At the beginning of 2012, I was fortunate enough to commence community based general practice training in rural South Australia with Adelaide to Outback GP Training. But before heading out into ‘GP land’ for a year, I interviewed at two practices in the country. Subsequently, I had this conversation with the second practice and GP supervisor:
Supervisor: “Just drive to Port Pirie and I’ll pick you up from there”
Gerry: “But I could just drive the whole way”
S: “No, no. I’ll fly there and pick you up”
G: “Oh, do you have a plane?”
S: “I’ve got two”
G: “Wow, flying is something I’ve always thought about doing sometime”
S: “Well we need to talk…”
And so I started my first GP placement and my flying training after generous encouragement from Dr. Scott. Following this first year of starting both country GP and flying training, I started to notice some similarities between the two. But GP training is not the first within the medical field to be compared to the aviation industry.
Anaesthetics has famously been linked to aviation in the past. And it’s not limited to both sharing the first letter of the alphabet. The obvious comparison involves the separate components of a typical flight and anaesthesia. Take off or induction, cruise on autopilot or maintenance and finally landing, or recovery. The other obversed similarity is that both professions can operate on the basis of 99% boredom, 1% sheer terror (or as one doctor so eloquently put, that moment of “S**T S**T S**T!“). The concept of anaesthetics learning from aviation was first described to me by a consultant as a 4th year student at Flinders Medical Centre. He discussed the case of Elaine Bromiley, who tragically died after unfortunately falling into the can’t intubate/can’t ventilate scenario. Her husband, an airline pilot, questioned the lack of standard operating procedures and checklists that were commonplace in his field. Dr. Leeuwenburg in KI commented in late 2011 on this association and brought to my attention an amazing analogy involving the dashing British flying ace Biggles found here (well worth a read).
But having completed some time in both GP and aviation fields recently, I would argue that general practice training has some similarities to flying training…
In flying training, there is a substantial amount of theory that needs to be learnt prior to gaining a recreational or private pilot licence. These are often in the form of books and sometimes a discussion with the flight instructor. Many medical courses require a few years of theory and required knowledge before being ‘let loose’ on the patient population. In the past it boiled down to knowing the nuts and bolts of the field in question before taking to the air or wards. Nowadays the curriculum for both flying and medical training integrates both practical and theory from the outset.
As a young lad I was a sucker for Microsoft Flight Simulator and took great (nerdy) joy in pretending to fly planes around the world. From top airline pilots to those learning to fly small aircraft, simulator training remains an inexpensive and safe way to practice emergencies. The same is true in general practice using mannikins, standardised patients and Observed Simulated Clinical Examinations (OSCE). These enable practice, honing of skills and assessment of doctors in a way that is safer for real patients.
In flying, it is important to practice difficult landings regularly. These can involve crosswind technique which need complex control inputs that allow the plane to land safely. Importantly, different crosswind conditions are tackled as no two landings or winds are the same. This is similar to GP where each patient is an individual, each one requiring different techniques. Especially ‘cross patients’.
Pilots are very familiar with maintaining a proper logbook and it’s something that I started last year when I took to the skies. Logbooks are a great way to demonstrate your experience in a clear and consistent format. I have also found it good to look back and relive the journey, much as this blog has helped. We are also required to keep a procedure log for the different skills that we might be exposed to and learn during our GP training. This is an online platform and has been beneficial (and will continue to be good) in highlighting any deficiencies that need to be addressed.
Written and practical exams:
It goes without saying that both aviation and medicine require thorough assessment of candidates who are entering a high stress workplace that has very little margin for error. Therefore both fields undergo a number of both practical and written exams to ensure that these fledgeling pilots/clinicians are of a reasonable standard. Fortunately, aviation exams are infinitely more fun, but on windy days can be just as nausea provoking as medical exams.
Then the time comes after hours of learning theory and practicing procedures, landings, consultations, takeoffs, examinations and stalling (applicable to both fields!) for the pupil to go it alone. [Side track: Go It Alone being a fantastic track by Beck with a guest bass guitar by Mr Jack White]. It’s time for the first solo flight or consultation! Both will always be memorable, a mixture of sheer terror and adventure. However in both areas, the supervisor or flight instructor is only a room or radio call away respectively. Fortunately in GP if things are going pear shaped, your supervisor can come in person to help. In the air, you’re on your own and may end up literally pear shaped.
Throughout training in both fields there is a massive base of shared knowledge available. Increasingly, many of these resources are online and even use novel platforms like smart phones and tablets. YouTube videos can also explain difficult concepts ranging from crosswind technique to vertical mattress suturing. The advent of free open access information has started to take off in emergency and critical care medicine and I wonder if something similar might begin in flight training.
In private aviation, there is a requirement for a biennial flight review (BFR). This involves a check flight with an instructor to make sure that no bad habits have formed. Similarly, all GP registrars (trainees) within most training providers, a medical educator visit (MEV) takes place. This is an opportunity twice a semester for another doctor to sit in on consultations to see how the registrar is progressing and if there are any problem behaviours developing or major gaps in knowledge.
CHF, CHT, PPL, PVD, RA-Aus, RSI, EFIS, ETT, GPS, GPRA, APO, APU…enough said. Both fields are often afflicted with what I like to call acronym overload or AO for short.
So as you can see, there are plenty of similarities. This probably highlights the fact that both fields need to produce highly trained practitioners that often work in stressful environments. Their assessments need to involved observed work so that their performance can be best judged. In many ways medicine has learn a lot from the aviation field. But I have certainly applied much of my medical knowledge or communication skills to aviation. Happy to hear your thoughts!