Jason D. Vadhan, DO
Department of Emergency Medicine
UT Southwestern Medical Center
Special thanks to our 2nd edition author
Joshua Lesko, MD, LT, MC, USN
Description of the specialty
Aerospace medicine is a specialty that resides within preventive medicine and focuses on the promotion of the health of pilots, astronauts, flight crewmembers, passengers, and patients being transported. While many specialties deal with abnormal physiology in normal conditions, aerospace medicine is commonly described as normal physiology in abnormal conditions.
History of the specialty/fellowship pathway
Space medicine fellowship has a rich history dating back to the 19th century when French physiologist Paul Bert first studied the effects of high and low pressure on balloonists. In 1918, 15 years after Wilbur and Orville Wright took to the skies, the first American flight surgeons were trained in aviation medicine. By 1948, the US Air Force established a division of space medicine to investigate the medical challenges of exploration. In 1953, the specialty was officially recognized within the medical community, and by 1958, the US Air Force rebranded aviation and space medicine as the School of Aerospace Medicine, coinciding with the inception of NASA.
Around the same time, several universities across the United States similarly developed aerospace medicine training programs. Programs, including Harvard University, Ohio State University, and the University of Oklahoma, were instrumental in training physicians to aid NASA and other agencies. Although a few of these programs have since closed, other programs began and continue to thrive across the United States today.
Why residents choose to follow this career path
As an emergency physician, pursuing a space medicine fellowship offers an exciting opportunity to work in a rapidly expanding field with a long and enriched history. Today, space medicine continues to play an essential role in maintaining astronaut safety and managing acute aerospace emergencies. These include discovering, preventing, and managing adverse physiologic responses in hostile environments. In addition, the evolving nature of space exploration and the medical challenges that come with it make space medicine an exciting and dynamic field to work in.
How do I know if this path is right for me?
Are you interested in the effects of low barometric pressures and oxygen tension on the human body? How about the short- and long-term effects of microgravity? Are you interested in learning about topics such as microgravity-induced bone loss, space adaptation syndrome, galactic and cosmic radiation exposure, G force-induced loss of consciousness, vertigo, or desynchronosis? Would you like to participate in the prevention and investigation of aircraft/spacecraft accident investigations? If you answered yes to these questions, this may be the career path for you.
Career options after fellowship/residency
Physicians who have completed this training program have vast employment opportunities, spanning from government and military opportunities to private industry. These opportunities include but are not limited to: National Aeronautics and Space Administration (NASA), Federal Aviation Administration, National Transportation and Safety Board, airline medical departments/clinics, aerospace manufacturing, commercial spaceflight operations, academic/university settings, and private independent practice.
Splitting time between departments
Traditionally, physicians who complete this training primarily take positions solely within the field of aerospace medicine. However, recent trends have shifted toward the expectation of physicians maintaining proficiency in their primary specialty. Each fellowship program demonstrates different requirements for maintaining medical proficiency and is largely program-specific.
At the current time, it will take a bit of negotiation to convince different departments to hire you and agree on a schedule that allows you to split time (including holidays and vacations). Prior to negotiations, consider how much time you wish to spend in each position and seek advice from other physicians who have experience with dual appointments. When you enter such negotiations, remember that your training in both fields makes you a valuable and unique physician.
Academic vs. community positions
This field has opportunities for physicians in the community, private, and government sector.
IN-DEPTH FELLOWSHIP INFORMATION
There are six civilian programs, as well as three military programs:
- Mayo Clinic
- University of California - Los Angeles
- The University of Texas-Medical Branch in Galveston
- The University of Texas Houston McGovern Medical Center
- Baylor College of Medicine - Harvard Massachusetts General Hospital
- The University of Arizona College of Medicine – Phoenix
- S. Air Force Residency in Aerospace Medicine at Wright-Patterson Air Force Base
- S. Navy Residency in Aerospace Medicine in Pensacola, Florida
- S. Army Residency in Aerospace Medicine
The UTMB Aerospace Medicine Residency Program is a two-year training program with academic coursework leading to a Master of Public Health degree and practicum experience in various aerospace medicine-related activities and rotations. The program prepares graduates for certification by the American Board of Preventive Medicine in Aerospace Medicine, with diverse routine training opportunities available through partners such as NASA, the FAA, and various preventive medicine sites.
