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DAvMed Regulations

DAvMed – Regulations

DAvMed – Guidance

DAvMed – Syllabus

 

DAvMed – Regulations

The Faculty of Occupational Medicine of the Royal College of Physicians of London was established “to develop and maintain the good practice of occupational medicine with a view to providing for the protection of people at work by ensuring the highest professional standards of competence and ethical integrity”.

The Diploma in Aviation Medicine is designed for medical practitioners who wish to specialise in the practice of aviation medicine.

It is established to demonstrate that the holder has achieved a level of competence appropriate to the specialist working in aviation medicine. It is quite separate from other qualifications of the Faculty and is not part of the formal training route to Membership or entry onto the specialist register of the General Medical Council of the UK.

D1. Candidates for the Diploma are required EITHER

(a) to provide evidence of full or limited registration with the General Medical Council of the United Kingdom

OR

(b) to possess a medical qualification acceptable to the Director of Assessment of the Faculty. These candidates must produce their original medical registration certificates, or diplomas of medical qualification, and official translations thereof if not in English.

D2. Candidates are also required to have EITHER

(a) completed a Faculty approved Diploma Training Course by the date of the examination. Candidates must provide a copy of their certificate of successful completion of such a course

OR

(b) demonstrate experience in the practice or teaching of aviation medicine. The examination entry form must be accompanied by evidence of the candidate’s experience in aviation medicine.

EXAMINATION FORMAT

D3. The examination is in two parts, part one is in aviation physiology and psychology, and part two is in clinical aviation medicine. Candidates are required to pass both parts.

Each part consists of three examination papers; a multiple choice question paper, a modified essay question paper and a structured short answer question paper.

AWARD OF THE DIPLOMA

D4. Candidates who have successfully completed the requirements specified in D3 will be awarded the Diploma in Aviation Medicine on payment of a fee (see D5). Holders of the Diploma may use the postnominals DAvMed. This qualification is not registerable with the General Medical Council.

ADVICE

D5. Any further advice on the Regulations may be obtained by writing to the Academic Dean.


 

DAvMed Guidance

INTRODUCTION

1. The Faculty of Occupational Medicine of the Royal College of Physicians of London took over the administration of this qualification in 1982 for doctors who wish to demonstrate a level of proficiency in aviation medicine appropriate to the practice of a specialist.

2. Regulations governing the Diploma in Aviation Medicine (DAvMed) have been published by the Faculty. It is the responsibility of candidates to ensure that they obtain the latest edition of the Regulations. These notes do not form part of the Regulations but are intended to provide guidance for candidates and those running courses to prepare candidates for this qualification.

DIPLOMA

3. This qualification is intended to meet the needs of registered medical practitioners who wish to demonstrate by a combination of training and examination, a level of knowledge and competence in aviation medicine consistent with the practice of a specialist.

TRAINING

4. A number of institutions may offer Diploma Training Courses covering the core syllabus. These courses may be full time, part time or by distance learning. The core syllabus covers the basic topics necessary to understand the principles and practice of aviation medicine.

5. Diploma courses are approved on behalf of the Faculty by the Director of Assessment to whom applications must be made in writing at least six weeks before the course is due to start. Approval is valid for one year only and it is the responsibility of Training Centres to reapply for approval.

6. The Diploma core syllabus requires a minimum of 300 hours direct training. To reach the required standard, candidates need to undertake further private study. This study includes reading appropriate books and journals, attendance at professional meetings such as those arranged by the Aviation Medicine Group of the Royal Aeronautical Society and other organisations, and visits to workplaces. Such private study is likely to require a minimum of 2-3 hours per week over six months. Those providing Diploma Training Courses should include advice about further study in their teaching.

EXAMINATION

7. Application for admission to the examination must be made by the advertised closing date and submitted via the Faculty’s online application system. All applications must be accompanied by the fee (see General Faculty Examination Regulations) and a copy of the certificate of successful completion of a Diploma Training Course. The examination is held in London in late March or early April each year.

