on becoming a nasa flight surgeon -...

On Becoming a NASA Flight Surgeon: The Survey of 51 Shuttle Surgeons

James G. Cushman, MD, MPH, FACS Resident, Aerospace Medicine, UTMB-Galveston 84th Annual AsMA Meeting, Chicago, IL May 15, 2013

Preventive Medicine/Aerospace Medicine

On Becoming a NASA FSJames G. Cushman, M.D., MPH, FACS

I have no financial relationships to disclose.

I will not discuss off-label use and/or investigational use in this presentation

Preventive Medicine/Aerospace Medicine

On Becoming a NASA FS: Introduction: Historical Perspective

2Preventive Medicine/Aerospace Medicine

• 1911 – U.S. Army Aeronautical Division/College Park, MD; Lt. John Kelley provided medical treatment to early aviators

• 1918 – “flight surgeon” coined; the original 32 flight surgeons trained at Hazelhurst Field in NY

• 1940’s – WW II build-up led to massive changes in US aviation

• 1953 – ABMS establishes aerospace medicine within Preventive Medicine

• 1955 – Ohio State University first accredited civilian ASM training (contributing 12 medical officers for NASA)

• 1999 -- Article by four aerospace medicine residency Program Directors (USAF, USN, WSU, UTMB-G)

On Becoming a NASA FS: Introduction: Previously published?


“Through the ages: A NASA flight surgeon at work” (Abstract No. 246 at the 77th Annual Meeting of AsMA, 2006. ASEM; 77:276. PV McDonald and Polk JD

NASA flight surgeon oral histories available via this and other such sites: http://spaceflight.nasa.gov/history/shuttle-mir/welcome/to-welcome.htm

The Space Medicine Association’s Reinartz Series of Oral Histories

Various references to NASA flight surgeon duties in publications, previously published surveys, aerospace medicine training articles, etc.

http://spaceflight.nasa.gov/history/shuttle-mir/welcome/to-welcome.htm

On Becoming a NASA FS: Introduction: Objective of Study


• to describe characteristics of NASA flight surgeons involved in the operational duties in support of Shuttle missions

• Understand the nature of the specialty• Contribute a database to the literature• Recognize this is a limited description of the NASA flight surgeon

• Crew surgeons (CS) and Deputy Crew Surgeons (DCS)

On Becoming a NASA FS: Capstone Survey Study: Methods


• commercially available online survey tool

• survey vetted by committee, JSC med ops members, UTMB-G Institutional Review Board

• 39 questions; including 9 Likert scale questions

• Likert – each with ≥ 5 variables, with response ranking 1-5 scale

• Analysis of variance performed with:

•1) test of fixed effects (between responses)•2) test of contrasts (between mean response for each question and the mean values

of each response per question

• Statistical analysis with SAS 9.2

On Becoming a NASA FS: Survey of the 51 Shuttle CS/DCS


Four Areas of Inquiry No. of Questions

Demographics and Training 15

Motivation 6

Service 10

Vision 4

On Becoming a NASA FS: Results: Demographics

•47/51 received surveys

•35 (.69) responded

•Not all questions were answered by all responders

•M (84.%); F (16%)

•91% born in US

No.Responding

Mean Age (yrs)

Median Age (yrs)

S.D.

Date of Survey

35 53.1 52 7.8

Date of Hire

35 37.1 35 6.9


On Becoming a NASA FS: Results: Training

Residency Training(97% responded)

Aerospace Medicine – 62%Emergency Medicine – 27%Internal Medicine – 21%Family Practice – 15%(Occ Med, Pathology, Neurology, Ob/Gyn, Urology, Psychiatry, 1 no response)

Clinical Fellowships(31% responded)

Space Medicine (2)1 each: NASA, USAF, ID, Pulmonary,Nuclear Med, CCM, Uro-oncology, Aeromed CC, other

Society Fellowships(97% responded)

AsMA (11), FACEP (7), Others (16)

Board Certification (ABMS)(100% responded)

Aerospace Medicine – 58%, Emergency Medicine – 33 %, Internal Medicine – 15 %, GPM/Occ – 15%, Family Medicine – 12%

Advanced Academic Degrees(94% responded)

MD alone – 24%; MD+MS – 24%, MD+MPH –21%, >2 advanced degrees – 15% 2

On Becoming a NASA FS: Motivation – Highest Scoring Answers


Question Mean S.E. p value

What sources of motivation to join the space program BEST describes yours?

“academic interest in and passion for space exploration”“desire to practice medicine in a space environment”

4.414.03

0.1630.165

<0.0010.001

Who was the most influential to you in your pursuing a career in space?

“self” 4.63 0.194 <0.001

Once you became a NASA Flight Surgeon (past or present), to what degree did the following serve to retain you?

“sense of contributing to human space exploration”“job satisfaction in Medical Operations”

4.264.00

0.1840.184

<0.001<0.001

On Becoming a NASA FS: Motivation – Lowest Scoring Answers



What sources of motivation to join the space program BEST describes yours?

“ability to work in a high tech industry”“desire to be an astronaut”

2.773.21

0.1600.165

<0.0010.020

Who was the most influential to you in your pursuing a career in space?

“school teacher (prior to college)”“professor (during or after college)”

“military mentor”

1.742.002.15

0.2180.1910.221

<0.0010.0010.010

Once you became a NASA Flight Surgeon (past or present), to what degree did the following serve to retain you?

