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Technical Report Documentation Page&+ 

1. Report No. 

FAA-AM-84-7 

2. Government Accession No. 3. Recipient's Catalog No. 

n 08 

4. Title and Subtitle 5. Report Date 

EFFORTS TO IMPROVE AVIATION MEDICAL EXAMINER PERFORMANCE THROUGH CONTINUING MEDICAL EDUCATION AND ANNUAL 

PERFORMANCE REPORTS 

6. Performins Organization Code 

8. Performing Organization Report NO. 7. Author's) 

J. Robert Dille and James L. Harris 

I 

9. Performing Organization Nome and Address 10. Work Unit No. (TRAIS) 

FAA Civil Aeromedical Institute 

P. 0. Box 25082 11. Contract or Grant No. 

Oklahoma City, Oklahoma 73125 

13. Type of Report and Period Covered 

12. Sponsoring Agency Nome and Address 

Office of Aviation Medicine j #--> Federal Aviation Administratioh-, $ 8. .- ;: g--.:, 1 800 Independence Avenue, S. W. 14. Sponsoring Agency Code 

Washington, D.C. 20591 ;-: ,:. h 

i, 1 7o.n 

15. Supplementary Notes ''-~~.z>q 

UNiV'Rslfy Of ~-~q~~~~,?~~~ rNST'T'rTF 

%4N.~p~~~~~~~~~, 

16. Abstract 

Continuing medical education (CME) serves to maintain or increase the knowledge, 

interpretive proficiencies, and technical skills that a physician uses in his/her 

practice of medicine. Resulting improvement in professional performance is frequently difficult to measure, particularly in aerospace medicine, but CME is 

required for relicensure and/or for medical society membership in 70% of states. 

The Civil Aeromedical Institute first received American Medical Association approval 

for Category I CME credit for attendance at FAA seminars in January 1973. We began 

preparing 21-item annual performance reports for each aviation medical examiner (m' 

in 1979 to attempt to isolate the causes of, and to reduce, computer rejection of 

about one-fourth of all medical certification input because of omissions or procedural errors. There was little improvement in error rate through 1982. We are 

presently conducting special sessions and open-book tests for new AME's, lecturing 

to military flight surgeons, and encouraging Regional Flight Surgeons to review 

reports of physical examinations from new and frequent- error AME's. We conducted 

a special analysis of 1983 AME performance data to determine the relationships 

between errors and omissions and number of exams performed, recency and frequency 

of seminar attendance, and pilot or military flight surgeon experience. Errors were 

significantly reduced with recent and frequent seminar attendance, larger volume of 

exams, and pilot and military flight surgeon experience. 

Aeromedical certification 

Aviation medical examiners 

Continuing medical education 

Performance 

Document is available to the public 

through the National Technical 

Information Service, Springfield, 

Virginia 22161. 

1 

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price 

Unclassified Unclassified 7 

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized 

EFFORTS TO IMPROVE AVIATION MEDICAL EXAMINER PERFORMANCE 

THROUGH CONTINUING MEDICAL EDUCATION 

AND ANNUAL PERFORMANCE REPORTS 

INTRODUCTION 

Louis H. Bauer, M.D., the first Medical Director in the Aeronautics 

Branch, U.S. Department of Commerce, conducted 12 training conferences 

for aviation medical examiners (AME's) in 1929 and 1930. No further courses 

were held until the present seminar program was begun in December 1960. 

To date, 279 3-day and 5-day seminars have been held with a total attendance 

of about 31,500. 

The Federal Aviation Administration (Fa) AME seminars conducted by 

the Civil Aeromedical Institute were first approved by the American Medical Association for Category I continuing medical education (CME) credit 

in January 1973 and are currently approved until 1988. The American 

Academy of Family Physicians and the American Osteopathic Association 

also regularly grant CME credit for attendance. 

CME is composed of any education or training that serves to maintain, 

develop, or increase the knowledge, interpretive and reasoning proficiencies, 

applicable technical skills,professional performance standards, or ability 

for interpersonal relationships that a physician uses to provide the services needed by patients or the public. The end result is usually improved 

patient care outcome. While 70% of states require CME for reregistration 

of a license to practice medicine and/or for continuing membership in 

state medical societies, studies rarely document any demonstrated improvement in patient outcomes. 