8. The examination is in two parts. Part one is in aviation physiology and psychology, and part two is in clinical aviation medicine. Each part consists of a one hour multiple choice paper, a two hour modified essay paper and a 45 minutes structured short answer paper. It is designed to assess not only the factual knowledge of the candidates but also their understanding of the principles involved and their capacity to apply this knowledge to specific problems or scenarios.

9. For each of the two parts (physiology and psychology, and clinical aviation medicine) 50 marks are awarded for the multiple choice question paper, 75 marks are awarded for the modified essay question paper and 25 marks are awarded for the structured short answer question paper. Candidates are required to pass both part one and part two to be awarded the DAvMed. The multiple choice questions are machine marked and the results are statistically analysed to ensure standardisation with previous DAvMed examinations and to exclude unsatisfactory questions. The modified essay questions and structured short answer questions will be marked independently by two Faculty trained examiners. A candidate’s performance in each paper will be assessed relative to a standard set by the examiners. Raw marks may be adjusted to preserve a common standard between examinations. The pass mark may therefore vary between sittings of the examination.

10. Examiners are appointed by the Assessment Subcommittee and are required to participate in training.


 

DAvMed – Syllabus

The aim of the syllabus is to provide medical practitioners with an outline of the knowledge base in advanced Aviation Medicine so as to prepare them for the examination for the Diploma in Aviation Medicine (DAvMed) of the Faculty of Occupational Medicine of the Royal College of Physicians of London. Details of the examination requirements and regulations can be found above.

Syllabus Summary

Physiology. General human physiology in the environment of flight with particular emphasis on the respiratory, circulatory and nervous systems, the special senses, the control of body temperature and the dynamic response of the body to forces.

Psychology. The scientific study of human behaviour with particular regard to perceptual processes, the making and implementation of decisions, and factors which affect skill, performance and learning.

Applied Aviation Physiology and Psychology. The application of physiology and psychology to the flight task and environment. The topics include characteristics of the work-space, personal equipment and survival equipment, environmental control and life-support systems, the safety of flying personnel, the assessment of skilled performance and fatigue, acquisition and interpretation of biological data, theory and practice of teaching, training design, the training of aircrew, emergencies, the conduct and management of field studies, the investigation of accidents, space biology.

Selection. The selection of flying personnel, their medical examination, medical standards, aptitude and personality tests, anthropometry, selection for special duties, standards for air traffic controllers and other ground staff, the carriage of the sick or injured, re-categorisation and disposal of aircrew, and the effects of ageing.

Clinical care. Duties of the flight medical officer, aeromedical examiner and aspects of the practice of clinical medicine and surgery of special significance in aviation.

Public Health. National and international regulations and their implementation, actuarial statistics, hours of work, circadian rhythms, sanitation and hygiene including the handling of food, immunisation, climatic factors, radiobiology, bacteriology and parasitology, and accident statistics.

SYLLABUS – CORE AVIATION AND SPACE MEDICINE KNOWLEDGE

The Earth’s atmosphere

  • Structure of the atmosphere
  • Composition of the atmosphere
  • Physics of the atmosphere
    • Density and pressure
    • Temperature
    • Ionising radiation
    • Standard atmosphere
    • Gas laws

Cardiovascular and respiratory physiology

  • Cardiovascular physiology
    • Measurement of cardiovascular pressures
    • Peripheral resistance
    • Capillary fluid exchange
    • Pulmonary circulation
    • Cardiac output
    • Control of cardiovascular system
    • Cardiovascular response to changes in posture
    • Valsalva manoeuvre
    • Cardiovascular response to exercise
  • Respiratory physiology
    • Tissue respiration
    • Carriage of gases by the blood
    • Gas exchange in the lung
    • Control of ventilation
    • Gas tension gradients

Hypoxia and Hyperventilation

  • Types of hypoxia
  • Hypobaric hypoxia
    • Cardiovascular response
    • Neurological effects
    • Clinical features
  • Hyperventilation

Prevention of hypoxia

  • Maximum and minimum acceptable concentration of oxygen
  • Pulmonary ventilation in flight
  • Respiratory gas flow in flight
  • External resistance to respiratory gas flow
  • Prevention of hypoxia below 40,000 ft
  • Prevention of hypoxia above 40,000 ft
    • Respiratory effects of pressure breathing
    • Circulatory effects of pressure breathing
    • Effect of pressure breathing on the head and neck

