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a) Identify examples of common symptom patterns from history which suggest the need for
investigation.
b) Identify examples of common patterns of examination signs which suggest the need for investigation.
c) Identify examples of common abnormalities of routine investigations which suggest the need for
further investigation.
2.4.2 Arrange appropriate investigations:
a) From common examples of medical conditions, describe the approach to selecting investigations.
b) Describe how to arrange the appropriate investigations.
c) Review the investigation findings and report findings.
3. USE THE AVAILABLE MEDICAL INFORMATION
TO FACILITATE A COMPLETE MEDICAL ASSESSMENT
3.1 If required by the licensing authority, provide a risk-based aeromedical opinion
In assessing an applicant who does not fully meet the relevant medical Standards, often a degree of judgement
ICAO Preliminary Unedited Version — May 2010 V-1-21
is involved and this is recognised by ICAO in the concept of “flexibility” wherein, even though there is a
medical standard, and the applicant does not meet the standard, “accredited medical conclusion indicates that
….exercise of the privileges of the licence applied for is not likely to jeopardise flight safety” and this
conclusion takes into consideration the relevant ability, skill, and experience of the applicant as well as any
limitations placed on the licence holder (Annex 1, paragraph 1.2.4.9)
Many States task their medical examiners not only with conducting examinations but with the authority to
issue or decline a Medical Assessment. For some this is a temporary decision pending confirmation by the
Licensing Authority; for others it is the substantive decision. In some States, the medical examiner may be
even further delegated the authority to form an accredited medical conclusion. Even in States where the
regulatory authority makes the “issue/decline” decision centrally, the medical examiners may be asked to
advise pilots or controllers on temporary unfitness. Almost inevitably, examiners will be making aeromedical
decisions, which is the core function of civil aviation medicine practitioners.
3.1.1 Compile and review findings
a) Describe process for reviewing the findings from history, examination and investigations, and
compiling a list of relevant medical conditions and considerations.
b) Describe process for checking completeness of the compiled information and preparing for
communication to relevant parties.
3.1.2 Consider work context and assess risk:
a) Identify aspects of the applicant’s work and work environment which affect the level of flight safety
risk associated with the medical condition.
b) Identify possible restrictions or other risk mitigating factors which could be applied.
c) Taking those factors into account, describe the process for assessing the flight safety risk imposed by
the applicant’s medical conditions, to estimate the severity and likelihood of aeromedical
consequences from those conditions.
3.1.3 Formulate recommendation:
a) List the steps for preparing a recommendation or opinion to the licensing authority.
b) Demonstrate how to make a recommendation from an example of clinical material.
3.1.4 Communicate opinion to applicant and authority as required:
a) State the licensing authority’s requirements for examiners to provide them a recommendation or an
opinion.
b) Describe the required process for communicating the recommendation/opinion.
c) List any potential legal considerations associated with communicating this information.
The processes for communication will be context-specific, with each State needing to ensure its examiners are
competent with the relevant procedures.
ICAO Preliminary Unedited Version — May 2010 V-1-22
3.2 Conduct administrative processes
Although the processes and detail may vary greatly amongst States, it is inevitable that one of the key areas of
competency for examiners will be the administrative process of medical examinations. These will include
elements such as record keeping, reporting and communicating with the Licensing Authority. It will also
encompass participating in and supporting whatever review or audit process is undertaken by the Licensing
Authority. There may be elements of follow-up required of the applicant such as periodic review during the
period of validity of the Medical Assessment. Good medical practice requires that one examiner alone is not
responsible for assessing fitness without some form of routine audit by another appropriately trained
individual. All of the administrative processes will be context-specific so that each State will need to ensure
its examiners are competent in this area.
　
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