The UCLA Space Medicine Fellowship is a two-year fellowship designed to support missions that facilitate human space travel. Fellows will have the opportunity to rotate through SpaceX, enroll in a specialized engineering curriculum through Caltech/JPL, undergo biomechanical, surgical, and dental training at UCLA, and perform austere medical training in arctic environments and Mars analog missions while also conducting research with NASA.
The UTHealth Houston Space Medicine fellowship is designed to provide hands-on training for Emergency Medicine physicians in acute medical care in space while stationed in the Houston Medical District. The program aims to produce physicians who can offer their medical expertise on and off Earth, with opportunities to collaborate with various partnering agencies in the aerospace industry. The fellowship emphasizes understanding the nuances and limitations of providing medical care in space, hands-on training in interventional procedures, and mastery of aerospace engineering concepts, with research opportunities also available.
The BCM-MGH Space Medicine fellowship is a 24-month program covering the 5 main domains of Space Medicine practice; prevention, health maintenance, acute care, behavioral health, rehabilitation, and human systems integration. The BCM-MGH Space Medicine Fellowship is affiliated with a variety of commercial, academic, and government partners to create an unparalleled training experience.
Training includes didactic sessions and hands-on rotations in Space Medicine operations, vehicle recovery, crew health maintenance and reconditioning, acute care management, and systems engineering design among other topics. Core faculty are actively practicing experts in these and related fields from the BCM Center for Space Medicine, the Henry J. N. Taub Department of Emergency Medicine, and The Harvard-MGH Division of Wilderness Medicine with extensive experience in government and commercial spaceflight research and operations. Fellows are expected to maintain clinical currency and afforded protected time to do so.
In partnership with Banner Health and SpaceX, the University of Arizona College of Medicine–Phoenix fellowship program offers the one-year Aerospace Medicine and Surgery Fellowship. This opportunity is designed to prepare physicians to work in the commercial aerospace medical field and provide austere surgical and critical care support. The APEX Fellowship represents the first fellowship training program in the U.S. that focuses on surgical and procedural skills for aerospace missions, with collaborating surgeons and physicians nationally.
The Mayo Clinic Aerospace Medicine Fellowship is designed to provide experienced clinicians with an established aerospace proficiency to focus and refine their aerospace medicine abilities and become leaders in both the clinical and research domains, advancing aeromedical science and aerospace safety.
Length of time required to complete fellowship
All programs are 2-year training programs.
Skills acquired during fellowship
Fellows will gain the skills to become an aerospace specialist and will be leaders, educators, researchers, administrators, and master clinicians in this field. They will learn how to manage and optimize the health of those in aerospace environments. They will be able to promote aerospace operational safety and apply ergonomic concepts to this environment. They will also be trained in facilitating optimal care of patients transported in aerospace environments.
Master's degree coursework
Aerospace Medicine basic flight surgeon training
Military and civilian aviation experiences
Space medicine experiences
Hypobaric and hyperbaric experiences
Basic and advanced aerospace and aeromedical sciences
Electives such as travel medicine, administration, etc.
Flight Medicine clinic
Board certification afterwards?
This fellowship is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Those who complete this training will be board-eligible for certification in aerospace medicine by the American Board of Preventive Medicine (ABPM).
Average salary during fellowship
Resident compensation and ancillary expense coverage varies from program to program. Interested candidates are encouraged to inquire about each program. Applicants to the Navy, Army and Air Force programs will be active duty, and their pay is set by the standard military pay scales, searchable online.
PREPARING TO APPLY
How competitive is the fellowship application process?
The competition for space medicine fellowships can vary depending on the specific program and the number of available positions. Generally speaking, space medicine is a highly specialized field, so the number of applicants may be relatively small compared to other medical specialties.
That said, the competition for space medicine fellowships is still likely robust. Applicants for these programs typically have strong academic credentials, research experience, and a demonstrated interest in space medicine or related fields. They may also have experience working with NASA or other space agencies.
It is essential to have a robust application that highlights your qualifications, interests, and experience. Additionally, space medicine-related research, leadership in relevant extracurricular activities or volunteer work, and obtaining letters of recommendation from experts in the field are imperative to a successful match.