We have long been concerned about but usually unaware of the thoroughness of airman physical examinations by individual AME's. Those found 

to be performing cursory exams are usually not reappointed for the next 

year, but evidence is difficult to obtain. Detectable but unreported 

significant physical defects are rarely found in pilots killed in aircraft 

accidents. Also, certificates are rarely issued to airmen obviously not 

qualified. 

Year after year, 50%-52% of applications for airman medical certificates entered in the computer are rejected for omission of information, 

failure to meet the physical standards, or significant changes since the 

last exams. About half of these are administrative errors, which include 

omissions and procedural errors. 

We have used Federal Air Surgeon newsletter articles and seminar 

lectures for several years to attempt to reduce these costly mistakes, 

but to no avail. In 1979, we began preparing and sending to each AME 

a report of the frequency and percentage of his/her errors in 21 categories. These are reviewed by Regional Flight Surgeons, and ME'S with 

poor records are, we hope, contacted or even dropped. Again, there was 

no observed benefit. In fact, the error rate for military flight surgeons 

(who usually attend no seminars) increased from 35.3% in 1981 to about 

41% in 1982 and 1983 despite lectures at Army and Air Force operational 

aeromedical problems courses. 

1 
The 1983 consolidated performance summary report for active duty military, Reserve, and National Guard flight surgeon units is shown in Table I. 

The error rate is calculated by dividing the number of errors and omissions 

that cause the computer to reject an application by the number of reports 

of exams received. Granted, some reports may contain multiple errors and 

others none, so that the true rate of rejected documents is not obtained. 

However, the data are valid for makingscomparisons and for determining 

trends and the incidence of errors serious enough to result in rejection 

of the application by the computer. Few military flight surgeons are 

contacted regarding individual applications with errors and omissions 

because of our insufficient staff and assumed good health of active military pilots; many say they have never seen a performance report. 

TABLE I. PERFORMANCE SUMMARY REPORT: MILITARY FLIGHT SURGEONS, 1983. 

Total exams performed: 47,756 

Errors Identified 

Total Exam 

Frequency Rate (X) 

A - 

B - 

D - 

E - 

FGH - 

I - 

JKLMN0- 

PQRS - 

T - 

vWComputer-issued corrected certificate 

Corrected certificate issued by certifica - 

Intraocular tension, item 52, blank 

Field of vision, item 54, blank 

Color vision, item 53, blank 

Al or part of medical history, item 21, 

Abnormalities, items 25-48,. blank 

AME not authorized first class 

Distant vision, item 50, blank 

Near vision blank 

Distant or near vision exceeds standards-- 

certificate issued--no waiver held 

Class of certificate issued higher than 

applied for 

Student/medical combination issued to airman 

less than 16 years of age 

Blood pressure, item 56, exceeds standards 

or omitted-- certificate issued 

Pulse, item 57, exceeds standards or omitted-- 

certificate issued 

Certificate issued of higher class than 

waiver issued class 

Medication field, item 15, blank 

Hearing field, item 49, blank and no audioUrinalysis field, item 58, blank 

AME error letter sent to AME 

Certificate issued to airman obviously not 

tion personnel 

blank 

gram given 

qualified 

1,408 

190 

4,491 

483 

49 5 

1,777 

16 3 

19 1 

654 

816 

1,787 

744 

8 

1,971 

2,057 

32 

677 

400 

1,291 

5 

1 

2.9 

0.3 

9.4 

1.0 

1.0 

3.7 

0.3 

0.3 

1.3 

1.7 

3.7 

1.5 

4.1 

4.3 

1.4 

0.8 

2.7 

2 
Recently, we added a special Thursday evening session (before the 

3-day Friday-Sunday seminars) with a discussion of administrative procedures and an open-book test for newly designated physicians. We now give 

certification update lectures to all AME's at seminars rather than offer 

optional certification clinics. One Regional Flight Surgeon has new and 

high-error AME's send 10 reports of physical exams to his office for grading. International AME's must now attend a seminar before designation. 

