The room fell silent in the way that it typically does before something significant, when dialogue dwindles and the only sound is the beating in your ears.

“Captain Kumar,” the instructor announced, “you are experiencing an in-flight engine failure. What course of action will you take?”

I stood rigid, spine straight, as my classmates shifted their attention to me with the intense scrutiny of a medical team assessing a delicate case. A drop of sweat trickled down my forehead. And in an instant, Wright-Patterson Air Force Base blurred at the edges. I was no longer a flight surgeon trainee. I had reverted to an intern at Saint Michael’s Medical Center in Newark, New Jersey, standing in a small, fluorescent-lit conference room clutching a handful of EKGs, each one increasingly erratic and unclear.

The cardiology attending, an old-school physician with a keen interest in rare conduction disorders, notably Brugada syndrome, tapped the upper right corner of the tracing with a capped pen. “Well, Doctor Kumar,” he began, extending the title just enough to impart a sense of provisionality, “please walk us through this, step by step. Is this normal?”

Chief residents occupied the rear wall. Medical students gathered near the entrance. The overnight team stood alongside me, eager to see if I could differentiate artifact from pathology under the weight of collective scrutiny.

I had completed my intern year only a few years prior to AMP, but as I awaited my standup scenario, that familiar feeling, of being publicly tested with no allowance for hesitation, came rushing back. Both environments demanded the same essential quality: poise under observation.

Aerospace Medicine Primary (the six-week course that initiates Air Force flight surgeons) is separated into three two-week segments: academics, flight operations, and advanced aeromedical principles. The academic section unfolds in a vast hall adorned with bright red seats, affectionately yet grudgingly dubbed the big red bed.

I never witnessed it personally, but the tales lingered: Anyone who dozed off during the lengthy lecture marathon risked having an old aircraft tire hung around their neck, a ritual designed to correct posture, alertness, and attitude simultaneously. Whether myth or relic, it clearly conveyed the culture: Fatigue is acceptable; disengagement is not.

Next came flying. Cirrus SR22s for cross-country navigation, formation exercises, and nighttime landings. Pitts S-2s for aerobatic maneuvers that dismantled your vestibular certainty. Other aircraft types for tactical and physiological lessons. None of it was spectacle. It represented applied physiology (hypoxia, spatial disorientation, task saturation) translated from theoretical knowledge into practical experience. But nothing rivaled the psychological intensity of standup.

In military pilot training, standup distills stress to its most fundamental form. The instructor presents an emergency (engine failure, hydraulic malfunction, runaway trim) and calls on a student. The student rises and begins with the required phrase: “I will maintain aircraft control, analyze the situation, take appropriate action, and land as soon as conditions allow.”

Then follows the boldface: the critical-action steps memorized verbatim. Not loosely. Not approximately. Precisely. Any hesitation signifies failure. A misplaced term equals failure. Deliver it steadily or nervously; precision is all that matters.

The reasoning is clinically sophisticated: If you cannot articulate the steps during a tranquil morning in a classroom, you will not execute them when inverted at altitude with smoke engulfing the cockpit and flames dancing at your periphery.

That’s why, when my instructor presented my hypothetical engine failure that morning, my thoughts immediately retraced to that conference room at Saint Michael’s. The few EKGs fanned between my fingers. The cardiologist circling the right precordial leads. The chief residents observing from the back of the room. The medical students murmuring about ischemic patterns or potential Brugada morphology. And me (an intern who had scarcely learned to trust his clinical judgment) striving to maintain composure as I outlined millimeter variations in ST elevation under pressure.

We often perceive that medicine and military aviation inhabit distinct cultures, governed by different codes, differing expectations, various types of stress. However, their educational methods closely resemble one another more than either discipline acknowledges. Both depend on controlled exposure to high-pressure situations. Both view public correction not as punishment, but as preparation. Both anticipate trainees to stand up, without notes, and navigate uncertainty, whether that uncertainty is a malignant arrhythmia or a simulated engine failure during takeoff.

Standup instilled in me that emergencies favor memorized, internalized sequences over improvisation. Residency taught me that cognitive overload manifests similarly whether you are decoding an EKG at 3 a.m. or reciting boldface in a quiet room filled with peers.

That morning at Wright-Patterson, I recited my checklist without error. Yet what lingered with me was not the sequence itself. It was the realization that whether you are standing in a hospital conference room or in a pilot-training classroom, the fundamental question remains unchanged.