Assist Like A Pro – Part 2

Unlock the GOOD GREAT ASSIST Mindset

 

How Great Assistants Maintain Harmony In A Surgery

Surgical assisting isn’t just about showing up and doing the job. It’s about being in sync with the surgical team and making the operation flow effortlessly.

In Part I, we tackled the GOOD in GOOD ASSIST. Now, it’s time to focus on ASSIST – the action steps that turn you into the Surgical Assistant every surgeon dreams of having by their side.

Think of surgery like a beautifully orchestrated symphony. Each member of the team is a musician, with the surgeon as the conductor. Your job as the surgical first assistant is to anticipate every note, harmonize seamlessly, and keep the performance smooth and uninterrupted.

Let’s explore how to make your ASSIST skills as polished as a world-class musician’s:

Anticipate

Switching Hands

Smooth Surgery Assist

Ink About It

Stick With What You Know

Till You Master It Practice

“Anticipate” – See the Next Note Before It’s Played

The best assistants don’t just react to the surgeon; they intuitively move with the rhythm of the procedure. They transition smoothly to the next note because they know it’s coming. A great surgical first assistant also knows what’s coming and they stay at least two steps ahead of the surgeon to ensure every transition is smooth and effortless.

If you find yourself constantly reacting instead of anticipating, it can feel like you’re always scrambling. You’re playing catch-up instead of orchestrating the flow of the case. Every hesitation, every delay, disrupts the harmony of the procedure.

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How to Master Anticipation:
  • Know the score – Proactive: Study each procedure from the same books surgeons use to learn the procedure so you can predict what’s coming next. Case prep is key.
  • Read the conductor – Reactive: You do also need to react. Pay attention to subtle surgeon cues (hand movements and focus shifts) to react in a timely and smooth manner.

“Switching Hands” – Play with Both Hands, Not Just One

Imagine a pianist trying to play a concerto with one hand tied behind their back. The result? A clunky, incomplete performance. In surgery, relying exclusively on your dominant hand slows you down, limits your precision, and increases the difficulty of your performance. The best assistants are ambidextrous, seamlessly using whichever hand provides the best result without breaking the rhythm.

For example, if you are holding a retractor with your right  hand (dominant) and need to cut suture, but you aren’t comfortable cutting with your left hand, you might switch hands unnecessarily. This extra step slows you down, makes your movements less efficient, and diminishes your expert presence.

In the ACE Surgical Assisting Program, we teach students the science of how to cut suture with their left hand just as effectively as with their right.

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How to Get It Right:
  • Train both hands like a concert pianist – The best surgical first assistants get there by practicing with  both hands until there is no weak side.
  • Break the habit of unnecessary hand-switching – Choose the hand that is best for the situation, not just the one that feels more comfortable.
  • Rehearse in low-pressure settings – Practice with your less dominant hand before you’re in the OR, so it feels natural when the time comes.

“Smooth Surgery Assist” – Keep the OR Flowing Like a Perfect Melody

Early in my assisting career, a surgeon turned to me and said, “You know what I like about you, Dan?”

If you know me, you can probably guess where my mind went. In that split second, I was already imagining the next words: “Dan, your skills are better than most surgeons I’ve ever worked with!”

Nope… Instead, he said, “You stay out of my way.”

I wasn’t sure if it was even a compliment… but I soon realized it was one of the highest forms of praise an assistant can receive. Staying out of the way didn’t mean standing idly by – it meant executing every task seamlessly, without disrupting the rhythm of the surgery. You and the surgeon work harmoniously and simultaneously together without getting in each other’s way.

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How to Glide Through Surgery Like a Pro:
  • Assist everyone, not just the surgeon – The best assistants help the scrub tech, circulator, and anesthesia so the whole team works together.
  • Move with the rhythm of the procedure – Anticipate the next step instead of waiting for instructions.
  • Be invisible but essential – A flawless performance means everything flows without unnecessary distractions.

“Ink About It” – Keep a Surgical Journal

Musicians don’t just practice – they take notes on their performances, reviewing what worked and what needs improvement. You should do the same in surgery. Keeping a surgical journal helps you refine your skills, track patterns, and remember surgeon preferences.

Good case prep helps with this. After studying the procedure, any deviation a surgeon makes from your research will stand out, so write it down. Refer back to your journal the next time you assist that surgeon and you’ll perform as though you’ve worked with them for years – even if it’s just your second time.

