Eureka! Measuring Competency in Intravenous (IV) Cannulation by Paramedic Students
Timothy Howey, BA, NREMT-I; David Page, MS, NREMT-P

Introduction: Learning intravenous (IV) cannulation is an integral part of a paramedic student's education. Wilson (1991) proposed a graphical method of tracking motor learning in IV and endotracheal intubation skills. He proposed the moment of competence was achieved if a student averaged an IV success rate of 80% over 20 attempts.

Hypothesis: Paramedic students who achieve an average IV success rate of 80% over 20 attempts have achieved an IV skill competency point (CP) and will remain near an 80% IV success rate.

Methods: Between January 2001 and December 2003, paramedic students participating in FISDAP, a national computerized student tracking system, used a web page to prospectively report their clinical experiences. The student's preceptors also completed a paper evaluation. Instructors at each of the participating training programs then verified the data by comparing the computerized records to the paper evaluations.
Inclusion criteria consisted of student consent, successful graduation and instructor verification of student records.
IV graphs following the Wilson model, termed Eureka Graphs, were generated. Students with twenty additional attempts after the CP, termed CP+20, were analyzed.

Results: A total of 875 students met the criteria for inclusion in the study. Of these 53 graphs were found to have obvious data entry errors and were excluded. The remaining 822 (94%) student graphs were analyzed. Of these, 695 (85%) students achieved a CP. 559 (68%) completed 20 more IV attempts beyond the CP (CP+20). The average success rate for the CP+20 group was 81%. 330 (59%) of CP+20 students remained above an 80% success rate and 485 (87%) of CP+20 students remained above a 70% success rate.

Conclusion: Wilson's method of determining a moment of competency has been proven. IV Eureka graphs are an effective tool to objectively measure IV skill competency. More research is needed to determine if this model of measuring and graphing learning can be used with skills other than IV cannulation.