Oxygen equipment and pressure clothing

  • General classes of oxygen systems
    • Closed and open circuit oxygen systems
  • Oxygen system requirements
    • Physiological and general requirements
  • Oxygen equipment
    • Oxygen sources
    • On-board oxygen production
  • Continuous and demand flow delivery systems
  • Oxygen masks
  • Pressure clothing
    • Full and partial pressure garments

Principles of the pressure cabin and the effects of pressure change on body cavities containing gas

  • Physiological effect of pressure change at altitude
    • Hypoxia
    • Gas expansion
    • Decompression illness
    • Cabin air quality
  • Cabin pressurisation schedules
  • Principles of cabin pressurisation systems
  • Causes of failure of cabin pressurisation
  • Physics of rapid decompression
  • Effect of cabin depressurisation on occupants

Sub-atmospheric decompression sickness

  • Causes of decompression sickness
  • Clinical presentation of decompression sickness
  • Incidence of decompression sickness
  • Prevention of sub-atmospheric decompression sickness
  • Management of decompression illness
  • Evolved gas disease Arterial gas embolus
  • Ebulism White matter hyper-intensities Principles of recompression therapy

Effects of long-duration acceleration

  • Physical principles
  • Exposure to +Gz acceleration
    • Musculoskeletal effects of +Gz acceleration
    • Cardiovascular effects of +Gz acceleration
    • +Gz induced loss of consciousness and A-LOC
    • Pulmonary effects +Gz acceleration
    • Tolerance to +Gz acceleration
  • Exposure to –Gz acceleration
  • Exposure to –Gz to +Gz acceleration (push-pull)
  • Exposure to Gx and Gy acceleration

Protection against long-duration acceleration

  • Anti-G straining manoeuvres
  • G-protective systems
    • High-G training
    • Physical conditioning
  • Positive pressure breathing
  • G induced neck injury

Short duration acceleration

  • Short duration v long duration acceleration
  • Nature of short duration impact
  • Human tolerance to short duration acceleration
  • Factors affecting human tolerance to impact
    • Magnitude and duration of force
    • Rate of onset
    • Direction of force
    • Site of application of acceleration
  • Occupant characteristics and tolerance to impact
  • Anatomical and physiological aspect of impact tolerance
    • Skeletal injury
    • Joints
    • Abdomen
    • Chest
    • Head and face
    • Spine
  • Survivability and tolerance to impact

Head injury and protection

  • Mechanics of head injury
  • Clinical presentation of head injury
  • Tolerance to head injury
    • Direct impact
    • Linear acceleration
    • Rotational acceleration
  • Methods of preventing head injury
  • Mechanics of head protection by a helmet
  • Tests for helmet protection
    • Penetration resistance
    • Shock absorption
    • Helmet retention
    • Rotational acceleration
  • Other functions of helmets

Aircraft assisted escape systems

  • Escape from aircraft
    • Ejection seats
    • Canopy clearance methods
    • Forces of assisted escape
    • Escape parachutes
    • Escape under extreme conditions
    • Escape from helicopters
  • Unassisted escape
  • Parachute descent
  • Parachute landing
  • Injuries associated with emergency escape
  • Injuries associated with impact crashes
  • Management of escape injuries
  • Aeromedical disposition of ejection injuries

Restraint systems and aircraft crashworthiness

  • Restraint systems
    • Lap belts
    • Multipoint harnesses
  • Seat orientation
  • Airbags
  • Concept of crashworthiness
    • Container
    • Restraint
    • Environment
    • Energy attenuation
  • Post crash factors

