If you’ve spent time in the operating room and want to be more involved in the procedure itself, the surgical first assistant role may be your next step. The Certified Surgical First Assistant (CSFA)® credential from the National Board of Surgical Technology and Surgical Assisting (NBSTSA) shows employers and surgeons that you’ve completed accredited training and met a national standard for assisting at the table.

In this guide, we’ll cover who the exam is for, the official eligibility requirements and fees, how long to study, the career and salary picture, how to maintain the credential, and which next steps make sense.

Who Should Take the NBSTSA CSFA Exam?

The CSFA is designed for people who provide direct, hands-on surgical assistance: exposure, retraction, suction, hemostasis, tissue handling, and wound closure. It fits you well if you are:

  • A recent or upcoming graduate of a CAAHEP-accredited surgical first assistant program. This is the main eligibility route, and many graduates test soon after finishing their program while the material is fresh.
  • A Certified Surgical Technologist (CST) moving into first assisting. Many first assistants start in the scrub role and build on that foundation with formal first assistant training.
  • A surgical assistant whose employer or state expects national certification. Hospitals and surgical groups often list certification in job postings, and some states, such as Texas, regulate surgical assistants.
  • A former CSFA whose credential lapsed. Current or previously certified CSFAs are eligible to sit for the exam.

The exam may not be the right move yet if you haven’t completed an accredited surgical first assistant program. On-the-job training alone doesn’t qualify you for the CSFA, even if you already assist in surgery.

What Are the NBSTSA CSFA Eligibility Requirements?

According to the CSFA Candidate Handbook (2025) and the NBSTSA eligibility page, you qualify through one of two routes:

  1. Program graduate: You graduated from a surgical first assistant program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). You’ll submit a copy of your diploma, a transcript, or a signed, notarized letter from your program director showing your graduation date and degree type.
  2. Current or previous CSFA: You provide evidence of your CSFA certification.

Students testing on campus before graduation must send proof of graduation to NBSTSA within 60 days of the exam date before their results are released. NBSTSA retains sole authority over eligibility decisions and doesn’t refund processing fees for ineligible applicants, so check your documents carefully before you apply.

How Do You Apply, and What Does It Cost?

You apply through NBSTSA’s CSFA application page, and testing is available year-round. Per the 2025 handbook, the exam fee is $240 for Association of Surgical Technologists (AST) members and $350 for non-members.

Once approved, you schedule with PSI, and you get one free reschedule if you request it at least 48 hours before your appointment. If you don’t pass, you can retest up to three times per calendar year with no waiting period, paying the full fee each time.

How Long Should You Study for the NBSTSA CSFA Exam?

Most candidates do well with 8 to 12 weeks of consistent study. That’s our guidance, not an NBSTSA requirement. Recent graduates who just finished clinical rotations can often do well with the shorter end. Plan closer to 12 weeks, or longer, if you’ve been out of school for a while, if your clinical experience was concentrated in one or two specialties, or if anatomy and pathophysiology feel rusty.

Here is a sample 10-week plan weighted to the outline:

  • Week 1: Take a mixed baseline, read the content outline line by line, and download NBSTSA’s free CSFA Study Evaluation.
  • Weeks 2–4: Intraoperative Procedures (67 items). Work through hemostasis methods, dissection and tissue handling, stapling devices, minimally invasive and robotic assisting, drains, and suturing and closure techniques.
  • Weeks 5–7: Advanced Anatomy and Physiology (36 items). Go system by system and pair each system with its common procedures, structures at risk, fractures, and malignancies.
  • Week 8: Equipment Sterilization and Maintenance (15 items), especially electrosurgery, power equipment, dermatomes, and robotics.
  • Week 9: Preoperative and Postoperative Procedures, Administrative and Personnel, Microbiology, and Pharmacology (32 items combined). Drill positioning, prep, dressings, wound healing, and dosage calculations.
  • Week 10: Timed mixed sets, a full-length practice exam, and targeted review of your most-missed topics.

For experienced surgical assistants: Your intraoperative instincts may be strong, but the exam asks for textbook answers, and it tests specialties you may not see often. Spend more time on Advanced Science and on procedures outside your usual service line.

For recent graduates: Your book knowledge is fresh. Focus on applying it to scenarios, which is where the exam separates candidates.

What Careers Can the CSFA Support?

The CSFA targets the surgical assistant role. Common job titles include surgical first assistant, surgical assistant, and first assist. Settings include hospital operating rooms, ambulatory surgery centers, and surgeon practices. Some assistants work for a hospital or surgical group, while others are self-employed or contract with surgeons. Specialty paths such as cardiovascular (including vein harvesting), orthopedics, neurosurgery, and robotic surgery are common as assistants gain experience.

The U.S. Bureau of Labor Statistics (BLS) reports that surgical assistants held about 24,400 jobs in 2025. The largest employers were hospitals (38%), dental offices (25%), physician offices (16%), and self-employment (8%).

What Is the Salary for a Certified Surgical First Assistant?

According to the BLS Occupational Outlook Handbook for surgical assistants and technologists, the median annual wage for surgical assistants was $66,800 in May 2025, compared with $64,650 for surgical technologists. BLS projects employment of surgical assistants and technologists combined to grow 5% from 2025 to 2035, faster than the average for all occupations, with about 8,600 openings each year.

The BLS doesn’t report pay by certification, so the CSFA itself doesn’t guarantee a specific salary. Pay varies with region, specialty, call responsibilities, experience, and whether you’re employed or independent.

How Do You Maintain the CSFA Credential?

The CSFA renews every two years. Under AST’s continuing education policies for the two-year cycle, CSFAs must earn 38 CE credits, at least 8 of them live. BLS, ACLS, and PALS courses are accepted for CE credit. You submit your credits to AST first, then complete NBSTSA’s renewal application, and NBSTSA recommends submitting CE credits 60 days before your expiration date. You can also recertify by exam. Current fees and steps are on the NBSTSA renewals page.

What Certifications Stack Well With the CSFA?

The best next credential depends on where you want your career to go:

  • Certified Surgical Technologist (CST)®: If you entered first assisting from another path, the CST from NBSTSA rounds out your scrub-role credentials and can make you more flexible for staffing.
  • Advanced Cardiovascular Life Support (ACLS): The outline includes assisting in resuscitation; many employers expect it for surgical staff, and it counts toward CE credits.
  • State licensure or registration: If you work in a state that regulates surgical assistants, meeting that requirement is often the most important next step.
  • Physician assistant (PA) education: Some first assistants who want a broader scope, including prescribing and independent patient management, go on to PA programs and the PA-C credential.
  • Educator roles: Experienced CSFAs often teach in surgical technology or surgical first assistant programs, where a bachelor’s or master’s degree strengthens your application.

Start Preparing for the NBSTSA CSFA Exam With Pocket Prep

Pocket Prep’s NBSTSA CSFA practice questions include 750 questions with detailed explanations and a full-length 175-question mock exam, so you can study in short sessions between cases and still build toward test day. A Quick 10 quiz fits into a lunch break, and study reminders help you maintain a steady streak over your 8 to 12 weeks. Your next role at the table is within reach.