Pilot Medical Disclosure Survey IC

Pilot Medical Disclosure Decision Making Survey

[bold text] OMB CONTROL NUMBER: 21XX-XXXX
EXPIRATION DATE: X/X/XXXX

[bold text] Paperwork Reduction Act Burden Statement

[Text] A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 21XX-XXXX. Public reporting for this collection of information is estimated to be approximately 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

[Text] You are invited to take part in a research study about how pilots make decisions regarding the disclosure of health conditions to the Federal Aviation Administration (FAA). This study aims to better understand pilot experiences, concerns, and thought processes around medical disclosure. The goal is to inform efforts to reduce unnecessary barriers and burdens in the reporting process.

Participation is voluntary, and you may choose to stop at any time. The survey will take approximately 10–15 minutes to complete. Your responses are confidential.

Upon full completion of the survey, you will receive $25 in compensation. This is contingent on finishing the survey and providing valid responses to attention check questions included to ensure data quality.

The Civil Aerospace Medical Institute (CAMI) National Airspace System Safety Research Laboratory (AAM-520) is administering this survey on behalf of the Office of Aerospace Medicine (OAM) with the assistance of a third-party contractor, Cherokee Federal. To ensure confidentiality and anonymity, only the lead researcher, Dr. Julia Beckel, and the designated third-party contractor will have access to your responses for data processing and compensation purposes. No personally identifying information will be included in any data shared outside this limited team, and all results will be reported in aggregate or de-identified form.

[bold text] Consent to Participate
By clicking ‘Next’, I agree to participate in this study. Additionally, I understand and consent to the release of de-identified response and aggregate data sets for research purposes only. I understand that personally identifying information WILL NOT be included in any released data.

Demographics

1. What is your age (in years)?

   • Open text (numerical 6 digit)

2. What is your gender?

   • Male

   • Female

   • Prefer not to answer

3. What is your highest level of education?

   • High school or equivalent

   • Associate or undergraduate degree

   • Graduate or professional degree

4. What is your marital status?

   • Single (never married)

   • Married

   • Living with partner

   • Separated

   • Divorced

   • Widowed

5. Is flying your primary source of income?

   • Yes

   • No

6. What is your estimated monthly salary?

   • Less than $7,500

   • $7,500–$9,999

   • $10,000–$12,499

   • $12,500–$14,999

   • $15,000–$19,999

$20,000 or more

7. If flying is your primary source of income, do you have Long Term and/or Short Term disability through your employer?

   • Yes

   • No

   • Not Applicable

8. If yes, do you believe your disability insurance would cover [insert condition]?

   • Yes

   • No

   • Not Applicable

9. Approximately how many flight hours have you accumulated?

   • Less than 3,000

   • 3,000-4,999

   • 5,000-6,999

   • 7,000-8,999

   • 9,000-11,999

   • 12,000-14,000

   • 15,000 or more

10. To what extent do you believe the aeromedical certification process contributes to flight safety?

    • Not at all

    • Some extent

    • Moderate extent

    • Great extent

    • Very great extent

11. Have you ever been diagnosed with a physical or mental health condition that could potentially affect your FAA medical certification status?

    • Yes

    • No

    • Prefer not to answer

12. If yes, did you disclose the diagnoses to your Aeromedical Examiner (AME)?

    • Yes

    • No

    • Prefer not to answer

13. Have you ever had a deferred aeromedical examination or been issued a special issuance?

    • Yes

    • No

    • Prefer not to answer

14. Do you typically see the same AME for each of your aeromedical examinations?

    • Yes

    • No

15. What factors influence your decision to see the same AME, or conversely, see different AMEs?

    • Availability

    • Cost

    • Scheduling tools (i.e., text, call, online option)

    • Distance

    • Reputation

    • Other (please specify)

16. Approximately how long have you been seeing the AME who performed your most recent medical examination?

    • This was my first time seeing this AME.

    • Less than 1 year.

    • 1-2 years

    • 3-5 years

    • 6-10 years

    • 11-15 years

    • More than 15 years

Closeness To AME (Adapted version of the Relational Quality Scale by Venetis)

The following items ask about your relationship with your primary Aeromedical Examiner (AME). If you typically see a different AME for each aeromedical exam, think about the AME you saw during your most recent exam. Please respond with how strongly you agree or disagree with each statement.

17. I feel close to my AME.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

18. My AME’s opinion is important to me.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

19. I am satisfied with the relationship I have with my AME.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

20. I trust my AME to act in my best interest.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

21. I would prefer to continue seeing my current AME.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

The following sections of the survey are meant to gauge your reactions to each set of questions as it relates to the condition of [insert condition].

NOTE: One of the below definitions will be presented to respondents based on study group.

Depression: Depression is a common mental health condition that can involve persistent sadness, low energy, trouble concentrating, sleep changes, and loss of interest. These symptoms may affect mood, focus, and decision-making – even when the symptoms aren’t visible to others.

Sleep Anea: Sleep apnea is a sleep disorder which causes interrupted breathing during sleep, often leading to poor sleep quality, daytime fatigue, difficulty concentrating, and slowed reaction time. Symptoms may not always be noticed by the person affected.

Cardiac Disease: Cardiac disease includes heart conditions that can cause chest pain, shortness of breath, dizziness, palpitations, or fatigue. These conditions can vary in severity and may increase risk of sudden unconsciousness.

Condition Specific Aero-Relevance

Imagine you are experiencing symptoms of [insert condition]. Next, indicate how strongly you agree or disagree with the following statements.

