Aviation Rectum

Do you know what the word rectum means? It almost killed him! So in aviation, think stalls, spins VFR into IMC…you get the picture. 

Actually, it refers to the straight piece of gut just above the anus. But I prefer jokes – why can’t you have intense pain when flying? You need to be in a wigwam or tepee. I know, sound of readers groaning!

Like pilots, doctors have to undergo initial, and then continuing (medical) education, known as CME. Our initial training involves college, medical school, internship, residency, and often specialty “fellowship” tutelage. The parallels to flight would be obtaining the private pilot’s license, then completing various additional qualifications – instruments, multi-engine, tailwheel, instructor, commercial, etc.

For specific US states, there are different requirements once one is a fully qualified and trained doctor, with variations on exactly how many documented hours per year are needed, and whether special courses need to be taken for certain specialties. For instance, in California there is a necessity to obtain 50 hours documented CME for each biannual certification with a one-time course in pain management and the treatment of terminally ill and dying patients. This course must also include the subject of the risks of addiction associated with the use of Schedule II drugs, but pathologists and radiologists are exempted from this requirement. One can see the parallels to biannual flight reviews (BFR), the need for regular dusk-to-dawn takeoffs and landings, and so on.

In flying, in addition to the BFR, we read magazines and accident reports, attend safety briefings and conferences, and maybe acquire simulator time or do additional flights with more experienced pilots. And talk flying with our buddies. Endlessly. Either at the FBO, in the hangar, over a drink or nowadays, over Zoom. If aviation uses 27 Right, medicine is operating out of 27 Left; truly a parallel course. And that parallel course now involves a lot of time at our computers engaging in online education.

Like all healthcare practitioners, I had to go through a detailed and lengthy educational process to prepare me for my career as a surgeon; medical school, internship, residency, and then additional training in my subspecialty. And the most important thing I learned was that I was navigating a course via multiple waypoints to a lifetime of learning. Doctors need to stay sharp and up to date, so that they can not only scratch that itch but also know what is causing it!

We were told that 50% of what we learned in medical school would, in five years be proven incorrect. They just didn’t tell us which half. And if you graduated as long ago as me, by the laws of diminishing returns, most of what I learned was incorrect. Aviation also has parallels – when I started flying it was all NDBs and VORs. There was no GPS, WAAS, or high-performance singles in the GA fleet. So aviation also advances to achieve safer and more efficient flight.

As a surgical trainee I spent a lot of time learning how to do various operations  to address peptic ulcer disease. Now? Well, now we treat ulcers with antibiotics because we know that they are caused by a microorganism, Helicobacter pylori, a bug that we did not even know existed when I was studying surgery.

Other changes during my professional lifetime? Too numerous to list, but here are a few that the general public knows about: CAT scans, MRI, cardiac stents, Ebola and HIV and that cervical cancer is caused by a virus. When I started studying, antibiotic resistance was almost unheard of and the choice of drugs to treat cancer and other diseases was a tiny fraction compared to today.

And on and on and on. In fact, most of what I learned at medical school is passé – except the most important thing; the love and desire to learn. Those remain the same.

Okay, at medical school for anywhere between 4 and 7 years, we learn basic medical science – well, that hasn’t changed much. Yes, biochemistry, microbiology, and pathology are much more complex and in truth, I struggled to understand immunology back in the day – I wouldn’t have a hope today.

Medical training funnels us from a broad and general knowledge toward a specialty, and even subspecialty training – we go from knowing a little about a lot, to a lot about a little. Taken to the logical conclusion, we end up knowing absolutely everything about almost nothing at all!

Medical education is so rigorous, of course, because it is complex and literally, people’s lives are at stake, so the oversight is necessary and sensible. Just like flying.

And then, after all those years, one is qualified, sanctified, a fully baked and licensed doctor. But as above, to retain that position we have to commit to CME. Different laws for each country, region, and sometimes, specialty, the principal is the same; medical science is constantly changing, and we owe our patients a duty of care to provide the most up-to-date, evidence-based care possible. And to do that, we have to stay up to date.

Whether it be the cause of disease, method of diagnosis, therapeutic interventions, things are constantly changing. And sometimes, of course, we discover that what we were doing is actually harmful. All doctors adhere to the Hippocratic principle, now adapted to the modern world. While we no longer “swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses,” we do commit to the concept of Primum non nocere, “firstly do no harm.” We have to stay current, and without continual medical education, we would never evolve our way of practicing medicine.

And guess what, the science of how we learn is also evolving, and we need to ensure we get the best information in the best possible way.

First, we are encouraged to consult several different sources of information; one classic component of continuing medical education is the universe of peer-reviewed articles in medical journals. Different types of articles, whether original research, bench top or clinical, meta-analyses and even case studies, these reputably published journal missives are a surefire way to ensure you are keeping up-to-date with medical knowledge in one’s field of interest. It’s a great way of keeping sharp and at the leading – or should I say bleeding edge! Of course, pilots also need to stay ahead of their leading edge by reading everything available.

Educational courses are a great source of furthering and enhancing our medical education as they enable us to dig deeper into a specific topic within our specialty. You can be the best doctor in the world, but still need a refresher course from time-to-time, or education to explore a new approach or treatment. During the COVID-19 pandemic, many educational courses have had to resort to being delivered virtually, but it is still critical that these go ahead.

When physicians attend conferences, it’s not just the keynote lectures, free papers, poster sessions, and symposia we consume, it’s the ad hoc conversation, the random chat over a coffee or beer with an old colleague or new friend. We get to run ideas by one another, plan collaborations, compare notes. Those corridor conversations – akin to flying-talk at the airport – have thus far not been simulated by virtual conference sites – I certainly hope we can get back to travel soon, but if we cannot, we have to find a way to recreate those spontaneous interactions.

Podcasts and webinars have been around for years, but we’ve seen them both dramatically increase this year, as face-to-face contact has been hindered. If we look at Zoom, for example, daily virtual meetings rose from 10 million in December 2019 to a huge 300 million in April 2020.

Webinars are a fantastic way of consuming knowledge from the comfort of your own home or during a lunch break or whenever and wherever you have the time, as many can be watched on demand, which means they are suitable for anyone with a hectic schedule. In healthcare, we are seeing registration numbers that may prove to be higher than for in-person courses or conferences.

The key thing is to tailor your continuing educational content for your needs and keep that curiosity driving your passion for flight. We are the luckiest people in the world; we are privileged to be able to take to the skies, and while the current environment is limiting opportunities to fly, at least for pleasure, please explore ways to hone your knowledge and skills with the plethora of opportunities out there. Just as physicians continuing to learn how to save lives, the same applies to pilots.

I am told that in the buffoon’s medical dictionary a tumor means an extra pair of something and a terminal illness refers to getting sick at an airport, but I want to quote a friend of mine who told me that he aspires to go to bed less dumb every night. What a great goal.

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.
Topics: Pilot Health and Medical Certification

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