The Legacy of the Wright State University Aerospace Medicine Residency Program
INTRODUCTION: In the mid-1970s, NASA required a robust training program for physicians responsible for the medical needs of the Shuttle astronauts. Personnel at NASA worked closely with academicians and subject matter experts at Wright State University (WSU) to develop and establish a residency program in aerospace medicine. This academic training program was initiated in 1978 and closed in 2018. The objective of this historical piece is to catalog, for posterity, the impact this training program has had on national and international human spaceflight and aviation.
METHODS: A thorough review of all available historical documents and oral histories provided by contemporaries were reviewed in detail, including a search of every available resident’s thesis and all available historical documents and reports at WSU and NASA Headquarters.
RESULTS: Over the past 40 yr, WSU has graduated 172 individuals with an M.S. degree focused on aerospace medicine, of which 84 were residents. Nearly 50% of these residents have worked closely with NASA. Many others became integrated into academia, the aviation industry, or international space programs.
DISCUSSION: With the growth in interest for government and commercial spaceflight, the field of aerospace medicine is poised to grow. Although it is not well known outside of the Aerospace Medicine community, the legacy of this pioneering, 40-yr civilian-based program is of significant value. If not recorded in an easily locatable and accessible manner, many of the challenges and outcomes from this residency could be lost until future generations have to spend the money, time, and effort to relearn them.
Doarn CR, Shimada K, Shepanek M. The legacy of the Wright State University Aerospace Medicine Residency program. Aerosp Med Hum Perform. 2021; 92(9):744–750.
“Space medicine is still an infant science—but no other frontier of medicine is more exciting. In determining the need and role of various human parts, their creation, and their possible substitution, you shall be probing the origins of life itself.”
President John F. KennedyAerospace Medical CenterSan Antonio, TX, 1963
In 2018, we celebrated the 100th anniversary of aviation medicine. From 1903 to 1918, there was little data and much speculation about how the human body would react to powered flight. To address the clear future need, in 1918, Theodore C. Lyster helped establish the U.S. Army Air School of Aviation at Hazelhurst Field as the Air Service Medical Research Laboratory. 10,17 From that day forward, aviation medicine grew along with military aviation, commercial aviation, and now, human spaceflight. As interest in spaceflight grew after World War II, aviation medicine expanded to aerospace medicine, both in practice and training. 4,7
Doarn and Mohler reported on the early academic programs at Harvard University (1954–1972) and at The Ohio State University (1959–1977), how those programs developed, and the role they played. 6 Aerospace medicine training has occurred worldwide in support of national interests and efforts. In 2005, Ducatman et al. presented a discussion on residency training in preventive medicine. 7 Mohler reported on the training of aerospace medicine physicians at Wright State University in 1985. 13 Howard reported on training in the United Kingdom. 9 Tokarev et al. reported on physician training in the Union of Soviet Socialist Republics and the United States. 16 Billings discussed the training program at The Ohio State University, which was initially an aviation training program and later evolved into an aerospace medicine training program. 3 This program provided 51 trained physicians, 12 of whom worked at NASA in some capacity. Grenon et al. discussed the challenges of aerospace education for Canadian physicians. 8 And, while each of these programs has matriculated significant numbers to the field, it is the Wright State University program that produced the most graduates and has had the most significant educational impact for those four decades.
METHODS
To understand the contribution and legacy that the Wright State Residency Program had on the field of aerospace medicine, a thorough review of all available material was conducted. The source material included personal communications with Dr. Mohler in the years before his death and discussions with the Wright State University archivist (William Stoltz). In addition, all existing materials at Wright State University, including files, department/college newsletters and reports, residency newsletters and NASA Headquarters archived proposals, and annual reports from Wright State University. Much of the historical record is no longer available due to it being lost as a result of moves or destroyed.
