Lessons for new first assistants based on real operating-room experience, including the habits that can slow learning or create unnecessary risk. I am sharing this from the perspective of a Navy-trained surgical professional with more than two decades in the operating room and experience as both a CST and CSFA.

Trying to Look Experienced Instead of Being Teachable

One of the fastest ways to slow your growth is pretending you understand an instruction when you do not. First assisting requires confidence, but safe confidence includes asking for clarification.

Experienced surgeons can usually tell when someone is guessing. A concise question is safer than an incorrect movement.

Using Too Much Force

New assistants may believe stronger retraction creates better exposure. Excessive force can damage tissue, increase fatigue, and make the field worse.

Learn direction before force. Small changes in angle and countertraction often accomplish more than pulling harder.

Blocking the Surgeon With Suction

Suction should clear the field, not occupy it. New assistants sometimes chase every drop of blood and place the tip directly in the surgeon’s working space.

Watch the surgeon’s hands and line of sight. Clear what needs to be cleared and move when the tip is no longer helping.

Focusing Only on the Task in Your Hand

Tunnel vision is common. You may become so focused on one retractor or suture that you stop noticing the broader field.

Continue monitoring sterility, tissue tension, equipment, the scrub’s needs, and changes in the procedure. The assistant must remain situationally aware.

Rushing Closure

Speed is useful only when technique remains safe. Uneven bites, poor tension, damaged needles, insecure knots, and missed layers are not signs of efficiency.

Build consistent technique first. Speed develops through repetition.

Failing to Prepare for the Case

Experience as a scrub can create overconfidence. You may know the general procedure but not the anatomy, approach, implant, or surgeon-specific assisting expectations.

Review the procedure and likely danger areas. Preparation allows you to understand instructions faster.

Making the Scrub Person Work Around You

A new assistant may unintentionally block the Mayo stand, grab instruments without communication, or return items unpredictably.

Remember that the scrub is managing the entire sterile setup. Communicate clearly and return instruments safely. Your advancement does not make the scrub role less important.

Ignoring Ergonomics

Poor positioning can cause rapid fatigue and long-term injury. Adjust your stance, table height, step stool, and equipment when possible.

OSHA identifies prolonged standing, force, and awkward posture as surgical-suite risks. Protecting your body is part of maintaining competence.

Related reading: How Surgical First Assistant Pay and Jobs Work.

Working Outside Your Scope or Privileges

Pressure can come from surgeons, managers, or coworkers. Being asked to do something does not prove you are authorized to do it.

Know your education, privileges, state requirements, and facility policy. Professional boundaries protect the patient and your career.

Taking Every Correction Personally

Correction is part of learning. The surgeon may need an immediate change and may not have time for a gentle explanation during a critical step.

Address disrespect through appropriate channels, but do not confuse direct clinical instruction with a personal attack. Learn the lesson and keep improving.

Related reading: What Surgical First Assistant Clinicals Are Really Like.

Frequently Asked Questions

How long does it take to feel comfortable first assisting?

Comfort varies by prior experience, case volume, specialty, precepting, and individual learning. Competence develops over repeated supervised practice.

What should I do after a difficult case?

Document what you learned, review the anatomy or technique, ask focused questions, and avoid turning one case into a judgment about your entire ability.

Is it acceptable to tell a surgeon I have not done something before?

Yes. Honest communication allows the surgeon and team to adjust supervision and protect the patient.

Sources