Requirements to apply
Before applying, all programs have specific prerequisites, and prospective applicants must meet these qualifications. These requirements can be found on the program websites. For example, The Mayo Clinic requires a minimum 3-year accredited residency and board eligibility or board certification. UCLA requires graduation from a four-year emergency medicine residency program or equivalent. The University of Texas and the Navy require a minimum 12-month internship at an accredited residency, where 11 of these months must have included direct patient care. All civilian programs encourage the completion of a prior accredited residency program.
Research is not required to apply for these programs but is strongly encouraged. Research is beneficial, regardless of the field of study, but research specific to aerospace medicine may hold more weight.
Suggested elective rotations to take during residency
There are a variety of elective rotation opportunities available to medical students and residents. These include, but are not limited to, the following: the UTMB Principles of Aviation and Space Medicine course, The NASA Aerospace Medicine Clerkship, local rotations in hyperbaric medicine, research, global health and travel medicine, aerospace toxicology, health policy, etc.
Suggestions on how to excel during these elective rotations
Be interested and engaged during your rotations and demonstrate your enthusiasm and willingness to be a part of the team. Be courteous to everyone, all staff and patients alike. Read every night and continue to expand your knowledge base. Your electives are excellent opportunities to find colleagues to write letters of recommendation. With this in mind, it is important to treat every clinical day as if it is an interview day and strive to place your best foot forward.
Should I complete an away rotation?
While you do not need to complete an away rotation, it may be helpful for you to gain exposure in the field and also to help you network. Because this is a small and unique field, chances are your residency program offers limited exposure.
What can I do to stand out from the crowd?
Your CV should include activities that display your interest in aerospace, demonstrate your leadership skills, and indicate your research experience. Top applicants will have demonstrated interest in aerospace in multiple areas, including having completed an aerospace medicine elective rotation or clerkship, and may even have obtained a private pilot’s license. Membership in AMSRO and attendance to the annual AsMA conference is strongly encouraged. Seek opportunities such as blog post authorship, literature reviews, lecturing, and attending national aerospace conferences. Becoming chief resident would also be helpful (but is not required). Consider joining a national organization to demonstrate your interest in the field.
Should I join a hospital committee?
Developing and maintaining professional leadership is important for acceptance. Given this, clinical operations and/or patient safety committee involvement may be useful.
Publications other than research
This is highly encouraged. Use FOAMed to your advantage and become active in blog posts and podcasts. Seek out writing opportunities in magazines and journals. EM Resident, published by EMRA, is always looking for authors. X (formerly Twitter) and Facebook, while not traditionally considered publications, may be a great way to network and also to increase the EM community’s knowledge about aerospace topics.
How many recommendations should I get? Who should write these recommendations?
Each program has its own requirements about the number of recommendations required (typically 2-3 letters). However, all programs at minimum require a letter of recommendation from either your program director or your department chair.
What if I decide to work as an attending before applying? Can I still be competitive when I apply for fellowship?
Yes! Clinical experience is highly valued, especially among those who wish to eventually work as a NASA flight surgeon. The key for applying after residency is to make sure you continue to be involved in leadership and publication activities beyond residency. You do not want 5 years to pass without adding something new to your CV.
What if I’m a DO applicant?
All programs accept USMLE and/or COMLEX scores.
What if I am an international applicant?
International applicants are encouraged to discuss availability with programs directly, or consult program specific websites as such opportunities may vary year-to-year.
How many applications should I submit?
Applicants should apply to all programs they would seriously consider attending if offered a position.
How do I pick the right program for me?
Applicants should pick a program in a location where they can imagine living for 2 years, where they feel comfortable, and where they can be successful. Your fellowship program should clearly and strongly believe in you and be supportive of your future goals. Do not ignore your inner voice; if you feel uncomfortable at the program during an interview, this may not be the fellowship for you. If you have a spouse or significant other, do not forget their opinion, especially when it comes to program location and their ability to work or thrive in that city.
Common mistakes during the application process
Be truthful on your CV. Be cautious of listing too many projects, especially those that are incomplete or in which you did not have a clear or strong role. It is better, for example, to have 1 complete research project than 3 projects in data collection phase. Your letters of recommendation should be from writers who are strongly supportive of you. If your letter writers seem a bit uncertain when you ask them to write a letter for you, take this as a sign to find someone else. Pay attention to the details, such as making sure there are no grammatical errors and meeting all deadlines. Be courteous to all those with whom you interact, both via email and in person. Being rude to a program coordinator is a guarantee to sink your chances at that program.
