Terrifying. Intimidating. Overwhelming. Whether you are an experienced first assistant, or you are entering the cardiac surgery OR for the first time, scrubbing with a surgeon you don’t know is often an unnerving experience. After many years of training PAs, and taking students to the OR, as well as hearing surgeons complain afterward, I feel like I’ve experienced it all. Some PAs immediately fly in the operating room, and some just can’t seem to get there. I’ve thought about why this is, and have tried to come up with a short list of things that I think always set a PA up for failure.