Medical education’s next frontier: Space

In 1961, Yuri Gagarin became the first human in space. With every kilometre he ascended, he pushed the boundaries of human achievement and catalyzed a surge of interest in exploration, research, development – and medical innovation.

With the Artemis Moon missions expected to launch this year and estimates that the first person on Mars could land as early as 2030, the time is ripe for medical institutions to get involved in a rapidly growing field ripe with opportunities.

In fact, the doctors of tomorrow want to learn more about space medicine. A 2023 survey of American medical students indicated that more than 85 percent of those surveyed would like to learn more about space medicine. Some medical schools and teaching hospitals in the U.S., including the Ronald Reagan UCLA Medical Centre and the University of Colorado Anschutz Medical Campus, have started offering programs specifically focused on preparing trainees for future careers in human spaceflight. In Canada, however, the current medical curriculum has limited opportunities. Canadian medical schools can change this and empower learners interested in these careers by providing them with the educational support needed to shoot for the stars.

While space medicine may sound like a pie-in-the-sky endeavour, it is a field that has been in existence in some form since the Aero Medical Association was formed in 1929. During the First World War, the medical needs of pilots were brought to light, highlighting the need for specialized care distinct from the general population. After the U.S. Air Force School of Aviation Medicine established a Department of Space Medicine in 1950, the discipline evolved to encompass both aviation and space medicine due to the shared environmental challenges.

These unique environmental effects can be felt across every organ, from the musculoskeletal to the neurovestibular system. During space flight, microgravity takes over, producing a sense of weightlessness and leading to debilitating symptoms as body fluid is redistributed upwards, intracranial pressure increases and plasma volume reduces. As the flight goes on, prolonged microgravity exposure and gravitational unloading lead to bone demineralization and skeletal muscle atrophy. The increase in intracranial pressure eventually leads to the worsening of neurovestibular impairments and the degradation of visual acuity. Outside of the protection of Earth’s atmosphere, ionizing radiation damages cellular DNA and increases cancer risk, and acute high radiation exposure can be fatal. Upon re-entry, the crew can be subjected to depressurization sickness, fires, trauma and the potential for difficult landings. Then, once the mission concludes, physical rehabilitation begins.

The role of a space medicine specialist, also known as a flight surgeon, extends beyond clinical care for the crew. Everything from audiology to pharmacogenomics is assessed to evaluate the effect of a space environment on physiology, performance and survivability. Flight surgeons are currently working alongside the Canadian Space Agency (CSA) on projects such as the optimization of G-suits and space suits, and the development of personal detector systems for radiation exposure. The benefits of space medicine research isn’t limited to the exosphere. Technologies that were first tested during spaceflight, such as the use of ultrasound in novel diagnostic situations, have led to updated standards and regulations on Earth. As spaceflight becomes more commercialized, it’s clear to see that these professionals are key to propelling space travel into the future.

The Artemis missions aim to put people back on the Moon and eventually establish a base of operations and preparations for the next milestone in space exploration: a manned mission to Mars. Space tourism also will drive a need for doctors. Companies like Elon Musk’s SpaceX and Jeff Bezos’ Blue Origin have already begun bringing people into space, and all of those launches required health-care professionals to get off the ground. Luckily, doctors already provide specialized training for astronauts for emergency situations, and some astronauts have a health-care background themselves.

Some astronauts have a health-care background themselves.

Techniques for treatment will need to be developed to account for limited resources and environmental challenges. An area experiencing extensive development is robotics and remote treatment, which could enable health-care providers on Earth to remotely perform surgical procedures in space. However, all technologies that rely on remote communications have an insurmountable flaw: latency. Information can only travel at the speed of light, and with missions going as far as Mars, this may manifest in a delay of up to 20 minutes. This is where we can see space medicine shift from a supportive role to one where active in-person involvement is essential.

Efforts to improve access to space medicine education in Canada began decades ago, with the CSA selecting Canadian medical students and residents to attend NASA’s prestigious Aerospace Medicine Elective at either the Kennedy Space Center (KSC) on the Space Coast in Florida or the Johnson Space Centre in Houston. More than 10 years ago McGill University had recommended creating new modalities for space medicine training, specifically remote learning for crew medical officers, however, this has not yet become available. Although these efforts aim to improve access to space medicine education, few Canadian medical students are aware of these opportunities, and even fewer can access them.

A strong interest in space medicine, coupled with the limited inclusion of space medicine in the Canadian medical curriculum, creates an opportunity for change. Raising space medicine awareness is key and lobbying medical communities to increase recognition of space medicine as a discipline is essential. Longitudinal incorporation of space medicine into the medical education curriculum can then happen. Case-based learning models are an excellent delivery option for such integration. As is done with other disciplines, specific cases can be developed around space medicine, encouraging a baseline understanding for all students while also allowing for independent exploration of topics of interest. For example, during discussions on bone physiology, bone density loss during space flights can be integrated. Learners could also be provided with additional opportunities such as supplementary courses and experiential learning, as is becoming implemented by other medical schools outside of Canada. Lectures delivered by space medicine experts can increase awareness, draw connections with relevant medical topics and create avenues for gaining hands-on experiences. Experiential learning opportunities in space medicine can also be provided directly by medical schools similar to other shadowing and elective experiences in conjunction with organizations such as the CSA and the Canadian Society of Aerospace Medicine (CSAM).

As technology evolves and the need for medical expertise in space becomes more apparent, the incorporation of space medicine education into medical curricula is essential. By increasing awareness and providing educational opportunities, medical schools can inspire students to explore and pursue this exciting field.

These future health-care professionals will be well-prepared to support the expansion of space travel and drive advancements in medical care both on Earth and beyond.