Medical Specialties - Aerospace Medicine (4 Mar 2026)

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Dr Marilena Giannoudi (00:45)
Hello everyone and welcome to a very special edition of RCP conversations. You notice my stuttering as this will be a special episode covering both clinical conversations and career conversations. My name is Dr. Maralena Giannudi and I am on the Trainee and Members Committee. And today I'm delighted to be joined by Dr. Manav Sharma on a special episode.

talking all things aerospace medicine, which is why we are going to be combining it as a special episode across both of our channels. Dr. Sharma is an aerospace medicine consultant and I will let him give us an overview of his titles and his career before we get started. So good morning and thank you for joining me.

Dr Manav Sharma (01:45)
Hi, Dr. Marilena and thank you for having me on the podcast. So as she's already introduced me, I am Dr. Manav Sharma. I am a specialist in aerospace medicine. So I was a flight surgeon with the Indian air force for 22 long years. I specialized in aerospace medicine after joining the military back home in India. And then once I finished my masters, the government of India sent me to the United States to do my advanced diploma in aerospace medicine.

at the US Air Force School of Aerospace Medicine. Following which, I was with Fighter Squadrons and also senior faculty at the Institute of Aerospace Medicine at Bangalore, India. And finally, I became a fellow of the Royal College of Physicians at Edinburgh last year. After retiring from the Air Force last year in June, I have been working for a private company based out of Abu Dhabi in the United Arab Emirates as a specialist in aerospace medicine. That's a little bit about me.

Dr Marilena Giannoudi (02:43)
Just a little bit of what you've been doing for many decades. So welcome. I'm so happy that we get to talk about such an exciting field. I guess the main question to start with is what is aerospace medicine?

Dr Manav Sharma (03:02)
Aero space medicine is a branch of medicine that deals with people who cant pull over to the side of the road if something goes wrong. That includes pilots, astronauts, cabin crew and airline passengers as well. So the job is to make sure that even when gravity, oxygen, speed and sleep are all misbehaving, the humans in charge are not. In simpler terms, it is about making sure that

When the physics becomes extreme, thin air, high gravitational forces, weird sleep cycles, the humans involved still make good decisions and see clearly, think clearly and they come back in one piece. So you see, you have a human, we take him or her out of his natural habitat and strap him into a fast, noisy machine at 40,000 feet above sea level and still expect that person to

make good decisions and have steady hands. And that's where aerospace medicine sets in because we are the people who deal with these people who operate in such extreme environments, be it in the atmosphere or even beyond.

Dr Marilena Giannoudi (04:15)
Excellent. So what is covered within this broad purpose of aerospace medicine? You said it's about humans making good decisions when, you know, subject to extreme physics. So what kind of decisions do they need to be making? How do we help them with that?

Dr Manav Sharma (04:38)
So aerospace medicine is a big tent. It covers classical medicine for pilots, other aircrew, astronauts, passengers, dealing with everything from cardiovascular risk, diabetes, motion sickness, barotrauma, hypoxia, and a host of other things. Then there is the geeky hands-on side to the speciality, where we do ergonomic assessments of cockpits and workstations just to ensure that

If a switch is in the wrong place or a seat is badly designed, eventually the human who's operating in that workspace will pay the price. So we ensure that doesn't happen. We check aircrew aircraft compatibility, which means can this person safely reach, see and operate everything that he needs in all phases of flight without becoming a contortionist, let's say. And we measure aircraft noise and vibration. Another thing, the amount of light.

that a person is getting exposed to. It's kind of difficult to be a highly reliable professional, so to speak, if your ears are losing functionality or you can't see well. And then around that you have human factors, which is putting the right person in the right place. You have aircraft accident investigation. You have aeromedical evacuations, which is air evacuations. And then of course, the final frontier, space flight medicine, where you get to answer questions like, what do you do with long-term?

bone loss in a person in space. It's a broad church. Stethoscopes, spreadsheets, and the inevitable anti-G-suit.

Dr Marilena Giannoudi (06:17)
Lovely. And I think you've kind of mentioned this, but just for our listeners, who are the patients that you would look after?

Dr Manav Sharma (06:28)
Patients are fighter pilots pulling G, airline pilots, you know, probably trying to stay sharp after crossing six time zones, or cabin crew juggling stuff at 40,000 feet inside a metal tube with, you know, the drinks tolly in the aisle, and astronauts who spend days together in the International Space Station or could be going up for a short tourism kind of a sojourn in space.