Accident Investigation

  • UK investigations
  • Overseas investigations
  • Organisation of accident investigations
  • Agencies and aircraft accidents
    • Military
    • Civilian
    • Aviation pathology
    • Aeromedical expertise
    • Aviation psychologist
    • Human factors
  • On site investigation
  • Evidence gathering and preservation
  • Clinical outcome
  • Medical response to aircraft accidents
  • Mortuary
  • Identification
  • Post-mortem examination
  • Analysis of evidence
  • Disease in aircrew
  • Disease as a cause of accidents
  • Toxicology
  • Therapeutic drugs
  • Non-medical cause of accidents
  • Events before impact
  • Events at or after impact
    • Accident reconstruction
    • Aircrew equipment assemblies
    • Survival equipment
  • Physiology of survival
    • Sea survival
    • Extreme environments
  • Aircraft fires and aircrew fire protection
  • Medico-legal considerations

Human physiology and the thermal environment 

  • Thermal stress
    • Heat and temperature
    • Heat balance
  • Thermal environment and its assessment
  • Heat stress indices and measurement of body temperature
  • Physiological response to thermal stress
    • Heat regulation
    • Effectors responses

Thermal stress and survival

  • Hyperthermia
    • Heat Syncope
    • Heat exhaustion
    • Heat stroke
  • Hypothermia
    • Generalised hypothermia
    • Non-freezing cold injury
    • Freezing cold injury
  • Acclimatisation
  • Clothing and personal cooling systems
  • Environmental cooling systems
  • Survival in hot and cold environments

Vibration Principles of vibration

  • Natural and forced vibration
    • Mechanical properties of tissues
  • Vibration sources
  • Measurement and analysis of vibration
  • Biomechanical effects of vibration
    • Mechanical impedance of the body
    • Body resonances
  • Effects of vibration
    • Vision
    • Cardiovascular
    • Respiratory
  • Neuromuscular
  • Human tolerance to vibration
  • Protection against vibration
  • Occupational hazards of vibration

Anthropometry and aircrew equipment integration

  • Anthropometry
    • Measurement techniques
  • Application of anthropometry data
  • Sizing and fitting of aircrew clothing
  • Aircrew equipment assembly integration
    • Laboratory tests and evaluation
    • Effect on aircrew procedures
    • Effect on escape and survival
    • Dynamic test
    • Environments test
    • Flight trials
  • In-cockpit functional and anthropometric assessment of aircrew and aircrew equipment assemblies

Sleep and wakefulness

  • Recording and classifying sleep stages
  • Sleep architecture
  • Sleep deprivation
  • Insomnia
  • Sleep disorders
  • Circadian rhythms and sleep cycles
  • Alertness management techniques
  • Crew work-rest scheduling
  • Pharmacological strategies

Vision

  • Characteristics of light
  • Light and dark adaptation
  • Colour vision
    • Defects in colour vision
  • Image processing
  • Performance of the eye
    • Visual acuity
    • Contrast sensitivity
    • Depth perception
    • Differentiation of motion
    • Constant relative bearing
    • Retinal size
  • Aviation hazards to vision
  • Night vision goggles

Spatial orientation and disorientation

  • Spatial awareness
  • Vestibular system
    • Semicircular canals
  • Otolith organs
  • Threshold of motion perception
  • Visual vestibular interaction
  • Disorientation in flight
    • Orientation error accidents
    • Input errors
    • Inadequate orientation cues
    • Central errors
  • False perception of attitude and linear motion
    • Somatogravic illusions
    • Oculogravic illusions
    • G excess illusion
    • The leans
  • False perception angular motion
    • Somatogyral illusions
    • Oculogyral illusions
    • Cross-coupled (Coriolis) illusions
    • Flicker vertigo
    • Alternobaric vertigo
  • Disorientation in helicopter flight
  • Disorientation and night flying
  • Dissociative sensation (break-off)
  • Prevention of spatial disorientation
    • Aircraft factors
    • Aircrew factors

Motion sickness

  • Signs and symptoms
  • Aetiology
    • Visual-vestibular conflict
    • Intravestibular (canal-otolith) conflict
  • Incidence
  • Significance to aircrew performance
  • Prevention
    • Behavioural measures
      • Adaptation
      • Desensitisation therapy
      • Aircrew selection
    • Pharmacological measures

