Flight Instruction in Canada and in Medicine

One of my passions is teaching. I first learned to teach while I was an Air Cadet. Then, when I was in college training to be a commercial pilot, I taught Air Cadets their flying scholarship program. After returning from Australia with my freshly minted Bachelor of Aviation, I started my career as a professional pilot.

In Europe, pilots often come to the airlines straight from high school. The airspace and aviation industry being what is it is there, airlines will hire high school graduates ("cadets" is often the term) and then train them from the initial stages right up to flying complex airlines. In return for this investment of training, the cadet is required to provide a return of service - several years worth of service. This isn't usually a problem because for many pilots the end-goal of their flying careers is to fly for a major airline. Since the schedules, promotions, and salary at airlines are entirely dependent upon seniority - this is a pretty good deal for everyone involved.

In Canada, we are only recently starting to develop these kinds of relationships with airlines. In general, however, most pilots in Canada need to build time to get to the airlines. Due to our vast landscape and airspace, plus our relative privilege and wealth as Canadians, almost anyone can become a pilot if they have the financial means. With a large and robust air taxi and commuter (smaller airlines) industries, pilots in Canada have traditionally needed to build time to qualify for their Airline Transport Pilot Licence ("ATPL").

A Private Pilot Licence ("PPL") requires a minimum of 45 hours and allows the holder to fly a single-engine airplane in good weather during the day. Additional ratings can allow the pilot to fly at night, in poorer weather, or fly a multi-engine airplane. The Commercial Pilot Licence ("CPL") requires a minimum of 200 hours total time, some additional training on top of the PPL, and allows the holder to fly for hire. Most commercial pilots are also qualified to fly multi-engine airplanes at night and in poor weather (what's called a multi-engine instrument rating or multi-IFR). The ATPL requires a total time of 1500 hours, with certain requirements of flight time in various categories (pilot-in-command time, cross-country time, multi-engine time, etc.) Whereas many people obtain their CPL by training for 18 to 24 months, most pilots spend years working towards their ATPL.

Traditionally, there were two routes to building experience: flight instruction and flying float planes. Flight instruction generally allowed the pilot to remain in the southern parts of Canada, while float flying generally took place up north.

I decided to teach. This required additional training on top of my CPL. After taking the ground school and passing the written exam, I challenged the flight test and received by Class IV Flight Instructor Rating.

There are four classes of flight instructors:
  • Class IV: allows the holder to teach people how to fly, but this person must be supervised by a senior instructor;
  • Class III: allows the instructor to teach without supervision;
  • Class II: allows the person to supervisor junior instructors and become the Cheif Flight Instructor ("CFI") of a flight school;
  • Class I: allows the holder to train commercial pilots to become Class IV flight instructors.
Most instructors building time obtain their Class III flight instructor rating and then never teach again. Instructing is seen as a stepping stone to a better job.

I enjoyed teaching. I was fortunate to teach not only Air Cadets and civilian (private) students from all walks of life (teenagers, retirees, professionals, farmers, etc.) but I also created and taught some post-secondary courses for Conestoga College and the University of Waterloo.

When I transitioned to my career in medicine, I noticed that many instructors were excellent physicians, but received little to no training in how to teach. I have asked many peopled involved in medical education and this is consistent across many universities.

Early on in my first year at the University of Toronto's MD program, I was invited to help teach family medicine residents how to teach. This was not because of my background in instruction, I was simply one of many first-year medical students that were invited to participate in being taught a technique of how to examine a patient complaining of knee pain. They wanted first-year medical students because we were essentially blank slates and had not yet been taught this technique.

Two exceptionally bright and eager family medicine residents came into a room and taught me the technique. They did admirably well, but I was surprised at the lack of supervision / observation while they taught me. From what I gathered, they received a roughly one-hour seminar that morning on how to teach and then were thrown into their roles as instructors. I'm not sure what debriefing took place, but I'm sure there was some. Very different from how we train flight instructors.

