By Dan Bump SA-C, CSFA: In my January 18, 2015 blog post, we discussed what surgeons really need
from their first assistants. Some surgeons have learned to make do with
just an extra pair of hands. But that doesn't address everything a
surgeon needs and deserves from an assistant. The American College of
Surgeons (ACS) and the American Medical Association (AMA) have issued
some pertinent and cogent statements in this regard that are eye opening
in a big way.
The official ACS statement on surgical assistants says in part, "The
first assistant during a surgical operation should be a trained individual
who is able to participate in and actively assist the surgeon in completing
the operation safely and expeditiously by helping to provide exposure,
maintain hemostasis, and serve other technical functions. The qualifications
of the person in this role may vary with the nature of the operation,
the surgical specialty, and the type of hospital or ambulatory surgical facility.
The American College of Surgeons supports the concept that, ideally, the
first assistant at the operating table should be a qualified surgeon or
a resident in an approved surgical education program. Residents at appropriate
levels of training should be provided with opportunities to assist and
participate in operations. If such assistants are not available, other
physicians who are experienced in assisting may participate.
It may be necessary to utilize non-physicians as first assistants. Surgeon's
Assistants (SA's) or physician's assistants (PA's)
with additional surgical training should meet national standards and be credentialed by the appropriate
local authority. These individuals are not authorized to operate independently."
The AMA concurs when stating, "Ideally, the first assistant to the
surgeon at the operating table should be a qualified surgeon or resident
in an education program that is accredited by the Accreditation Council
for Graduate Medical Education (ACGME) and/or the American Osteopathic
Association (AOA). Other appropriately credentialed physicians who are
experienced in assisting the responsible surgeon may participate when
a trained surgeon or a resident in an accredited program is not available.
The AMA recognizes that attainment of this ideal in all surgical care
settings may not be practicable.
In some circumstances it is necessary to utilize appropriately trained
and credentialed unlicensed physicians and non-physicians to serve as
first assistants to qualified surgeons " (emphasis added by ACE). See
Both the ACS and the AMA recognize non-physicians with proper surgery-specific
training and credentials as appropriate for qualified surgeons to utilize
in surgery as surgical assistants. Certainly, Surgical Technologists and
OR Nurses require additional training to become surgical assistants. But
even mid-level healthcare professionals such as PAs and NPs require additional
surgery training to meet the ACS and AMA standards for surgical assistants.
The same is true of unlicensed physicians. At some hospitals, it will
be enough for PAs, NPs, and unlicensed physicians to demonstrate successful
attendance at a surgical lab to acquire the necessary surgical skills.
Other hospitals may require them to earn a surgical assistant credential
such as CSA, SA-C, CSFA, or CRNFA. In those cases, graduating from a full
surgical assistant program is required in order to qualify for the certifying exam.
So what is proper training and how does it address all the needs a surgeon
may have for an assistant? There are two models of training and both seek
to fill these needs but in different ways. Your challenge is to choose
the training model that works best for your particular needs and situation.
Proper training addresses the ideal as set out by the ACS. They identify
the ideal surgical assistant as a second 'surgeon or a surgical resident.'
In fact, historically the surgical assistant was indeed the surgeon's
partner or a surgical resident. Given that ideal, the mission of proper
training would be to help the non-physician provide a service as close
as possible to the service provided by a second surgeon.
Model One provides the standard minimal training as outlined by either the
Association of Surgical Assistant's (ASA) Core Curriculum for Surgical Assisting or the
Association of periOperative Registered Nurses' (AORN) Core Curriculum
for RN First Assistants . After instructing their students according to the prescribed minimums,
model one programs leave it up to the surgeon(s) their graduate will be
working with to teach them the more advanced skills the surgeon wants
them to have. A weakness in this method is the graduate may end up being
very good for that surgeon but not for others. Of course, any program
using the above curricula can go above and beyond the outlined standards
if they wish.
Model Two looks at the ideal surgical assistant as described by the ACS
and AMA and takes full responsibility for
all the training required to bring their graduates as close to the ideal as
possible. Very little if any of the training is left up to the surgeon(s)
they'll end up working with. This model also manages a nagging issue
prevalent in the industry. Surgeons judge you on the very first case you
assist them on. If the surgeon sees you need additional training, they
may limit your opportunities to work with them on a deeper level. If however
the surgeon observes that you already perform very well, two good things
happen. 1) they relax and let you be more involved on a deeper level in
the procedure and, 2) since they don't have to teach you the things
they expect you to know already, they can focus on teaching you their
unique techniques and trade secrets – the things that make them
the best at what they do. This is the ultimate goal of model two training.
You are a unique individual. And as such, you have so much to offer as
a properly trained surgical assistant. You have to decide which model
of training would work best for you. If you want to get more details regarding
what a genuine model two program would look like, read more about the
ACE program on this website. Then, whether you choose our program or you
think another one might be better for you, you'll have a much clearer
and detailed picture to help you make an educated decision for your career
As always, I welcome your comments and suggestions on this blog. I really
want to hear from you and get a conversation going on this subject. You
can also feel free to call us at 888-920-0447 if you want to learn more
about our uniques model of training.
Are you interested in becoming a surgical assistant? Contact
ACE Surgical Assisting today to
request more information and to learn more about advancing your career.