Noise and communication

  • Physical characteristics of sound
    • Sound pressure
    • Complex sounds and frequency analysis
    • Propagation of noise
  • Mechanics of hearing
  • Subjective sensation of hearing
    • Loudness and nosiness
    • Measurement of noise
  • Aircraft noise
    • Jet aircraft
    • Rotary wing aircraft
  • Protection of aircrew against noise
  • Noise legislation
  • Hearing loss
  • Psychological and performance effects of noise
  • Communication in aircraft
  • Speech intelligibility

Aviation psychology: aircrew selection and training 

  • Principles of selection
  • Evaluating selection
  • Practical aspects of selection
  • Principles of training
  • Practical aspects of training Simulation

Aviation psychology: crew resource management

  • CRM training and courses
  • Evaluation of CRM training
  • Psychology of small groups
  • Personality and leadership
  • Stress and workload

Human Factors:error and accidents

  • Predisposing factors
  • Disruptive factors
  • Enabling factors
  • Perception errors
  • Intention errors
  • Action errors
  • Decision making
  • Workload and fatigue
  • Human factors investigation taxonomies

Aircraft hygiene

  • In-flight catering
  • Water supplies
  • Disposal of waste
  • Pest control
  • Cleaning and disinfection

Medical standards and international regulation

  • Regulation of civil aviation
  • International Civil Aviation Organization
  • European Aviation Safety Agency
  • Federal Aviation Administration and other regulatory aviation authorities
  • UK Civil Aviation Authority
  • Civil aviation medical requirements
  • Civil aeromedical examiners
  • Airline medical requirements
  • Military aircrew medical requirements

Incapacitation risk

  • The ageing pilot
    • Commercial pilots
    • Private and sports pilots
    • Military pilots
    • Maximum and minimum age rules
  • Aeromedical fitness  assessment
  • Acceptable levels of risk
  • One percent rule
  • Role of the aeromedical examiner

Medication and aircrew

  • Prescribed medication
  • Over the counter medication

Unmanned Aerial Vehicles

  • Challenges
  • Medical Standards for Controllers
  • Risks
  • Disorientation

Clinical Aviation Medicine

Candidates should have an understanding of the following clinical conditions. They should be able to understand how these clinical presentations can influence licensing decisions, future/continued employment, and passenger travel. Candidates should be able to formulate and implement an aeromedical management plan.

Aviation and cardiovascular disease 

  • Aviation and cardiovascular risk
  • Crew
  • Passengers
  • Cardiovascular incapacitation
  • Coronary heart disease
  • Rate and rhythm disturbances
  • Atrioventricular conduction disturbances
  • Intraventricular conduction disturbances
  • Ion channelopathies
  • Endocardial pacemaking
  • Heart murmurs and valvular heart disease
  • Pericarditis, myocarditis, endocarditis
  • Cardiomyopathies
  • Congenital heart disease
  • Peripheral vascular disease
  • Venous thrombosis
  • Syncope
  • Hypertension

Aviation and respiratory disease

  • Crew and passenger risk
  • Asthma
  • Sarcoidosis
  • Pneumothorax
  • Obstructive sleep apnoea
  • Chronic obstructive pulmonary disease
  • Bullous lung disease and cysts
  • Bronchiectasis
  • Pulmonary tuberculosis
  • Atypical mycobacterial disease
  • Interstitial lung disease
  • Pulmonary thromboembolic disease
  • Pulmonary malignancies

Aviation and Gastrointestinal disease

  • Gastro-oesopahgeal reflux disease
  • Peptic ulcer disease
  • Inflammatory bowel disease
  • Coeliac disease
  • Travellers’ gastrointestinal infections
  • Liver disease
  • Gallstones
  • Pancreatitis

Aviation and metabolic and endocrine disorders

  • Diabetes mellitus
  • Endocrine disorders
  • Anterior pituitary hypofunction
  • Anterior pituitary hyperfunction
  • Hypothyroidism
  • Hyperthyroidism
  • Addison’s disease
  • Cushing’s disease
  • Conn’s syndrome
  • Phaeochromocytoma
  • Disorders of calcium metabolism
  • Lipid disorders

Aviation and renal disease

  • Renal response to the flying environment
  • Heamaturia
  • Proteinuria
  • Renal stone disease
  • Chronic renal failure
  • Benign prostatic hypertrophy
  • Bladder carcinoma

