neurocognitive demands on airline...

Neurocognitive Demands on

Airline Pilots

Carlos Porges, Psy.D., A.B.P.P.Clinical NeuropsychologistBoeing 757/767 pilotUnited Airlines

Aeromedical Psychology Seminar

Denver, Colorado

21-24 September 2017

Career Change

PSYCHO- LOGIST

Professional Background

• Neuropsychologist• Board Certified (ABPP) in Rehabilitation• TBI/CVA assessment and rehab• Formal training in Multicultural issues• Aviation psychology

Professional Background

• Airline Transport Pilot (ATP)

• Type rated in E-120, CL-65 and Boeing 757/767

• About 10,000 hours flight time, about 7,500 of them flying paying passengers in jets both in a regional airline and long-haul global passenger airline

A Different Perspective

Preview

• Brief Orientation to the Unique Demands of the Aviation Environment and Aviation Evaluations

• Cognitive Demands• Personality/Adjustment/Cultural Issues

Task Demands

• A pilot operates a complex machine that freely moves—with no “pause” button-- in an infinitely variable 3-D environment colored by weather, mechanical, geographical, procedural, traffic, time and human factors.

• Once an aircraft starts to taxi, the pilot’s crucial task is to never let the airplane go to a place his mind has not been to at least 10 minutes before. The pilot, in effect, must think faster than the aircraft moves.

• The pilot who cannot keep mentally apace with events will find himself increasingly overwhelmed by a logjam of information—an overload—that will saturate him or her to the point of ineffectiveness.

Task Demands

• Each Pilot Individually Performing PASAT and Manakin while working together (mostly verbally) to solve

• a Magical WCST where you sort for new rules every time, under time pressure

• THEN....Boring, Skull-crushing Dullness

• Each condition has safety implications

Task Demands

• Low workload phases of flight are not unlike CPT

• “pilot response” annunciation on MFD

Task Demands

Mental Abilities are Critical

• The Superior Pilot uses his Superior Judgment to avoid using his Superior Skill


• The Eyes of a Hawk

• The Reflexes of a Lynx


• If a pilot ever needs his hawk eyes and lynx reflexes to save the day....

• He incurred in errors of judgment “upstream” because...

• He should never find himself in that position


• So, the Neuropsychologist must place a special emphasis on assessing FRONTAL NETWORK FUNCTIONS

• Working Memory, Multitasking, Problem Recognition, Hypothesis Generation, Problem Solving Strategy Implementation

• Appropriate Persistence, Appropriate Abandonment, Mental Flexibility, Frustration Tolerance

Are we measuring relevant cognitive domains?

• YES! But….

• What is Aeromedically Significant Impairment?

• FOR EXAMPLE: MATH SKILLS


• Sometimes we can agree that pilot X has weak math skills, and functions lower than his colleagues on standardized tests…which is all well and good.

• But the BIG QUESTION has to be (always in neuropsychology!)

• SO WHAT?


• Dr. Kay was amused by an assessment I conducted of an experienced major airline pilot with a history of Anxiety Disorder and Irritable Bowel Syndrome. He self-reported his symptoms, obtained treatment, was stable on medication for several years. Began and ran a home business on the side. His chief pilot described him as a “Model Employee”.


• He (always) performed poorly on CogScreen Math accuracy and speed (below the 5th%ile), and about 1 standard deviation below the mean relative to other pilots on other measures of arithmetical ability.

• History of math weakness, but completed a BA in Engineering

• He was rejected on review because of “aeromedically significant deficits on tests of math reasoning”


• This did not pass the SO WHAT test


• I thus devised my own homegrown math questions, designed to be representative of the real world math demands of flying, based on my 25 years experience as a neuropsychologist and 10,000 hours or so flying jets.

• In my opinion, they are as demanding as CogScreen or WAIS-IV measures, and they load on working memory

Math demands

Your personal airplane burns 9 gallons of gas an hour and you have a 40-gallon tank. How long can you fly if you want to land with 1 hour of fuel left?

You are cruising at Flight Level 370 and show a 420 knot groundspeed. Your destination airport is at 1,000 feet msl. Assuming there are no ATC restrictions, how far away from the airport should you start your descent to land? At what rate of descent, in feet per minute?

