By Fabian Voncken, active airline pilot (ATPL). I have taken this medical examination about twenty times, and I have performed most of the tests it contains on the other side: before aviation, I was a nurse. This page is the map of the terrain, not a diagnosis.
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.
What this page does, and does not do. It describes what the examination checks and the public thresholds. It predicts no fitness: deciding if you are fit, fit with restrictions, or unfit, is the role of the AME, based on your file. I am a pilot and former nurse, not a doctor, I inform, I do not diagnose.
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.
The pilot's perspective. Bring your usual glasses/contact lenses and their prescription. If you wear contact lenses, know that you will need to be able to remove them: acuity is noted with and without correction. If this is your very first need for correction, it is precisely one of the situations to report to your AME (MED.A.020(b)), and, if it occurs between two examinations, before resuming flying. I'll come back to this below.
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.
L'audiométrie tonale l'« audiogramme » proprement dit, n'est pas systématique en classe 2 : elle n'y est requise que si vous détenez ou visez une qualification de vol aux instruments (IR/BIR). En classe 1 (et en classe 2 dès qu'une qualification IR/BIR est ajoutée) elle est requise à l'examen initial, puis tous les 5 ans jusqu'à 40 ans, tous les 2 ans jusqu'à 60 ans et tous les ans ensuite (MED.B.080 a)1) i)). Pour un candidat initial, le texte fixe des seuils publics : la perte ne dépasse pas 35 dB à 500, 1000 et 2000 Hz, ni 50 dB à 3000 Hz, sur chaque oreille prise séparément (MED.B.080) ; mais ces chiffres décrivent la norme, c'est l'AME qui les applique à votre tracé, ce n'est pas un test à vous faire tout seul. En prorogation ou renouvellement, un dépassement peut être compensé si votre audition reste fonctionnellement satisfaisante.
Le point du pilote. Votre capital auditif ne repousse pas : les cellules de l'oreille interne, une fois perdues, le sont pour de bon. Le protéger en vol, c'est aussi protéger votre licence. J'en parle en détail dans Protéger son audition en vol.
cardiology3 · Le cœur et la tension
L'AME ausculte le cœur, prend votre tension (ce que le règlement européen dit vraiment des seuils : hypertension, diabète et aptitude) et réalise un électrocardiogramme (ECG) à l'examen initial, puis à intervalles qui dépendent de votre âge et de votre profil. L'objectif n'est pas de vous piéger : c'est de dépister ce qui pourrait poser problème en vol.
La tension mérite un mot à part. Beaucoup de candidats voient leur tension grimper dans le cabinet : l'« effet blouse blanche ». Un AME connaît ce phénomène : il peut reprendre la mesure après quelques minutes de calme. Ce qui compte, c'est votre vraie tension, pas celle d'un pic de stress, et surtout, on ne cherche jamais à la masquer : une tension bien traitée n'est pas un problème, une tension cachée en est un. Si votre tension vous inquiète, le bon interlocuteur est votre médecin traitant, qui dispose de plusieurs moyens de s'assurer d'un bon équilibre tensionnel, pas une astuce de dernière minute.
Le point du pilote. Évitez un café de trop et un effort intense juste avant : les deux font monter la tension et peuvent brouiller le tracé. Arrivez un peu en avance, le temps de vous poser. Le détail, routine du jour J, gestion du stress, est dans Préparer sa visite.
science4 · L'analyse d'urine et le bilan
L'analyse d'urine est obligatoire à chaque visite, y compris en classe 2 (MED.B.035). C'est un dépistage simple et rapide, qui cherche le sucre, les protéines et le sang (trois des quatre cases du formulaire officiel d'examen, la dernière étant « autre » (AMC1 ARA.MED.135, rubrique 235)) des signaux qui, s'ils apparaissent, orientent vers un bilan complémentaire.
Deux conseils d'AME pour ne pas fausser ce dépistage : venez bien hydraté, et évitez le sport dans les 48 heures qui précèdent. Selon votre âge et vos antécédents, un bilan sanguin (glycémie, parfois lipides) peut s'ajouter. Là encore, ce sont des examens de dépistage : un résultat isolé n'est pas un verdict, il déclenche au besoin un regard plus précis.
Le point du pilote. Si vous suivez un traitement ou avez des résultats d'examens récents, apportez-les. Ils évitent des questions en suspens, et ils montrent que votre situation est déjà suivie.
clinical_notes5 · Les antécédents et les traitements
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 golden rule. One never stops a treatment on their own before an examination to "slip through the cracks". One talks to the AME, or the doctor who prescribed it. A well-managed and declared treatment can almost always be handled; a hidden treatment that surfaces means broken trust, and that is where real trouble begins. The AME is your ally, not your adversary.
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
What exactly does the medical examination check?
At each examination, the examiner checks your vision, hearing, heart, and blood pressure, performs a urine test, and reviews your medical history, including the mental health component. Depending on the certificate class—1, 2, or LAPL, and your age, additional tests may be added (ECG, blood test, audiometry). This page details them step by step. Final fitness remains a decision for the aeromedical examiner (AME).
Is an audiogram mandatory at every examination?
For class 2, hearing is tested at each visit (conversational voice). Pure-tone audiometry is only required for class 1, or class 2 when an instrument rating (IR/BIR) is added.
What are the audiogram thresholds for a first examination?
For an initial applicant, the public reference point is a hearing loss not exceeding 35 dB at 500, 1000, and 2000 Hz, and 50 dB at 3000 Hz, with each ear tested separately. Exceeding this is not disqualifying in itself: it is the aeromedical examiner (AME) who interprets the audiogram as a whole.
Is the urine test systematic?
Yes. For both class 1 and class 2, the urine test is part of the examinations performed at every visit.
Can I know if I am fit before taking the examination?
No. This page outlines what the examination checks and the public criteria to help you prepare, but it provides no diagnosis. Fitness to fly is a medical decision that belongs exclusively to the aeromedical examiner (AME).
You have the list. You are missing the schedule.
Knowing what to gather doesn't tell you when to do it, nor what to ask for first because it takes the longest to come back. This order is what makes a file solid on D-Day.
The guide is the reverse schedule dated from D-90 to the morning of the exam, with tear-out checklists to print and the question sheet to take out during the consultation.
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