Transition in Training Opportunities and a Growing Need
The Apollo Program ran from 1961–1975 with the last lunar landing mission, Apollo 17, occurring in late 1972. The Apollo Applications Program, which consisted of three Skylab missions and a joint USSR/U.S. docking mission, Apollo-Soyuz Test Project, ran through 1975. The Space Shuttle Program began in 1969, was formally initiated in 1972, and had its first launch (STS-1) in 1981. As the Apollo program wound down, it seemed to some that the need for aerospace medicine trained physicians was diminishing. The Harvard and Ohio State programs were terminated. 6
In 1977, it was clear to senior NASA medical personnel that there was a need to establish a new training program to prepare physicians to support human crews of the new, upcoming Space Shuttle program. Thought was given to establishing such a training capability at Wright State University as Wright-Patterson Air Force Base (WPAFB) was not only close by, but had outstanding academic and research opportunities for a new Master’s degree and residency program in Aerospace Medicine. In addition, WPAFB had a long and distinguished role in human spaceflight going back to the late 1950s with Dr. Stanley White and others. Dr. White was stationed at WPAFB before being assigned to NASA’s Manned Spacecraft Center in Houston. 20 Many of the medical efforts, technologies, and life support systems for the early space program came out of WPAFB’s Aerospace Medical Research Laboratory. 19
To address the high operational tempo and multiple flight requirements of the upcoming Space Shuttle program, Drs. Sam Pool and Arnauld Nicogossian, and others, initiated new crew medical and selection standards and established the foundations of medical policy to support this program. 5 The type of astronauts required to support the Space Shuttle Program and the operational tempo required to support multiple planned missions were different from the Apollo era. Early Shuttle program estimates included the possibility of flying 50 missions per year. This tempo would require a large number of highly trained and experience Aerospace Medicine physicians.
Dr. Nicogossian (an Ohio State University residency graduate) was an early advocate of establishing a new aerospace medicine residency to address the unique needs and requirements of the Space Shuttle well in advance of using the new vehicle to send humans into space. 16 As Doarn and Mohler have reported, discussions were held with Dr. Charles Billings about developing a program in California in association with NASA Ames Research Center and Stanford University and with Dr. Stanley Mohler about Wright State University, which was adjacent to WPAFB in Dayton, OH. 6 In 1978, a multiyear, civilian residency program was initiated at Wright State University with Dr. Mohler as its first director. The first residents were admitted in 1979. 13
NASA’s Partnership with Wright State University
As the NASA-funded program at Wright State University began, two individuals were selected to receive a NASA stipend. These individuals most often then matriculated to a NASA field center, usually Kennedy Space Center (KSC) or Johnson Space Center (JSC). Non-NASA-funded residents were part of the program and were funded either with their own resources or sponsored by another organization, including aviation companies and militaries from around the world. During the course history, there were years when WPAFB denied entry of certain nationalities. When that was the case, the student skipped classes at WPAFB or did thesis work outside of WPAFB at other appropriate settings. This cadre of physicians enhanced the training program with reflections of both space medicine and aviation medicine.
Academics and Decadienal Review
In its earliest days (c. 1980), the Wright State University program consisted of 2 yr of academic work and was recognized as a residency period by the Accreditation Council for Graduate Medical Education (ACGME), and as a master’s course in Aerospace Medicine by the university. Later it was modified to be a residency course. 14,21
The first year was the academic year, which fulfilled class requirements. It was possible to graduate as a master’s student if a thesis was completed. The second year was a practicum year and the final year was the residency. The third year, a practice year, fulfilled a 3-yr requirement to sit for the American Board of Preventive Medicine Aerospace Medicine subspecialty exam.
Over the 40-yr program, there were several directors. The founding and initial director was Stanley R. Mohler, M.D. (1979–2004), followed by Robin Dodge, M.D., M.S. (2004–2011), Farhad Sahiar, M.D., M.S. (2011–2013), Dean Olson, M.D., M.S., M.S. (2013–2017), and Thomas F. Jarnot, M.D., M.S. (2017–2018). Aside from Dr. Mohler, the other directors were all graduates of the residency program.
This ACGME-approved residency included a wide variety of courses and each student was required to complete a thesis. Over the years, the curriculum evolved to: 1) meet standards set by the ACGME; and 2) keep pace with the medical training needs of the evolving Shuttle flights to a fully operational International Space Station. Courses were taught by a variety of scholars and subject matter experts in aerospace and aviation medicine and life sciences, including Drs. Stanley Mohler, Ken Beers, Robin Dodge, Richard Garrison, and Mary Anne Frey. In addition, a wide number of guest lecturers also shared their knowledge and experience. Students did their research both at WPAFB and in the community. Students also rotated to Federal Aviation Administration (FAA) sites, the Civil Aerospace Medical Institute (CAMI), and NASA’s KSC and JSC.
