The surgeon and assistants do not have a predetermined strategy to address intraoperative movements and communication.

Prior to beginning any procedure, the surgeon should address what is expected of the assistant. This is particularly important for transient assistants (e.g., medical student on a 1-week rotation). It should be specified whether verbal or nonverbal intraoperative communication is preferred. If unsure, assistants should seek clarification of what tasks will be expected of them. Surgeons should actively direct their assistants.

Novice assistants are thrust into a procedure without orientation (especially salient for academic centers with high turnover of rotators and trainees).

Clearly define the role of the assistant and assess his/her comfort level with assisting prior to entering the room.

Provide written instructions on surgical-assisting preferences (i.e., how to cut sutures, appropriate amount of small talk with patients, and sterile technique).