“overall financial position”“ability to participate in research”

2.062.51

0.1840.184

<0.001 0.006

On Becoming a NASA FS: Service – Highest Scoring Answers



What did you spend the most total time doing when assigned to a Shuttle mission?

“pre-flight crew support for mission readiness”“in-flight crew monitoring and support, including console”

3.863.74

0.1720.172

0.0020.003

What did you spend the most total time doing when NOT assigned to a Shuttle mission?

“attend planning meetings, administrative work” 3.60 0.174 <0.001

Please rank relative importance of skill set as a NASA flight surgeon in Medical Operations

“specialized knowledge/experience in space/aerospace”“optimal medical knowledge and experience”

4.294.00

0.1650.165

<0.001 0.005

On Becoming a NASA FS: Service – Lowest Scoring Answers



What did you spend the most total time doing when assigned to a Shuttle mission?

“NASA non-crew medical assignments”“post-flight crew exams and f/u to baseline”

2.852.86

0.1800.172

0.0070.006

What did you spend the most total time doing when NOT assigned to a Shuttle mission?

“AOD (Aircraft Operation Directorate) support” 1.88 0.176 <0.001

Please rank relative importance of skill set as a NASA flight surgeon in Medical Operations

“strong personal support system”“varied academic background”

2.82 3.09

0.1700.165

<0.001 <0.001

On Becoming a NASA FS: Vision – Highest Scoring Answers



What do you feel is the relative importance of DIRECT flight surgeon involvement in the following program choices over the next 10 years

(2012-2022)?

“continue emphasis on preventive medical care in space” 4.06 0.157 <0.001

What do you feel is the relative importance of DIRECT flight surgeon involvement in the following program choices after ISS utilization is

complete (after 2022-2025) ?

“continue emphasis on preventive medical care in space” 4.13 0.166 <0.001

Please rank the following sources of continuing medical education (CME) for the flight surgeon in terms of what you consider to be

important for maintaining professional development?

“remaining clinically active (part-time) in field of original specialty”“focused space medicine study, reading & conferences”

3.833.63

0.1730.173

<0.001 0.043

On Becoming a NASA FS: Vision – Lowest Scoring Answers



What do you feel is the relative importance of DIRECT flight surgeon involvement in the following program choices over the

next 10 years (2012-2022)?

none n.a. n.a. n.a.

What do you feel is the relative importance of DIRECT flight surgeon involvement in the following program choices after ISS

utilization is complete (after 2022-2025) ?

“study and plan countermeasures for visual impairment, intracranial pressure (VIIP) issue”

3.38 0.166 0.007

Please rank the following sources of continuing medical education (CME) for the flight surgeon in terms of what you consider to be

important for maintaining professional development?

“AsMA conferences and committee work” 2.91 0.173 0.003

On Becoming a NASA FS: Results: Additional Findings


Motivation

•34% gave serious consideration to NASA FS before or during high school

•77% said primary motivation to attend medical school was to be a practicing physician; 16% had NASA in mind (MD vs. astronaut)

•85% anticipated a space medicine career prior to completing 1st residency

Service

•89% indicated career goal at hire was to be a NASA FS

•29% indicated career as astronaut was a factor at hire

• 80% had prior leadership experience (military, clinical medicine, community)

•60% had served in the military prior to NASA

• 49% are/were private pilots; 54% had flight experience (including backseat)

On Becoming a NASA FS: Summary


NASA CS/DCS are largely self-motivated, aware early of space interest, yet chose medical school to practice medicine

Training sought in ASM, EM, IM, PM, FM Inspiration found in meeting key people in key places Strongest motivators: passion for space exploration and an academic

interest in space; &; the desire to practice medicine in a space environment

As a group, the responses indicated that desire to become an astronaut was not a motivator to join NASA or to become a FS

• 22% saw it as a possible career path toward the corps; at the time of hire by NASA, 29% indicated a possible career path toward the corps.



60% of respondents served in the US military before/during NASA

Medical focus: Crew support and mission readiness and in-flight crew monitoring and support

Valued: Optimal medical knowledge and experience including specialized

knowledge in space and aerospace

Means: Part-time clinical activity in the field of original specialty + focused space medicine study were significantly valued

Job satisfaction: Derived from the sense of contributing to human space exploration and the role in Medical Operations.



Looking forward the next 10-15 years and beyond, CS/DCS envision the role of the FS being continued emphasis on preventive medical care in space

~3/4 of respondents would perform these duties as part of a commercial space program; 20% have experience already with doing so

On Becoming a NASA FS: Sources of bias in the Survey Study


• Population surveyed (single specific group)• Survey design (question selection, responses self-selected)• Sample size

On Becoming a NASA FS: Acknowledgements

Joseph Dervay, MD

Christine Arcari, PhD

Richard Jennings, MD

Edward Powers, MD

……and each of the Shuttle CS/DCS who served our US manned space program and graciously participated in this survey study, Thank You!


On Becoming a NASA FS: Policy considerations may include:


1. For continued professional development, the highest ranking response is ‘remaining clinically active (part-time) in field of original specialty.

2. ‘Continuing the focus on preventive medicine’ is the highest ranking response regarding direct FS involvement, rather than any specific medical issue or countermeasure. (Training implications)

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