All of them are our patients. But Dr. Maralana, what you need to understand is that we do deal with patients, but our clientele is not really patients in the true sense. We are more like occupational medicine specialists who deal with people who have a very specialized work environment. And then we try to optimize their role in their particular work environments. In addition to this, we also deal with people on the ground whose health affects flight safety directly.

for example, air traffic controllers, maintenance engineers, and the ground crew work in equally demanding environments, odd hours as well. And then let's not forget the odd patient, you know, who suddenly decides that 40,000 feet is the ideal place to discover that he suddenly has a medical problem, which he wasn't aware of earlier. So when people think of aerospace medicine, they'd probably imagine pilots and astronauts, but that's just

part of aerospace medicine. We deal with a whole host of people, all of them working with the aerospace industry and we try to keep people healthy and to keep their environment safe for them to work in.

Dr Marilena Giannoudi (08:10)
And so how often, because I guess a lot of it is about thinking of the patients, if I can use an inverted commas, as preventing harm. You know, it's all about prevention, occupational therapy and so on. How often are you reviewing these people?

Dr Manav Sharma (08:33)
Alright, so it's not just about preventing. There is a bit of therapeutic medicine involved as well. Let me answer this question with an example. Let's say there is an airline pilot who has had a myocardial infarction and has ambigone, let's say a PCI or maybe a CABG. Now, I'm not the one who's doing the PCI or the CABG, the cardiologist is, but

How quickly is this guy going to get back into the cockpit as my call? mean, so the reviews would be based on the cardiologist's opinion, his or her functional capacity, and then sort of put things together and say that, okay, in an environment where the cabin altitude is about six to 8,000 feet and this person's oxygenation level is so and so,

his ejection fraction is such and such. Do I think that this person would be able to handle an eight hour flight? then, you know, because it's not just him, it is the 300 people or the 500 people sitting behind him as well who are more important, right? So we just kind of take the whole picture and then create an opinion, which gives us an idea as to whether it is safe for this person to operate in that environment or not.

So to answer your question, how frequently do you review them? There's no one answer for this. It depends on the disability or the problem that the person is suffering from. And then depending on what the problem is, the reviews could be maybe three monthly review or a six monthly review or an yearly review. It depends.

Dr Marilena Giannoudi (10:18)
⁓

Yeah, that makes a lot of sense. And obviously you mentioned a little bit about your background and how you got there. Is that a typical training pathway? Is there a typical training pathway or how can someone who is interested in following such a career become involved?

Dr Manav Sharma (10:42)
The short version is you become a doctor first and then you learn how to keep people safe in places where humans are not really meant to be. the first thing is to have your basic medical training in order. Right. Now, after this, the training pathway differs depending on which part of the world you're from and which part of the world you are practicing it. For example, in the UK, aviation and space medicine

is a physician's speciality which you sort of entered into after core training in internal medicine, acute care, anesthesia or general practice. Right. So you have first a basic training pathway and program, and then you sort of, how should I put it? Maybe super specialized in radiation medicine, something like that. Okay. Then in addition to that, there are

University programs and diplomas such as the Master of Science or the PG postgraduate diploma courses in aerospace medicine. They provide structured teaching in aerospace physiology, human factors, clinical aviation medicine, research methods, so on and so forth. In other countries, pathways may route you through the military as a flight surgeon or through the civil aviation authorities, which is also a pathway for training in aviation medicine or aerospace medicine as we now call it.

And then there are countries like India, where aerospace medicine is a standalone specialty. So the Institute of Aerospace Medicine in India has a top class three year postgraduate training program in aerospace medicine and doctor of medicine training program, of which I am a product as well. And so the theme is the same everywhere, solid clinical grounding, and then a specialized training in the aeromedical world.

Dr Marilena Giannoudi (12:33)
How long does the specialized training take? And I appreciate that it might be different in different parts of the world, but as a ballpark figure, you know, how many years is really needed for you to complete your training?

Dr Manav Sharma (12:49)
Okay, again, so like you said, there is no one answer to this question. But just to give you an example, the King's College in London has a diploma program in aviation medicine. They also have a master of science program in aviation medicine. You have the University of Otago, New Zealand, which has a PhD program in aviation medicine. So the PhD program there could range from maybe, you know, three years, four years, something like that.

And then India has a postgraduate training program which is exactly three years long. So it could vary from anywhere from a year long diploma to a four year PhD with everything in between. I think, does that answer your question?

Dr Marilena Giannoudi (13:37)
I think so, yes. And in terms of reviewing the people that you review, and you know, I'm on purpose not calling them patients here, do the rules apply irrelevant of, you know, who you're seeing and where you're seeing them? Because obviously these people are traveling all the time between different countries, different time zones and so on.

Which health standards do you use in order to assess them?

Dr Manav Sharma (14:10)
That's a wonderful question. And again, there is no straightforward answer to this. the point is that human physiology is reassuringly consistent, right? But the regulatory authorities are unfortunately less so. The overall principles, at least for civil aviation medicine, they are governed by the International Civil Aviation Organization, or the ICAO, which is the body of United Nations. But then...

