HealthcareSeptember 25, 20269 min read

CSFA Exam Content Outline 2026: Sections, Items, Traps

Every NBSTSA CSFA domain, how much of the paper it is, what its questions ask you to do and the order to study it in, straight from the NBSTSA outline.

  • 3Domains
  • 175Questions
  • 240 minTime
  • 55.3%Heaviest area
  • $350Exam fee
NBSTSA CSFA exam content outline 2026 with domain weights

Table of Contents

The outline at a glance

National Board of Surgical Technology and Surgical Assisting publishes the CSFA outline that every NBSTSA CSFA question is written against (the 2024 CSFA content outline, still current in 2026). This page turns that document into what you actually need before you study: how big each area is, what the questions in it ask you to do, and the order to learn it in.

3domains
  • Perioperative Care~83 questions55.3%
  • Advanced Science~46 questions30.7%
  • Ancillary Duties~21 questions14%
150 scored items in 3 domains and 8 sub-areas: Perioperative Care 83 (Preop 8, Intraop 67, Postop 8), Ancillary Duties 21 (Administrative and Personnel 6, Equipment 15), Advanced Science 46 (Anatomy and Physiology 36, Microbiology 5, Pharmacology and Anesthesia 5). Weights are item counts / 150; NBSTSA's CSFA certification page rounds them to 55%, 14% and 31% and labels the third domain 'Basic Science', while the outline PDF calls it 'Advanced Science'. Plus 25 unscored pretest items spread randomly through the exam. CSFA vs CST: the CST is NBSTSA's entry-level surgical technologist credential (eligibility through a CAAHEP- or ABHES-accredited surgical technology program; exam fee $230 AST member / $340 non-member; renewal 30 CE credits every 2 years). The CSFA is the separate first-assistant credential: it requires a CAAHEP-accredited surgical first assistant program, has a first-assistant blueprint weighted toward intraoperative exposure, hemostasis and closure, costs $240/$350, and renews with 38 CE credits (8 live) every 2 years. Holding a CST does not by itself make you eligible for the CSFA.

What each domain actually asks

The official outline describes what each area covers. Below is what the questions in it ask you to do, which is what decides how you should study it.

Perioperative Care

55.3%~83 items

It asks you to: The dominant domain (83 of 150 scored items, 67 of them intraoperative). Questions put you at the table: which hemostasis method fits a bleeding vessel, how to retract or expose a structure without iatrogenic injury, which incision or position suits a named procedure, which closure technique or suture fits the tissue, and what to do when you see a sterile-field break.

  • Preoperative Preparation (8 items): chart review (H&P, labs, allergies), verifying surgical consent, confirming grafts and implants are available, choosing positioning devices and suture
  • Preoperative Preparation: patient positioning (supine, prone, lateral, lithotomy) with attention to pressure points, circulation and nerve injury; safety strap, antiembolic devices, return electrode pad, pneumatic tourniquet, Foley insertion
  • Preoperative Preparation: skin prep, surgical scrub, gowning and gloving (open and closed), draping, methods of operative exposure, active participation in the Time Out
  • Intraoperative Procedures (67 items): tissue handling and Halsted's principles, traction/countertraction, dissection techniques, providing visualization (retraction, sponging, suction, irrigation)
  • Intraoperative Procedures: temporary hemostasis (tourniquets, vessel loops, non-crushing clamps, digital pressure) and permanent hemostasis (clamping, cautery, ligating, clips, local hemostatic agents)
  • Intraoperative Procedures: trocar insertion under direct visualization, minimally invasive and robotic cases, stapling devices, graft preparation, injecting local anesthetic
  • Intraoperative Procedures: wound closure of tissue planes (suturing techniques, skin staples), drains and catheters, specimen handling, counts, corrective action for a break in sterile technique
  • Postoperative Procedures (8 items): wound dressings, negative pressure wound therapy, splints/casts and immobilization devices, suture/staple removal, patient safety during emergence from anesthesia

Advanced Science

30.7%~46 items

It asks you to: Mostly anatomy in surgical context (36 items): which structure lies next to the operative field, what a disease or fracture changes about the approach, and which vessel or nerve is at risk. The smaller micro and pharmacology slices ask about wound classes and healing, drug actions such as a preoperative anticholinergic, and dose or volume calculations at the field.

  • Advanced Anatomy and Physiology (36 items): pathophysiology and histology applied to tissue handling for abnormal anatomy (GI, GU, neuro, cardiothoracic, congenital defects)
  • Advanced Anatomy and Physiology: disease processes (GI, GU, cardiovascular, respiratory, endocrine), fractures (hip, shoulder, wrist, ankle, pelvis/spine), malignancies and metastatic disease
  • Advanced Principles of Microbiology (5 items): Standard Precautions, classification and pathogenesis, factors affecting wound healing, infection control and aseptic technique
  • Surgical Pharmacology and Anesthesia (5 items): handling and administering agents, recognizing drug reactions and interactions, assisting anesthesia providers, verifying, calculating and mixing medications and solutions at the sterile field

Ancillary Duties

14%~21 items

It asks you to: Questions test the non-cutting parts of the job: identifying the correct legal term for a situation (tort, negligence, consent issues), the right response to an OR fire or cardiac arrest, and how a given energy device or piece of power equipment works, is set up, or fails.

