to get to grips with a topic you’ll read one more paper which shows you just how much more you have to learn. Then, as your confidence grows you will take on a new challenge and have to start from scratch again. The constant challenge is definitely a pro, but sometimes feeling like you’re not progressing (when you really are) can be hard.
• Explaining what you do– As you may have gathered from this page, explaining exactly what we do can be quite tricky. You often have to remind yourself people aren’t as interested in your favourite graph (the Stoll curve*) or which aircraft has the best life support system (the Typhoon*) as you are!

*in my humble opinion

---

HOW DO I FIND OUT MORE?

Get involved in NGAM, follow us on Twitter, read our blogs and tutorials and feel free to get in contact if you still have questions.

---