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How to Make It a Habit:
  • Write down technique variations – Each surgeon has their own preferences. Record their differences so you’re always prepared.
  • Review before surgery – Reviewing your notes before a case makes you look like a pro with a perfect memory. You look like you really care, which your surgeon feels is a rare commodity.
  • Log mistakes made and lessons learned – Just like elite musicians analyze past performances, track your progress to keep improving.

“Stick With What You Know” – Confidence Over Guesswork

Imagine your surgeon just asked you to perform a task you’ve never been trained to do. Your heart races – should you just wing it and hope for the best? Absolutely not! In surgery, “fake it till you make it” is a terrible strategy. Guesswork leads to mistakes, and mistakes can have serious consequences. Even if you’ve seen the procedure thousands of times, mere observation doesn’t give you the insights and nuances that make for a successful procedure and that help you avoid consequential mistakes.

Instead, take a professional and proactive (and diplomatic) approach. Simply say, “I’ve never done that before. But I’d be happy to if you just teach me.” This shows confidence without overstepping your expertise. Most surgeons appreciate honesty and a willingness to learn.
Once the surgeon provides training, take it a step further – write down exactly what you were taught and have the surgeon sign it. Now, you have documentation of your training, which not only solidifies your learning but also serves as a record of your competencies moving forward.

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How to Keep It Safe & Smart:
  • Acknowledge your limits – Confidence is key, but never at the expense of patient safety.
  • Ask for training before attempting something new – Always request instruction before stepping outside your current skill set.
  • Document your training – Write down what the surgeon taught you and get their signature. This protects you, your patient, and reinforces your knowledge.
  • Use proven techniques over improvisation – Just like a musician follows the sheet music, stick to what you know works until you’re properly trained on something new.

A great Surgical Assistant doesn’t bluff their way through a procedure. They take every opportunity to learn the right way, document their training, and expand their skills safely.

“Till You Master It” – Keep Practicing Until It’s Second Nature

I was never a world-class musician. But as a teenager, I was an amateur magician, and through that experience, I learned something about mastering skills that I might never have understood otherwise.

Some magic tricks require no skill at all – just a bit of showmanship. But others demand extraordinary dexterity and precision. I’d practice relentlessly in my bedroom until I finally got it. And when I thought I had it down, I was eager to show it off.

That’s when reality hit me.

I’d step in front of an audience – my friends and family – ready to impress, and more often than not, I’d mess up. The pressure of performing for others unraveled my confidence. Sound familiar? This is exactly what you don’t want happening in the operating room.

Here’s the key lesson I discovered: Once you’ve got it… KEEP PRACTICING.

Many of you are fast learners. You pick up new surgical skills quickly, and once you feel comfortable, you’re ready to move on to the next challenge. But mastery doesn’t come from reaching “good enough.” The difference between a decent surgical assistant and a phenomenal one is what happens after they think they’ve learned a skill.

Mastery is about repetition, refinement, and pushing beyond comfort. It’s about training yourself so thoroughly that in high-pressure surgical situations, your skills activate instinctively. No hesitation. No second-guessing. Just seamless, confident execution.

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Why This Extra Practice Matters:
  • You’ll perform like a seasoned professional, even under extreme pressure.
  • Your surgical skills will become second nature – executed with precision and confidence.
  • You’ll develop muscle memory, eliminating unnecessary thinking and hesitation.

Think of this as leveling up your skills. You’re no longer practicing to get it. You’re literally practicing to master it. There’s a world of difference between competence and mastery, and this is where your time and effort should be invested.

How to Keep Mastering Your Craft:

  • Push beyond “good enough” – Keep practicing until your movements are fluid and automatic.
  • Train in downtime – Use simulation labs, practice at home, and refine efficiency and precision.
  • Seek feedback and apply it – The best surgical first assistants never stop refining their skills.
  • Consider retaking the ACE Surgical SkillLab – Mastery and expertise is built on the small, often overlooked and forgotten details. Revisiting the 6-day lab will reinforce and elevate your expertise and set you on the path of mastery like nothing else could.

Surgical assisting isn’t just about knowing techniques – it’s about embodying a mindset. GOOD ASSIST isn’t just an acronym; it’s the philosophy that separates the average from the elite.

Mastering these principles doesn’t just make you a better assistant – it makes you the kind of assistant every surgeon wants by their side.

So, here’s my challenge to you: Don’t settle for being good. Aim for mastery.

Keep practicing. Keep refining. Keep pushing forward. Your future self – the one standing confidently in the OR, seamlessly executing every movement – will thank you.