Not every student who was accepted into the program completed the requirements or submitted a thesis. In 2006, the thesis requirement became optional and many students did not complete one. Table I is a list of every available thesis written by each resident in fulfillment of the degree requirements. Each thesis has contributed to both human spaceflight and aviation. This comprehensive list covers a wide variety of subjects and will serve as an excellent reference source for understanding the many challenges in human spaceflight and aviation medicine, especially among researchers and developers. They remain relevant today.
RESULTS
Once the residency was up and running, a significant number of graduates from 1980 through the 1990s became employed by NASA. This pipeline to NASA began to wane in the late 1990s with only a few joining NASA from 2000 on. An academic program of this nature has many outcomes. These include many highly trained individuals and the faculty who remain our contemporaries today, influencing both aviation and human spaceflight. Residents came from around the world to train at Wright State University. A significant number continued gaining knowledge at NASA, international space programs, the FAA, CAMI, and other national and international airlines. The training provided an excellent foundation for career development and helped foster the growth of the program. 1
In addition to graduates assuming significant management roles at NASA in operational medicine and life science, the program added Michael R. Barratt, M.D., who graduated in 1991 and became a NASA flight surgeon and then a NASA astronaut. His spaceflight experience both on the Space Shuttle and International Space Station as well as his experience in Russia in support of the Shuttle/Mir Program added great value to the NASA flight surgeon community. He and many others not only used their academic experience to build meaningful careers, but also contribute to the field of aerospace medicine. Barratt’s experience also laid the foundation for two scholarly texts on clinical medicine in space. 2
The nearly 172 graduates—residents (84) and Master of Science students (87)—included individuals from the United States and 29 countries (Australia, Bahrain, Brazil, Canada, China, Colombia, Congo, Ethiopia, Germany, Ghana, Greece, India, Iraq, Iran, Israel, Japan, Jordan, Kuwait, Mexico, Pakistan, Portugal, Qatar, Saudi Arabia, Singapore, South Africa, South Korea, Sudan, Taiwan, Thailand, Unites Arab Emirates). This cadre included civilian and military physicians.
Over the life of the program, 195 students enrolled in the program with over 170 graduating. Of those who were residents, the majority were certified by the America Board of Preventive Medicine. The program also initiated the Stanley R. Mohler lecture series presented at the Experimental Aircraft Association AirVenture in Oshkosh, WI, USA.
Decline and Closure
On April 26, 2017, the Division of Aerospace Medicine within the Wright State University’s Department of Population and Public Health Sciences announced the closure of the residency due to a variety of issues within the university. Several students matriculated to the Aerospace Medicine Residency Program at the University of Texas Medical Branch (UTMB) to complete their degree requirements. While the residency and Master degree programs were closed down, a certificate in Aerospace Medicine was established to further promulgate training, albeit at a reduced level and intensity.
While Wright State University Aerospace Medicine Residency had been a key pipeline for aerospace medicine-trained physicians for nearly 20 yr, the perceived need at NASA JSC led to the development of a training program at the UTMB in Galveston with a focus more on space medicine. This program became a full fledge accredited residency in 1997 and its residents spend significantly more time at the NASA JSC due to its proximity to the Center and its focus on space medicine. 6
While the field of aerospace medicine training has its roots in aviation training, 11,18 it continues to grow, as reported by McGinnis et al. in 1998. 12 This growth will continue to lead graduates into numerous career paths. 1 While the training for the past 40 yr has principally been focused on the space part of aerospace, the Wright State University residency helped make a significant impact. The importance, scope, and breadth of the scholarly contributions that the residents made, solely based on their thesis titles, has been of importance and will continue to be a source of information and knowledge for the next generation of aerospace medicine physicians and perhaps even researchers.
Conclusion
As national and international efforts to develop commercial space endeavors move forward, the need for properly trained physicians to fill the ranks must be met with academic and scholarly vigor. As commercial programs move forward, highly trained aerospace medicine physicians, some of whom obtained their training at Wright State University, will contribute to this rapidly emerging paradigm. Sirek et al. reports on Canada’s efforts in this regard. 15 Residencies, fellowships, and training programs have arisen in preparation for a growing need, but it is the legacy of the Wright State University Aerospace Medicine Residency and its contributions that have made an indelible contribution to this field. It has made a foundation these new programs can build on.
While the program itself ran its course for nearly four decades, it is the knowledge acquired by those who willing sacrificed their time and energy to learn this field and lead space and aviation medicine to where it is today. We remember the outstanding faculty for their commitment to education and to the students who took the knowledge and met the challenge of aviation and human spaceflight head on.
Contributor Notes
