In this paper, we describe how usability provides the indexical ground upon which design work in a surgery is achieved. Indexical and deictic referential practices are used 1) to constitute participation frameworks and work sites in an instructional surgery and 2) to encode and manage participants’ differential access to the relevancies and background knowledge required for the achievement of a successful surgical outcome. As a site for both learning and work, the operating room afforded us the opportunity to examine how usability, which is a critical design consideration, can be used as a resource for learning in interaction. In our detailed analysis of the interaction among participants (both co-present and projected) we sought to describe a particular case of how usability was produced as a relevant consideration for surgical education in the operating room. In doing so, we demonstrate a set of members’ methods by which actors worked to establish and provide for the relevance of the anticipated needs of projected users as part of developing an understanding of their current activity.