Please contact each program and inquire about whether an additional application is required for their master's programs as well. The Navy deadlines are included with the BUMED 1524 notice published each summer, but are generally mid-October. The Air Force deadline is also usually mid-October.
Tips for writing your personal statement
Your personal statement should express your personality and, more important, express your interest in aerospace medicine. Do not fall into the trap of simply repeating what you have already listed in your CV. The best personal statements read as a story and grab your attention from the beginning to the end. Write about that life experience or perhaps patient encounter that initially sparked your interest in the field. Finally, consider explaining how this fellowship would help you attain your long-term career goals.
Is this a match process?
What happens if I don’t obtain a fellowship position?
Do not become discouraged. Many apply two or more times before being accepted because of the limited available positions. We also recommend taking a hard look at your application. Talk to the programs that rejected you and gently ask why so you can address these gaps. It also may be wise to ask someone in a leadership position, such as your program director, to look at your application to help identify weaknesses.
Take steps to increase your activities and also exposure within the aerospace medicine field. Practice your interview skills. Attend national conferences in the field to help you network with physicians and prepare to apply again next year. Worst-case scenario, there are physicians who are involved in this field without completing a fellowship. Seek out these physicians so they can help you build your niche in aerospace medicine.
How do I stand out from the crowd?
Strive to appear confident in yourself and your abilities without sounding arrogant. Know your application well and be ready to discuss anything listed on it. Be engaging with your interviewer. Be careful not to talk too much or dominate the conversation, but also do not be disengaged or overly quiet. Let your enthusiasm for aerospace medicine and also for their program shine. Make sure to send thank-you letters to all of your interviewers and to the program coordinator afterwards.
What types of questions are typically asked?
Why are you interested in aerospace medicine?
Why are you interested in specifically attending our program?
Tell me more about "blank" that you have listed here on your CV.
What are your 5- and 10-year career goals?
Do you have any flight experience?
Tell me more about your research experience.
Describe to me your dream job.
How many interviews should I go on?
Applicants should attend all interviews offered (assuming you applied only to the programs you want to attend).
PREPARING FOR FELLOWSHIP
Textbooks to consider reading
- Davis JR, et al. Fundamentals of Aerospace Medicine. 4th Philadelphia, PA: Lippincott Williams & Wilkins; 2008.
- Gradwell D, Rainford DJ. Ernsting's Aviation and Space Medicine. 5th Boca Raton, FL: CRC Press, 2016.
- Clement G. Fundamentals of Space Medicine. New York, NY: Springer; 2004.
- Reinhardt R. Basic Flight Physiology. 3rd New York, NY: McGraw-Hill Education; 2007.
Important skills to practice while in residency to prepare for fellowship
First and foremost, you should strive to become an excellent clinician during residency. Strive to expand your knowledge base of aviation and space medicine if possible. Seek activities that will build your skills in leadership, administration, clinical education, and research.
Tips on how to succeed as a fellow
Fellowship is a unique opportunity for you to gain experience, skills, and expand your knowledge base while under the guidance of mentors and attending physicians. Take advantage of every opportunity and purposefully seek out opportunities beyond the usual course and clinical work. Take time to read every day, and strive to be a master clinician within this field. Remember to always be considerate, dedicated, courteous, and compassionate. Work hard at your master's degree and excel at your coursework. Continue to network and build rapport with those within the field and work toward achieving your dream job after fellowship.
Journal: Aerospace Medicine and Human Performance
Aerospace Medicine Safety Blog: http://www.avmed.in/aerospace-medicine-safety-blog/
Go Flight Medicine: http://goflightmedicine.com/aerospace-medicine/
Naval Aerospace Medical Institute: http://www.med.navy.mil/sites/nmotc/nami/Pages/default.aspx
Society of US Naval Flight Surgeons
Aerospace Medical Association Annual Scientific Assembly
American College of Preventive Medicine annual meeting
United States Naval Aeromedical Conference
How to find a mentor
There is no central website that assigns mentors to those interested in the field of aerospace medicine. We encourage you to network with physicians in this field via conferences, away rotations, and email.