Different countries, different regions implement their own detailed rules for medical certification and standards. For example, the Federal Aviation Administration or the FAA in the US and the European Aviation Safety Agency or the EASA in Europe. other national bodies, authorities have slightly different classes of medical standards, certificates, investigation requirements and thresholds for conditions like cardiovascular disease or visual problems.

Now, military aviation is a completely different ballgame altogether, where the medical specifications are by and large similar, though they do vary a little bit between countries. But then the requirements are much more stringent and strict as compared to those of civil aviation. The science and the risk principles remain the same, but the paperwork and the exact cutoffs vary with which agency is actually undertaking

the examinations. The good news is that all of us, regardless of whether we are practicing in Asia or in Europe or in America or anywhere else or in Africa, we are all trying to solve the same problem, which is keeping people who fly, whether they are flying in the left-hand seat, the right-hand seat, or in row 2C, or whenever inside the cabin, or in a space capsule, we're trying to keep them safe, healthy.

and fit to operate in a challenging environment. So short answer to your question, the standards are largely similar, but there are minor differences between different agencies.

Dr Marilena Giannoudi (16:17)
Okay. And why did you choose this specialty? Because it's not one that, you know, we come into contact with a lot. I appreciate your army background may have influenced that, but you know, I don't know of anyone who has even thought about that as a specialty throughout my years of training. And I think.

We need to be raising awareness of these specialties that are more difficult to get into, let's say.

Dr Manav Sharma (16:51)
Yeah, so Dr. Marilena, you see, I was always fascinated by the roar of fighter jets soaring over my house when I was a kid. I belonged to the northern part of India and well, given the fact that the geopolitical situation in that part of the world has never been very stable, military has always been constituted more in the northern part of the country. we used to have these fighter jets flying all over our house all the time.

And so flying actually fight of flying was my first career choice, which for a variety of reasons never materialized. So once I graduated from medical school and like I said, aerospace medicine is a standalone specialty in the country in India. So once I graduated from medical school, I chose the specialty, which would take me closest to my general dream. Let's put it that way. Plus the fact that this specialty gave me the opportunity to do something really different from run of the mill medicine.

I joined the military and then once I was exposed to the specialty of aerospace medicine, I realized that this is an ideal blend of clinical medicine, know, hands-on geeky stuff, which nobody else probably knows how to do, but definitely nobody else is doing. I am the sort of walking talking authority on cockpit ergonomics stuff like, you know, whether a person can actually fly an airplane or not, depending on his arm size, for example.

or his arm length or his thigh length, which is basically what made me kind of choose this specialty. Another thing which probably I should be commenting on is the fact about, well, everybody chooses a profession to have a career, right? And a general question which everybody has, even I had when I was taking up the specialty was the career options.

in this particular field. Well, the fun part of this specialty is that the office could be anything from a squadron crew room to a space agency control center. All right. It need not be necessarily be a clinic where you see patients on a regular basis. Career options as a military flight surgeon working with air forces to keep crew healthy and mission safe or roles, civilian roles as an aviation medical examiner.

certifying pilots and aircrew and advising airlines on health, hygiene, fatigue, fitness to fly policies, so on and so forth. Then there are roles in space agencies focusing on astronaut selection, training, in-mission medical support, things like that. Research posts in universities, regulatory work with national and international aviation bodies. Space flight, commercial space tourism now, which is a big thing coming up.

And then there are consultancy roles in cockpit design, human factors, aircraft accident investigation, so on and so forth. Well, to be honest, it is one of those few specialties where your career can be simultaneously clinical, operational, research heavy, and where the regular workplace could be a centrifuge, an altitude chamber, or a disorientation simulator.

Dr Marilena Giannoudi (20:16)
so you'll never get bored.

Dr Manav Sharma (20:18)
No, you know, that is probably one thing that will never happen in aerospace medicine, getting bored. There will always be something interesting, something geeky, something funny coming up.

Dr Marilena Giannoudi (20:30)
Now, usually on career conversations, I ask whoever I'm interviewing about their specialty to give me an example of an interesting case that they've worked on to kind of highlight their specialty. I appreciate that that might be quite difficult in this instance because of the big variety of things that you see and deal with, but could you maybe give us one or two interesting cases of, you know, things that you've been involved in?

Dr Manav Sharma (20:59)
I actually jotted down a couple of cases which were really interesting. So the first one was, are you familiar with the Harrier Jump Jets, the Sea Harriers?

Dr Marilena Giannoudi (21:10)
No, but it sounds like I should be.