Before the residents left the room (I was their only student), I explained a couple of points that I use when I teach. I'll share them with you now. They are the seven learning factors and the AMOLT technique for starting a lesson.

7 Learning Factors
Transport Canada puts out a manual for flight instructors called the Flight Instructor Guide ("FIG"). This is the bible for flight instruction in Canada (it is available free of charge), though it is by no means complete. Among other subjects, the FIG describes:
  • The difference between ground school (evening classes on the theory of flying) and Preparatory Ground Instruction (practical lessons given immediately before a flight where new material is being conducted in the airplane);
  • Proper questioning technique;
  • Tips on teaching large classes vs single students;
  • Learning factors for effective teaching;
It is the last point that is worth expanding on. In order, the seven learning factors are, as described in the FIG:
  1. READINESS - Ensure students are mentally, physically and emotionally ready to learn.
  2. PRIMACY - Present new knowledge or skills correctly the first time. (Teach it right the first time.)
  3. RELATIONSHIP - Present lessons in the logical sequence of known to unknown, simple to complex, easy to difficult.
  4. EXERCISE - Ensure students are engaged in meaningful activity.
  5. INTENSITY - Use dramatic, realistic or unexpected things, as they are long remembered.
  6. EFFECT - Ensure students gain a feeling of satisfaction from having taken part in a lesson.
  7. RECENCY - Summarize and practise the important points at the end of each lesson, as last things learned and practised will be remembered longest.
"AMOLT"
Additionally, something that was taught to me at my first job as a flight instructor is how to start every lesson (no matter how small): "AMOLT", which stands for:
  • AIM - what is the objective to be achieved at the end of this lesson?
  • MOTIVATION - why should the student care?
  • OUTLINE - what are the main headings to this topic?
  • LINK - how does this lesson fit in the overall picture of training and to things that have previously been learned (see the learning factor of relationship above).
  • TKT (Threshold Knowledge Test) - ask a couple of quick questions to determine the students' level of knowledge. If their knowledge is below that required for this lesson, backtrack and re-teach the earlier information. If the students' knowledge is advanced, increase the complexity of examples, etc.
AMOLT can be accomplished in the first few minutes of any lesson. It could be as simple as saying, "Adam, imagine you're a family doctor and a 40-year-old female patient comes in complaining of left leg pain. What would you do?" [After narrowing it down to left knee pain and taking a full history, you're ready to move on to the physical examination.]

"Ok, great. At the end of this session, you will know how to conduct the physical examination of the knee and in particular how to describe the following issues... As with other physical examinations you've done, the knee exam will follow the following format, which we'll use as our outline for today's lesson:" [write this on the board]

Outline
  • Inspection
    • Anatomy
    • Swelling 
    • Bruising (etc.)
  • Palpation
    • Temperature (etc.)
  • Special Manoeuvers
    • Tests for meniscus injury (etc.)
Notice that the motivation section has already been incorporated into the introduction (you're a family doctor and your patient complains of knee pain). There is an infinite number of ways that this can be conducted. Early on in your career as instructors, people find it easier to provide all of the information, but as proficiency is gained, many instructors find developmental teaching more effective. Developmental teaching is where a series of well-structured questions allows the student to derive the correct answer (more on this in the FIG, for those interested).

The learning factors make learning more efficient and effective. The AMOLT technique orients the student and keeps both the learner and the teacher on track.

One of the most rewarding things I have done is learn how to teach. As with many professional skills, it is not something that is done once and then completed. I continually have to keep up to date with new techniques. I do so by teaching on Flight Instructor Refresher Courses, which allows flight instructors to renew their ratings without having to go through a flight test from Transport Canada. I find that rather than doing the same thing over again in a flight test, these courses teach new techniques and best practices. They drive the industry forward.

I teach with Aviation Solutions, one of only four providers Canada. When I teach on these courses, I also renew my flight instructor rating (which must be renewed every four years for a Class I rating).

I hope one day to apply these concepts to teaching medical students and residents.

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