What the medical examination tests, step by step

Many candidates arrive at the medical examination without knowing what will be looked at, and that is where unnecessary stress and bad surprises are born. I prefer that one arrives knowing what to expect. Here is, step by step, what the aeromedical examiner (AME) checks, the criteria that are public, and how to present yourself best at each one.

For practical preparation (what to bring, the 48 hours before, the initial examination) see the page Prepare for your medical examination. Here, we look at the examinations themselves.

visibility1 · Vision

It is the most scrutinized step, and the most misunderstood. Vision is checked at each examination (MED.B.070). Distance acuity, intermediate distance (instruments) and near vision, visual field, balance of both eyes and color vision are measured.

Wearing glasses or contact lenses is not disqualifying. What matters is that the correction brings you within the standards. If a correction is necessary, the AME enters it as a limitation code on your certificate. The main ones (defined in the EASA acceptable means of compliance, AMC2 MED.B.001):

• chevron_rightVDL correction for defective distant vision (glasses or contact lenses), with a spare pair available.
• chevron_rightVML correction for defective distant, intermediate and near vision (multifocal), with a spare pair.
• chevron_rightVNL correction for defective near vision to be available, with a spare pair.

The common point to the three: as soon as one of these codes appears on your certificate, you must have a second pair of corrective glasses immediately available on board; this can be checked in flight, and it is the rule that many discover too late. The text requires that it corrects in the same way as the one you are wearing (MED.B.070 (g)(5)). AMEs add a common sense precision: a tinted pair does not fulfill this role, it is in addition to it. The detail is on the page pilot glasses and spare pair.

hearing2 · Hearing

Hearing is tested at each examination (MED.B.080). In class 2, it is a conversational test: the AME verifies that you hear a common voice at 2 meters, back turned (AMC1 MED.B.080). Simple, but very real.

Pure-tone audiometry the "audiogram" itself, is not systematic in Class 2: it is only required there if you hold or are aiming for an instrument rating (IR/BIR). In Class 1 (and in Class 2 as soon as an IR/BIR rating is added) it is required at the initial examination, then every 5 years up to age 40, every 2 years up to age 60 and annually thereafter (MED.B.080(a)(1)(i)). For an initial candidate, the text sets public thresholds: the loss does not exceed 35 dB at 500, 1000 and 2000 Hz, nor 50 dB at 3000 Hz, in each ear separately (MED.B.080); but these figures describe the standard, it is the AME who applies them to your trace, it is not a test to do on your own. At revalidation or renewal, an exceedance can be compensated if your hearing remains functionally satisfactory.

cardiology3 · The heart and blood pressure

The AME listens to the heart, takes your blood pressure (what the European regulation really says about thresholds: hypertension, diabetes and fitness) and performs an electrocardiogram (ECG) at the initial examination, then at intervals that depend on your age and profile. The objective is not to trap you: it is to screen for what could cause problems in flight.

Blood pressure deserves a special mention. Many candidates see their blood pressure rise in the consulting room: the "white coat effect". An AME knows this phenomenon: they can retake the measurement after a few minutes of calm. What counts is your true blood pressure, not that of a stress peak, and above all, you should never try to hide it: well-treated blood pressure is not a problem, hidden blood pressure is. If your blood pressure worries you, the right person to talk to is your GP, who has several ways to ensure good blood pressure control, not a last-minute trick.

science4 · The urine test and the work-up

The urine test is mandatory at every examination, including in class 2 (MED.B.035). It is a simple, quick screening that looks for sugar, protein and blood (three of the four boxes on the official examination form, the last being "other" (AMC1 ARA.MED.135, item 235)) signals which, if they appear, point towards a further work-up.

Two pieces of AME advice not to skew this screening: arrive well hydrated, and avoid sport in the 48 hours beforehand. Depending on your age and history, a blood test (blood sugar, sometimes lipids) may be added. Here again, these are screening tests: an isolated result is not a verdict, it triggers a closer look if necessary.

clinical_notes5 · History and treatments

The examination begins with a medical history questionnaire, which you fill out with the AME. This is the most important part, and the one where honesty changes everything. Between two examinations, the regulations also list seven situations where you must consult your AME before resuming the controls (MED.A.020(b)):

• chevron_righthave undergone a surgical operation or invasive procedure;
• chevron_righthave commenced the regular use of any medication;
• chevron_righthave suffered any significant personal injury involving incapacity to function as a member of the flight crew;
• chevron_righthave been suffering from any significant illness involving incapacity to function as a member of the flight crew;
• chevron_rightare pregnant;
• chevron_righthave been admitted to hospital or medical clinic;
• chevron_rightfirst require correcting lenses.

The principle, and the three outcomes

If there is only one thing to remember: arriving prepared does not mean being declared fit it means arriving with the right file, without surprises, having understood what will be looked at. At the end of the examination, three outcomes are possible:

An "unfit" is not always a final point: there are mechanisms for referral to the authority, fitness with limitations and appeals, and they vary by country. Many pilots give up too early. See Medical unfitness: appeal and procedures. And if you have not yet made an appointment, the list of centers and certified doctors for the four countries is here: where to take your initial class 1.

Frequently asked questions