Dr Manav Sharma (21:13)
You need not be, it's okay. So the Harrier jump jets were vertical takeoff and landing fighter aircraft, which were traditionally designed for use on aircraft carriers. So the Indian Navy used to operate a bunch of Harriers before we sort of phased them out. And we had a Harrier pilot, so the fleet was aging and the problems with the aircraft fleet were sort of becoming more frequent. And we had this Harrier pilot from the Indian Navy whose complaint was typical. He said he could not see the

symbology on the head-up display. So the head-up display is a combiner glass in front of the pilot, a transparent glass on which all the aircraft parameters are sort of projected. So the pilot, you know, while flying the aircraft doesn't have to look down at the instrument panel to see what the aircraft is doing. Everything is on that screen in front of him. He could see everything, but he said he couldn't see the HUD. We call it the HUD, head-up display. And we were kind of foxed, you know.

There's nothing wrong with his color vision. There is nothing wrong with his vision, distant, near vision. know, the ophthalmological examination is absolutely within normal limits. What is it that's making him not see the HUD alone? so we went deeper. Psychology is a big part of aerospace medicine. So we actually got our aviation psychologist to have a look at him and we realized that

There was nothing wrong with his vision. was all about motivation for flying. Aging fleet, old aircraft, young boy, recently married, a wife not from a military background and the wife and his in-laws were kind of pestering him to quit flying because they were scared of the aircraft that he was flying. he sort of just came up with this theory that I can't see the HUD because if you can't see the HUD, can't fly the aircraft.

eventually labeled as low motivation for flying, taken out of flying. well, that was presented with an ophthalmological complaint and came out to be something psychological in fact. That was one. The second one was actually quite an interesting experience. I was a young captain, flight left in, as we call in India. And we had a patient who was in coma because of a benzodiazepine overdose. And the patient

was to be transferred by military aircraft to Delhi to the largest services hospital which is the Army Hospital Research and Referral in Delhi. well, was the youngest doctor in the, this is about almost 20 years back, I was the youngest doctor in the hospital. So obviously, I drew the short straw and I was told to accompany the patient in the aircraft to Delhi. Well, easier said than done. So the plan was

I would accompany the patient with the nursing staff, get on board the aircraft, travel with the patient to Delhi, offload the patient, accompany the patient to the hospital, come back to the airfield, board the same aircraft and then come back to my base. Now everything was fine except the part about coming back to the aircraft from the hospital because everything was catered for. The ambulance would receive us at the airfield, all of that. But there was nothing which would have taken me back.

from the hospital to the aircraft. So I went to my commanding officer of the hospital and I said, well, how do we sort this out? So he thought for a minute and then he says, where's the motorbike? I said, it's parked outside. said, all right, load it with the patient in the aircraft. So we had this military aircraft where on a stretcher there's this patient and then behind the patient is my motorbike. The entire nursing staff giving me weird looks because of the

combination of cargo on board the aircrafts. And then we got down in Delhi, the patient was put inside an ambulance, which was there at the airfield. And I sort of drove my motorbike behind the ambulance all the way to the hospital, handed over the patient, drove back, again put my bike in the aircraft and then flew back to my base. That's how aerospace medicine works, I guess.

Dr Marilena Giannoudi (25:31)
It's

not a typical day in the NHS, I tell you that.

Dr Manav Sharma (25:34)
It is not. It is not.

Dr Marilena Giannoudi (25:37)
Excellent. Well, I think that's all the questions that I have. don't know if you have any closing comments or remarks for, you know, any doctors in training that are potentially thinking about doing aerospace medicine and how they can get involved or just any closing remarks from yourself at all.

Dr Manav Sharma (25:58)
Definitely, Dr. Marilena, I would say if anyone is interested in physics, medicine, and aviation all at the same time, right? And you have a passion for doing something spectacularly different with your life and career, then aerospace medicine is for you. But if you are one of those who like spending time in the hospital and is happy with a regular hospital job,

seeing patients and that's what makes you happy then you cut out for aerospace medicine because this is where you will get to do so many non-medical things that at times you probably might start wondering that am I a doctor, a physicist or half a pilot? I don't know. That's I think what I have to say for people who are looking for aerospace medicine as a career.

Dr Marilena Giannoudi (26:52)
think that sounds lovely. And I think that's probably the best place for us to end it. Dr. Sharma, thank you so much for joining me. Thank you for all your advice, for sharing your story with us. I'm sure loads of people will be interested. I will take the time to just remind our listeners that we have more career focused podcasts on our channel, Career Conversations. For more clinical advice, go to Clinical Conversations.

And once again, just a massive thank you Dutch Cham for sharing your story with us and all your advice.

Dr Manav Sharma (27:28)
you're welcome and thank you for having me on the podcast Dr. Maira and it was really nice talking to you. Thank you so much.

Dr Marilena Giannoudi (27:33)
Thank you.