assisting isn't rocket science. it's not difficult. you basically need to give the surgeon exposure. if you can't do this, then just do what he tells you. that's all.
having said this, to work with a good assistant is amazing. a good assistant can predict what is going to happen next and get everything lined up so it all just goes that much easier.
as a student i assisted quite a bit. as a junior doctor i assisted a fair amount. as a registrar i assisted after hours for extra money. i can assist and therefore i can direct and teach a poor assistant. in fact, for me the ideal assistant is an inexperienced one that i can train and develop to my specifications. but i also use young doctors because they are the ones that need the money. they are the ones that work for the state and are underpaid. i remember how i needed money in those days and therefore i usually use these doctors. the practice that i work for has occasionally basically requested that i use the older gps but i feel a certain obligation to the state doctors.
but, especially when i am trying to favour those who need the money, nothing irritates me more than having to phone a whole bunch of people before i get an assistant. i mean when someone says they are on call or out of town, then i have no problem, but when they say they are tired or have a headache or need their beauty sleep or whatever they tend to fall to the bottom of the list of people i call. i recently was told by one of my assistants that another guy was wondering why i phone him so seldom. i didn't say anything, but i thought of all the times i did call him and he wasn't available because of 'social obligations'. it's at times like this that i realize i can be a typical surgeon. i don't want to know about inconvenience and the like. i just want an available assistant at midnight when i have a gunshot abdomen who is decompensating.
i recently lost two great assistants (they moved to canada where they are presently freezing). so now i am trying to reestablish an assistant base.
but it can be difficult to assist (unless it is your passion). no matter the time of day or night and no matter how little sleep you've had in the last week, when you are operating, all your senses are sharp. you are fully alert. you are fully alive. but to simply hang on a retractor at 3 in the morning while the surgeon works his magic can be mind numbing. and mind numbing when fatigued means sleep and sleep means poor assisting.
except the exceptions. many years ago while i was a medical officer in surgery (before i officially started specializing) we had a house doctor who had a special talent. awake he wasn't a particularly good assistant but in the early hours, he would hook the morris into the wound, push his feet up against the table, throw his head back and fall asleep. in this position he gave such good exposure the surgeon would demand total silence just in case someone woke him up.