The FAA's regulations require airline pilots to undergo a medical exam with an Aviation Medical Examiner (AME) every six months to five years, depending on the type of flying they do and their age. Aviation Medical Examiners are trained to determine the pilot's mental health and fitness to fly.

Commercial airline pilots in 2026 undergo a rigorous, multi-layered testing cycle that never truly stops. For Medical Fitness, pilots under 40 are typically tested once a year, while those 40 and older must pass a First-Class Medical exam every six months. Regarding Technical Skills, pilots must undergo "Recurrent Training" in a full-motion flight simulator every six to twelve months to practice emergency procedures and check-rides with an examiner. Additionally, they are subject to random drug and alcohol testing at any time. Every year, a "Line Check" is performed where a senior check-pilot observes them during a real, scheduled flight to ensure they follow standard operating procedures (SOPs). Finally, in 2026, many airlines have implemented "Continuous Monitoring" systems that analyze flight data from every journey to identify any deviations in pilot performance, effectively making every single flight a quiet, digital "test" of their professional capabilities.