Consideration has been given to all AME's attending before .appointment 

rather than within 1 year after and every 5 years thereafter, as presently 

required. Suggestions have been made that military personnel also be 

required to attend seminars. Revision of the application, history, and 

physical examination form (FAA Form 8500-8) to improve clarity has been 

discussed. 

METHODS 

In order to obtain information about the value of (i) repeated seminar attendance, (ii) an AME:airman ratio of about 1:lOO for economy &- for maintaining familiarity with procedures,* (iii) experience as a military flight surgeon (19% have), and (iv) pilot status (about 48% are), 

we analyzed the 1983 certification data for omission and certification 

error frequencies and rates for these status variables. We also examined 

errors for the past year to see if any early effects were evident from 

the Thursday evening sessions, certification lecture instead of clinic, 

or review of reports by one Regional Flight Surgeon. 

Error codes D, E, F, G, H, J, K, R, S, and T are considered to be 

omissions and primarily clerical errors. Error codes A, B, I, L, M, N, 

0, P, Q, V, and W are considered certification errors. 

RESULTS AND DISCUSSION 

The annual AME status vs. error report shows significant (at 0.05 

by the critical ratio rate test) reduction in omitted items and certification errors with (i) seminar attendance the previous year and, with one 

exception, (ii) more seminars attended (Fig. l), (iii) increased volume 

of exams per year (Fig. 2), (iv) pilot experience, and (v) military flight 

surgeon experience (Fig. 3). 

We did not determine if recency of exposure or program content was 

responsible for the improved performance with seminar attendance within 

the past year. Error rates, by Region, are not included in this report 

as originally planned but will be addressed in an analysis of errors and 

omissions for 1984. 

CONCLUSIONS 

Despite the high computer reject rate, it appears that the AME designation and training policies and practices are valid and should be continued. 

*The present AME:active-airman ratio varies from l:50 to 1:150 among the 

nlLtm Regions with an overall ratio of 1:86. \ 

3 
Increased attention needs to be given to decreasing the ratio of ME'S 

to active airmen in some Regions for improved economy and performance, 

requiring attendance at a seminar before appointment, Regional medical 

officers reviewing the reports of physical examinations performed by new 

and high-error AME's, training AME office assistants in metropolitan areas, 

providing better orientation (and perhaps required training) for military 

flight surgeon unit personnel, and getting poor Performance summary reports 

past NCOIC's and actually into the hands of military flight surgeons. 

4 
n 

8 

W 2o t 

W 

IOL 

cr 

a 

IO 

e 

w 

22.2 

0 \ 

\ 

\ 19.3 

0 \ 

\ \ 15.5 

12.5 

I 7.9 

5 0--0 Omissions 

Certification errors 0 

(a) Only change NS at 0.05 

0 

0 I 2 3 14 ANY PAST 

SEMINARS ATTENDED 

YEAR 

Fig. 1. Effects of the number of aviation medical examiner 

seminars attended and recency of attendance on 

the rates of certification errors and omission of 

information. 

5 
25 

20 

15 

IO 

5 

0 

20. 

26.0 \ 

\ 

\ 

\ 

5.6 O--O Omissions 

All changes significant at 0.05 

Certification errors 

I I I I I 

5 IO I 1-49 50-99 100-499 2500 

NO. OF EXAMS PER YEAR 

Fig. 2. Effects of the number of airman physical examinations 

performed each year on error rates. 

6 
Error Rate (%) 

15 

IO 

5 

0 YES 

OMITTED ITEMS 

13.4 

* 

11.3 . 

YES 

CERTIFICATION ERRORS 

12.9 

* 9.5 

P i lot Former Milit. F/S 

YES 

10.2 18.1 

* 

8.7 

YES A 

Pilot Former Milit. F/S 

Fig. 3. Effects of pilot and military flight surgeon experience 

on error rates. 

* Significant at 0.05 by critical ratio rate test, 

7