  • Administrative and Personnel (6 items): acting as technical expert for the team, communicating patient-specific considerations, interpersonal skills and group dynamics
  • Administrative and Personnel: ethical and legal practice in surgical patient care, culturally competent care
  • Administrative and Personnel: resuscitation during cardiac arrest or other life-threatening events, All Hazards emergency protocols, recognizing hazards (lasers, radiation, fire, chemical spill, surgical plume)
  • Equipment Sterilization and Maintenance (15 items; labelled 'Equipment Operation' in the handbook item table): electrosurgery units (monopolar, bipolar, vessel sealing), endoscopic equipment, positioning/stabilizing equipment, Doppler, dermatome and mesher, robotics, power drills and saws

Study it in this order

Weight is the only honest guide to where your hours go. The areas that make up the first half of the paper are core; the next third is support; whatever is left is a quick win you review last, not skip.

DomainWeightItemsPriority
Perioperative Care55.3%~83Core
Advanced Science30.7%~46Support
Ancillary Duties14%~21Quick win

Item counts are the weight applied to 150 scored questions and rounded, so treat them as approximate.

How the exam is built

ItemDetail
Questions175
Scored questions150
Unscored pretest items25
Time240 minutes
Question typesM, u, l, t, i, p, l, e, , c, h, o, i, c, e, , (, o, n, e, , b, e, s, t, , a, n, s, w, e, r, )
DeliveryComputer-based at PSI testing centers nationwide, by appointment Monday-Saturday (9 a.m. and 1:30 p.m. sessions); students can also test on campus through their program (web-based testing, WBT). A military base education center can give a web-based exam if the post is more than 100 miles from a test center. NBSTSA does not list live remote proctoring for the CSFA.
Passing standardCriterion-referenced raw cut score set by NBSTSA standard setting: you pass by answering 99 of the 150 scored questions correctly (about 66%), per the NBSTSA CSFA certification page. Pretest items do not count.
Fee$350 — $240 for AST members, $350 for non-members (NBSTSA CSFA application page and FAQ, checked September 2026; same as the 2025 Candidate Handbook). You must be an active AST member when you apply to get the member rate. The $60 application processing fee inside that price is non-refundable, and the exam fee is non-refundable once your Authorization to Test (ATT) is issued. Optional rush processing is $85 (3-5 business days instead of 2-4 weeks).
RetakesNo waiting period: you can reapply right away after a failed attempt, but you are limited to 3 attempts per calendar year. Each attempt needs a new application and the full testing fee (processing plus exam).

Where candidates lose marks

These are the places the outline and the real exam part ways, the parts of the outline candidates misjudge most often:

  1. Intraoperative Procedures alone accounts for 67 of the 150 scored items, which is more than every other sub-area except anatomy combined. Candidates who spread their study evenly across the outline underprepare for exposure, hemostasis, dissection, trocar placement, stapling and closure scenarios.
  2. Advanced Anatomy and Physiology is 36 items, and it is applied rather than textbook anatomy. Expect questions about which structure is at risk during a named procedure, how a fracture, tumor or congenital defect changes the approach, and which incision fits which operation. For example, a right subcostal incision is used for an open cholecystectomy.
  3. Temporary and permanent hemostasis are listed as separate tasks. Know when a tourniquet, vessel loop, non-crushing clamp or digital pressure is the right temporary choice, and when clamping, ligating, clips, cautery or a local hemostatic agent is the right permanent one, including tourniquet contraindications.
  4. Ancillary Duties (21 items) includes legal terminology and equipment. NBSTSA's own sample questions ask you to identify a tort. The 15 equipment items cover monopolar vs bipolar vs vessel-sealing energy, dermatomes and meshers, Doppler, robotics and power equipment, which CST-trained candidates may think they already know.
  5. Pace for 175 questions in 240 minutes, about 82 seconds each. Breaks come out of your time, and NBSTSA says you cannot return to a question after you leave it for a break. The 25 unscored pretest items are mixed in and cannot be identified, so answer every question as if it counts.

Turn the outline into practice

ExamCert AI has 1,188 CSFA practice questions with explanations, built around the same outline this page walks through. Work them by domain, find the weak area, and fix it before test day.

Practise CSFA on ExamCert AIHow to Become a Surgical First Assistant in 2026

FAQ

How many questions are on the CSFA exam?

The CSFA exam has 175 multiple-choice questions, and you have 4 hours to finish. Of these, 150 are scored and 25 are unscored pretest items mixed randomly through the test. The scored items are split into Perioperative Care (83), Ancillary Duties (21) and Advanced Science (46).

What score do you need to pass the CSFA?

According to the NBSTSA CSFA certification page, you pass by answering 99 of the 150 scored questions correctly, which is about 66%. NBSTSA sets this cut score through a standard-setting study with subject matter experts after each job analysis, and it is not curved against other candidates.

Which part of the CSFA content outline is largest?

Perioperative Care is 83 of the 150 scored items, and Intraoperative Procedures makes up 67 of them. That sub-area covers tissue handling, exposure, dissection, hemostasis, minimally invasive and robotic assisting, and wound closure. Advanced Anatomy and Physiology is the next biggest sub-area, with 36 items.

How is the CSFA exam different from the CST exam?

The CST certifies entry-level surgical technologists, who mainly work in the scrub role. The CSFA certifies first assistants, who provide exposure, hemostasis and closure alongside the surgeon. The CSFA outline puts much more weight on intraoperative assisting and advanced anatomy, and it requires graduation from a CAAHEP-accredited surgical first assistant program rather than a surgical technology program. The CSFA also costs more ($240/$350 vs $230/$340) and requires more CE (38 vs 30 credits every 2 years).

Sources

Figures on this page come from NBSTSA and the other primary sources below:

Checked September 25, 2026. Fees, outlines and eligibility rules change — confirm with NBSTSA before you book.