The process behind the CST® and CSFA® credentials is conducted by independent experts, validated by thousands of practicing surgical technologists, and reviewed by an external accrediting body. The full methodology is documented in NBSTSA’s publicly available CST Standard Setting Report and Job Analysis Summary.
Built from practice, not theory
NBSTSA contracts with PSI Services LLC, an independent exam development vendor, to conduct a formal job task analysis every five to seven years. A committee of subject matter experts representing varied experience levels, specialties, and geographic locations identifies the tasks, knowledge, and skills required to perform the role safely. Those findings are then sent as a validation survey to the full certified population. In the most recent cycle, 66,965 certified surgical technologists were surveyed across all 50 states, and nearly 3,000 completed responses were analyzed. Tasks are scored on both importance and frequency; only those meeting a defined criticality threshold make it into the exam.
A 150-item exam weighted toward application
The CST® exam contains 150 items across three competency areas: Perioperative Care (65%), Ancillary Duties (15%), and Basic Science (20%). Seventy-one percent of Perioperative Care items — the largest domain — require application of knowledge rather than recall. A surgical technologist cannot simply know what aseptic technique is. They must be able to apply it correctly under real conditions.