Your jet has a max takeoff weight of 240,000 lbs. You are at the gate, about to board passengers and cargo. Maintenance Control calls you and tells you they just found a maintenance issue that requires a 15% penalty applied to the Max Takeoff weight. How much can you weigh once you apply this penalty in order to be legal for Takeoff?


• Yes, you will criticize me for creating something with face validity…

• But these are, in fact, representative of the problems he will face in day to day line flying.

• He completed them accurately and in 30 seconds or less.

• That has to mean something, especially in light of his vocational history and his lifelong math weakness


• In answering the SO WHAT question, I concluded his math weaknesses were not aeromedically significant and recommended SI.

• The reviewer agreed and he has been flying without incident for over 2 years now


• Inability to perform tasks like these is strongly suggestive of an aeromedically significant weakness,

• “My goal in life…”

• Why are airlines so safe?

• Good Equipment

• Good support network

• dispatch, weather, etc

• Good people

• Standardization

Standardization

• Everything is done the same way, everyday, by everyone

• On Takeoff: PF advances thrust levers, verifies stable reading, commands “autothrottles”. PF focus is outside, PNF inside. At 100 kts, PNF checks all 3 speed indicators and says “100 kts”. This is the beginning of the high speed regime, where you reject ONLY for engine fire, failure, or inability to fly. 5 Kts before V1, PNF says “V1” and Captain removes his/her hands from the throttles (to prevent the temptation to abort). At Vr PNF calls “rotate”. When aircraft is climbing PNF calls “positive rate” and PF says “Gear up”

• You can fly with a stranger but you know exactly what will be done, how it will be done, what will be said and when--like a ballet

• Flows, call outs, checklists, profiles, abnormals

• Any deviation stands out starkly

Standardization

• Enhances Safety

• everything becomes overlearned

• The real AIRSHOW starts when something unusual happens


• Challenges in assessing FRONTAL NETWORK FUNCTIONS

• Problem: A subtle but relevant deficit in frontal network functions may not be reflected in day-to-day Line Flying or in Flight Simulator Training Sessions

• These tasks are overlearned and thus resistant to decline even as deterioration elsewhere becomes evident. Think V1 Cuts


• FRONTAL NETWORK FUNCTIONS

• Where DO these problems pop up more often?

• LOFT scenarios and unusual events in Line Flying (and real life, not flying)

• The fact someone performs well in recurrent checkrides and in line checks is thus not that relevant


• In Aviation, we speak of SITUATIONAL AWARENESS (SA)

• The ability to attend to and track multiple sources of information, quickly and accurately


• CRITICAL

• Aeromedically Pertinent

• Working Memory, Multi-tasking, Speed of Mentation, Impulse Control are


• In summary, we may be tempted to think that motor and visual-spatial skills are most important in safe flying.

• They are crucial, but pertain to the operating of the machine.

• Equally important, or more, is managing the operation of the machine.

• Example from Merchant Marine Captain or QF32

Personality Variables

• The Good Pilot Always Does the Right Thing Even When No One is Watching

• Integrity, Conscientiousness, Emotional Resiliency, and Good People Skills

• Of The “Big Five”, you would want someone with High Conscientiousness, Low Neuroticism and Moderate Agreeableness

Personality Variables

• Real World Examples• E-120 Bump in the night

• B6 FO

Personality VariablesTIPS

• Airline Pilots are proud and competitive: They

• Have a deliberate problem solving philosophy

• Hate being wrong

• Don’t read instructions

• “Get the mission done” mentality

• Generally not Psychologically Minded--MMPI

Job Stressors

• Airline Pilot 2nd most stressful uniformed occupation, after police officer (Raymond, 1988)

• Occupational/Economic Uncertainty• Explain seniority minutiae--• every 6 months you face the real possibility of your career

ending: checkride, medical exam, line check/ramp check• might explain “why is this pilot so nervous in my office?”

• Physiological Stressors• multiple atlantic crossings bring about subtle effect

• Interpersonal Stressors: Culture, Language, Generational

Job Stressors

• Cultural & Linguistic Issues are important in assessment:

THANK YOU

Carlos Porges, Psy.D., A.B.P.P.

•[email protected]

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