As the role and profession of the non-physician Surgical First Assistant continues to evolve, the educational standards for entry into the field are becoming much more defined than in times past. With the establishment of formal accredited Surgical First Assistant programs, the publishing of standards and guidelines for such institutions, and the development of legislation in many parts of the country, the profession has seen many positive changes. The current standards for certification and practice vary slightly amongst the major certifying bodies for the Surgical First Assistant, however the philosophy regarding the standard of care as it relates to the surgical patient is universal throughout these different agencies. Each believe that national certification for the non-physician Surgical First Assistant is vital to the effective, safe, and quality care of the surgical patient. The National Board of Surgical Technology and Surgical Assisting, the National Surgical Assistant Association, and the American Board of Surgical Assistants each have established criteria which must be met by each candidate wishing to sit for a specific professional certification credential. Meeting these criteria and becoming certified will enable Surgical First Assistants to practice in the field and fulfill professional, legislative, facility, and/or employer guidelines. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) has established and published guidelines for the profession of Surgical First Assisting. Programs which meet these criteria are able to be reviewed and obtain accreditation through CAAHEP, which is the premier accreditation body for allied health education programs. Currently, there are 10 schools in the United States which offer CAAHEP accredited Surgical First Assistant training programs. These programs typically last between 12 and 24 months and lead to a Certificate of Completion. A list of these programs can be viewed at http://www.caahep.org/Find-An-Accredited-Program/. In addition, the Association of Surgical Technologists has published the Core Curriculum for Surgical Assisting, which must be followed by accredited programs in order to assure consistency in education throughout the nation. Although formal programs for Surgical First Assisting currently lead to a Certificate of Completion, the Association of Surgical Technologists and the Association of Surgical Assistants have both adopted the bachelor’s degree in a field related to Surgical Technology as the preferred entry level educational model to begin a career as a Surgical First Assistant. However, the bachelor’s degree is not a requirement for certification, nor is it a requirement for many entry level positions.

Below are each of the requirements for certification and entry into the field of Surgical First Assisting as they pertain to each of the three major certifying bodies:

National Board of Surgical Technology and Surgical Assisting (NBSTSA)

Certified Surgical First Assistant (CSFA, formerly, CFA); two educational options for certification:

1. Clinical preceptor route - Current Certified Surgical Technologist with at least 350 surgical cases performed in the role of the Surgical First Assistant with two full years Surgical First Assistant experience within the last four years, evidence of current CST certification, and two notarized Experience Verification Forms from two surgeons or surgical supervisors documenting at least 350 cases and two full years of First Assistant experience during the last four years.
2. Formal training program route - A graduate from a CAAHEP accredited Surgical First Assistant program.

*See http://www.nbstsa.org/certifyingexam/eligibility.html for more information.

National Surgical Assistant Association (NSAA)

Certified Surgical Assistant (CSA); three educational options for certification:

1. Graduate from a NSAA approved Surgical Assistant training program (includes CAAHEP accredited programs and facility based programs approved by NSAA).
2. Medical Graduates and Allied Health Professionals can become eligible by meeting one of the following:

Medical Doctor/Doctor of Osteopathy/Foreign Medical Graduate:

Documentation required:

• NSAA Membership/Certification Application
• One letter of recommendation from a surgeon
• Copies of documents of training as a surgeon or documentation of surgical rotation for at least 2,250 hours of first assisting
• For FMG only – must either provide a copy of an English Equivalency Exam, or request a waiver of that exam with full knowledge that the Certification Examination is given in English

RN/PA/CFA/SA-C/OPA-C:

Documentation required:

• NSAA Membership/Certification Application
• Both NSAA affidavits – signed and notarized
• Three (3) letters of recommendation from surgeons the individual has assisted
• One (1) year of case logs showing the candidate's name as the assistant, as well as the type of surgeries performed
• Copy of current certification and/or license (must have held certification or licensure for the past 3 years and have a total of 2,250 hours of First Assistant experience)

3. US Military Trained

Documentation required:

• NSAA Membership/Certification Application
• One letter of recommendation from a surgeon the individual has assisted within the last three years
• Copy of DD214 or Certificate/Diploma from a military training program that had emphasis on surgical assisting
• 6 months to 1 year case log within the past 3 years

*See http://www.nsaa.net/membership.shtml for more information.

American Board of Surgical Assistants (ABSA)

Surgical Assistant-Certified (SA-C); two educational options for certification.

Note: these are the most current standards, and will not take effect until January 1, 2011 (Please click here for 2009-2010 standards):

1. Hold a medical degree from a medical school listed in the International Medical Education Directory (IMED), with the following documentation:

• Certified copy of medical school completion
  
• Certified copy of advanced or residency training
  
• Documentation of successful TOEFL exam or equivalent exam and/or coursework documenting English proficiency
  
• Copy of Curriculum Vitae (resume)
  
• If TOEFL: Internet-Based Total = 88-89 or greater, Computer-Based Total = 230 or greater, Paper-Based Total = 570-573 or greater

*The above-required items must document a minimum of two years primary or advanced surgical experience.

1. Documentation of successful completion of an ABSA approved formal Surgical Assistant training program and documentation of successful completion of an associate degree program or higher. Associate degree/college transcripts must document successful completion of all of the following college-level courses with a passing grade of "C" or better:

• 1 year, English Composition or Technical Writing (English Literature is not acceptable)
  
• 1 year, Human Anatomy & Physiology
  
• 1 semester, General Biology
  
• 1 semester, Microbiology
  
• 1 semester, Pathophysiology
  
• 1 semester, Pharmacology
  
• 1 semester, Verbal Communication course or equivalent
  
• 1 semester, College Algebra or higher

*see http://www.absa.net/2011_exam_prerequisites.htm for more information.

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