Aviation and haematology

  • Anaemia
  • Bleeding disorders
  • Deep vein thrombosis and anticoagulation
  • Thrombophilia

Infectious diseases

  • Infectious diseases
  • Malaria
  • Tropical diseases
  • HIV
  • Hemorrhagic fevers

Aviation and malignant disease

  • Certification and malignant disease
  • Certification assessment methods
  • Colorectal carcinoma
  • Lymphoid malignancy
  • Melanoma
  • Testicular tumours
  • Adenocarcinoma of the prostate
  • Renal carcinoma
  • Breast carcinoma
  • Lung carcinoma

Aviation and neurological disease

  • Injury to the nervous system
  • Cerebrovascular disease
  • Subarachnoid haemorrhage
  • Neurodegenerative disease
  • Tumours
  • Inflammatory disease
  • Infections
  • Myasthenia gravis
  • Paroxysmal disorders
  • Disturbances of consciousness

Aviation and ophthalmology 

  • Visual requirements for aviation
  • Ophthalmic examinations for aircrew
  • Refractive error in aviation
    • Management of refractive errors in aircrew
    • Corrective flying spectacles
    • Contact lenses
    • Refractive surgery
  • Ophthalmic disease in aviators
    • Ocular adnexae
    • Ocular anterior segment
    • Retinal disease
    • Neurophthalmology
  • Ophthalmic drugs

Aviation and otorhinolaryngology 

  • Otitic barotrauma
  • Sinus barotrauma
  • Hearing loss
    • Hearing tests and certification
  • Vertigo

Aviation psychiatry

  • Occupational psychiatry
  • Adjustment disorders
  • Mood disorders
  • Self-harm, attempted suicide and para-suicide
  • Post-traumatic stress disorder
  • Panic disorders
  • Obsessive-compulsive disorder
  • Personality disorder
  • Substance misuse
    • Drugs
    • Alcohol
  • Psychoactive medication and fitness to fly
  • Fear of flying
  • Break-off
  • Psychiatric aeromedical evacuation
  • Conduct disorder in passengers

Aviation and orthopaedic disease

  • Aeromedical disposition after fracture management
  • Fracture fixation
  • Upper limb disorders
  • Lower limb disorders
  • Spinal injury
  • Ejection seats and spinal injury
  • Congenital deformities Osteoporosis

Aviation and obstetrics, gynaecology and sexual health

  • Pregnancy
  • Infertility
  • Menstrual disorders
  • Oral contraception
  • Transgender aircrew

Aeromedical evacuation

  • Principles of aeromedical evacuation
  • Categorisation of patients
  • Choice of aircraft
  • General medical considerations
    • Gas expansion
    • Hypoxia
    • Vibration
    • Temperature control
    • Noise
    • Motion sickness
    • Fear of Flying
    • Medication and time zones
  • Clinical considerations
  • Aeromedical transport of critically ill patient
    • Team composition
    • Equipment
    • Effect of altitude and flight environment
    • Air Transportable Isolator and the infectious patient

Aircrew and radiation

  • Cosmic radiation
  • Solar particle radiation
  • Radiation fields at aircraft altitude
  • Radiation dose limits
  • Computer models for predicting dose exposure
  • Space weather effects
  • Cancer risk in aircrews

Space medicine

  • Manned space flight
  • Immediate medical problems
    • Decreased pressure
    • Acceleration
    • Radiation
    • Micrometeoroids
    • Nutrition and waste management
  • Long-term medical problems
    • Microgravity
    • Neurovestibular system
    • Cardiovascular system
    • Musculoskeletal system
    • Psychological and behavioural aspects
  • Commercial Space Flight

Aircrew roles,  responsibilities and aeromedical requirements

  • Civilian aircrew and cabin crew
  • Military aircrew
  • Air Traffic Controllers
  • Remotely Piloted Air System Crews

Passenger health

  • Cabin air issues
  • Health hazards in the airline cabin
  • Long distance travel

Pilots with disabilities

  • Aeromedical assessment of disabilities
  • Medical flights tests

Aviation epidemiology

  • Aircrew and other licence holders
  • Statistical theory