22. Failure to report symptoms related to [insert condition] could seriously impact flight safety.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

23. Pilots who experience [insert condition] and continue flying without disclosing it may pose a safety risk.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

24. Disclosing symptoms of [insert condition] is essential or protecting passengers and crew.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

25. Reporting [insert condition] helps reduce the risk of in-flight impairment.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

26. If I had [insert condition], it wouldn’t really affect flight safety (R).

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

Symptom Visibility

Please continue to imagine you are experiencing symptoms related to [insert condition]. As a reminder, [insert condition description].

Next please rate how strongly you agree or disagree to the following statements.

27. It would be hard for others to recognize I was experiencing symptoms (R).

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

28. Those close to me would recognize that I was experiencing symptoms.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

29. I would recognize that I am experiencing symptoms.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

30. The symptoms of this condition would be noticeable to others.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

31. If I didn’t tell anyone, they would be unlikely to notice (R).

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

Anticipated Response (Two sub-factors: 1) Supportive Response, 2) Anticipated Outcome)

These sets of items ask about what you think would happen if you decided to share health information with your AME. What do you think would happen if you were to tell your AME you were experiencing issues with [insert condition]?

As a reminder, [insert condition description].

If I told my AME I was experiencing issues with [insert condition], my AME would…

	Strongly disagree	Disagree	Neither	Agree	Strongly agree
Listen carefully to my concerns before making a decision.
Try to help me stay medically qualified if possible.
Look for ways to support my continued flying career.
Only report my condition if I had a severe case.

Reporting this condition to my AME would…

	Strongly disagree	Disagree	Neither	Agree	Strongly agree
Likely result in a temporary loss of flying status.
Have a negative impact on my flying career.
Lead to long-term restrictions.
Put future job opportunities at risk.

Stigma

The following items ask what you believe would happen if you had a problem with [insert condition] and people at work found out about it.

As a reminder, [insert condition description].

Please rate how strongly agree with the following statements.

40. My flying partner would question my ability to perform safely as a pilot.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

41. People at work would be uncomfortable flying with me.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

42. My career options would be limited.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

43. A supervisor/Chief Pilot might treat me unfairly.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

44. A supervisor might assign me to less favorable schedules or duties.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

45. People would think I’m exaggerating or faking the problem.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

46. I would be treated differently by my coworkers.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

Perceived Financial Impact

Please to continue to imagine you are experiencing symptoms related to [insert condition]. As a reminder, [insert condition description]

Next, please rate how strongly you agree or disagree with the following statements.

47. Disclosing this condition would cause a loss of income I cannot afford.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

48. I would worry about paying my bills if I were grounded due to this condition.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

49. Reporting this condition could lead to long-term financial hardship.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

50. I would risk serious economic consequences if I disclosed this condition.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

Likelihood of Disclosure

This set of questions asks about what you think you would do if you were actually experiencing issues with [insert condition]. As a reminder, [insert condition description]. Please mark how strongly you agree or disagree with the following statements as it relates to each condition.

51. I would discuss my symptoms with my AME during my next evaluation.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

52. I would contact an AME to tell them about my symptoms.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

53. I would wait to see if the symptoms got worse before deciding whether to tell anyone (R).

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

54. I would speak with a trusted colleague, union representative, or an aviation medical advisory representative before deciding whether to report the condition.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

55. I would disclose the condition only if I believed it created an immediate risk to flight safety (R).

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

Control Measures

For the remaining items, please mark the extent to which each of the proposed measures may help to improve aeromedical classification and the likelihood of pilots disclosing physical and mental health symptoms to their providers or AMEs. To what extent would it help if…

56. The FAA only performed reviews and made information requests related to conditions they classified as having the highest risk to operations.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

57. Pilots received temporary medical certificates during FAA reviews which allowed them to keep flying as long as their condition(s) didn’t create an imminent risk of incapacitation while on duty.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

58. The FAA streamlined its process for condition-specific evaluations and reduced the number of reviews and information requests for grounded pilots.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

59. The FAA was mandated to complete a review and make a final decision on pilot medical certification within 60 days of receiving requested information.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

60. The FAA prioritized enforcing actions against pilots withholding health condition information to those at greatest level of flight risk.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

61. The FAA offered a one-time amnesty from legal action for withholding health condition information.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

• MedXPress contained a required training module that described why FAA wants pilots to Strongly disagree

• Disagree

• Somewhat disagree

• Neither disagree nor agree

• Somewhat agree

• Agree

• Strongly Agree

62. FAA published background information and risk assessments which led to policies on information requests and reviews for related health conditions to better communicate the risks the FAA is trying to mitigate.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

63. Pre-flight checks included personal diagnostic tools to test fitness-to-fly (e.g., reaction time) to allow pilots to self-assess risk more objectively free of FAA or airline involvement.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

64. The AME exam included preventive tests to identify medical conditions and risk factors for pilot incapacitation, allowing for early intervention if pilots were unaware of symptoms or risks..

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

65. The knowledge standards for obtaining commercial pilot licenses included information on Might need examples of what these test might be...the layman will not umedical certification and disclosure requirements that emphasize pilot accountability and responsibility.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

66. The FAA provided clear methods for compliance with14 CFR 61.53, the regulation that mandates self-assessment and reporting of disqualifying medical conditions and prohibits pilots from flying if they know they are experiencing a medical condition that could impair their ability to fly safely.

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

67. The FAA created a voluntary disclosure program for pilots to disclose conditions and receive expert consultation on what to do next without automatically triggering FAA administrative actions (e.g., grounding).

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

68. Crew Resource Management training included more material on recognizing and responding to partial or full incapacitation?

    • Strongly disagree

    • Disagree

    • Somewhat disagree

    • Neither disagree nor agree

    • Somewhat agree

    • Agree

    • Strongly Agree

69. Is there anything not previously mentioned in the survey the FAA can do to reduce pilot barriers to sharing their physical and mental health information to AMEs?

    • [Open text – 500 character maximum]