ing programs are evident in preventive medi- cine (Lane et al., 1995), nursing (American Association of Occupational Health Nurses, 2007), and among pediatricians and other healthcare professionals (Etzel et al., 2003). This article proposes performance indicators to correspond with the 12 children’s environ- mental health competencies developed by Del Rio et al. (2023). Methods for the Development of Performance Indicators Performance indicators play a crucial role in articulating what trainees should know or be able to do to support the achievement of com- petencies and to ensure the transferability of such knowledge and abilities to on-the-job performance (Lane & Ross, 1998). Moreover, these indicators serve as an eective means to organize milestones and delineate assess- ments of competency attainment for both trainees and preceptors (Lane & Ross, 1998). The performance indicators presented here represent various learning skills—including knowledge, comprehension, and applica- tion—that correspond to the 12 children’s environmental health competencies (Del Rio et al., 2023). Provided as examples, these per- formance indicators are not meant to be com- prehensive or exhaustive. The performance indicators encompass a diverse array of steps and skills that collectively demonstrate a learner’s competence. For each competency, 3–10 performance indicators were developed. This flexibility allows educators and learners to choose the indicators most relevant to their specific assessment needs, ensuring a tailored approach to assess readiness. The performance indicators were collab- oratively developed by six members from the work group with input gathered from a broader community of experts in children’s environmental health. In February 2023, the co-leaders of the work group initiated the cre- ation of the first set of performance indicators. This initial set underwent a thorough review process within the work group that involved three rounds of iterative improvements before being presented to the larger Children’s Envi- ronmental Health Committee for evaluation. The updated performance indicators were given to all 213 current members of the Chil- dren’s Environmental Health Committee 10 days prior to presenting the indicators at the scheduled May 2023 monthly committee
meeting. A total of 14 members attended the meeting, and feedback on the indicators was collected through various channels including email, video conferences, and discussion for 3 days following the meeting. Subsequently, this feedback was consolidated into a single document that underwent a meticulous review process by the work group during two additional meetings to address and incorpo- rate the received input. The review conducted by the Children’s Environmental Health Committee recom- mended several key enhancements to the organization of the performance indicators within each competency. Specifically, it was suggested to align these indicators with the ordered knowledge or skills as outlined within the respective competency. Furthermore, the committee advised aligning the performance indicators with learning levels following the guidelines and terminology set forth by Bloom’s Taxonomy of Learning (Anderson, 2001; Bloom, 1956). This well-established pedagogical framework encompasses three distinctive learning domains: cognitive, aec- tive, and psychomotor. The framework also encompasses hierarchically structured learn- ing objectives, from foundational knowledge to comprehension, ultimately fostering higher- order evaluation and creativity. Additionally, the committee provided valu- able insight regarding the need for clarity in defining the scope of children’s health. Their insight emphasized the inclusion of both physical and mental health eects and consid- ered the integration of additional performance indicators to address environmental disasters and emergencies (e.g., wildfires, community- wide chemical spills, extreme weather). All the feedback contributed by the committee was diligently compiled and thoughtfully consid- ered during the revision process. In addition to the valuable input received from the committee, the work group integrated recommendations drawn from other compe- tency-based training programs for physicians. These recommendations encompassed vari- ous strategies aimed at enhancing the clarity and relevance of performance indicators with a focus on ensuring their enduring under- standing beyond transient buzzwords (Lane & Ross, 1998). Among these recommendations, the use of straightforward and inclusive lan- guage was emphasized to maintain compre- hension of the indicators over time.
Furthermore, as in the competency-based training programs for physicians, concise introductory statements clearly stating what the performance indicators address in the corresponding competency areas were incor- porated (Lane & Ross, 1998; Lane et al., 1995). Additionally, the work group sought to dierentiate between indicators related to knowledge base expectations and indicators pertaining to abilities (Lane et al., 1995). The work group also considered the alignment of performance indicators with the five overarch- ing categories of public health services con- cerning child health, as identified by APHA (2019). These categories include “informing the public, surveillance and diagnosis, train- ing and technical assistance, policy develop- ment and enforcement, and linking to needed services.” Lastly, the term “stakeholders” in competency #2 was changed to “community members” to align with preferred terms for working partners and community collabora- tors suggested by CDC (2022). The updated set of performance indicators underwent two additional rounds of review and refinement by the work group. This work culminated in the final list of performance indicators for the 12 children’s environmen- tal health competencies in September 2023 (Table 1). Discussion The proposed performance indicators align with the critical competencies in children’s environmental health and are examples of evidence that can be used as a basis for monitoring achievement of each compe- tency. These indicators are not meant to be comprehensive—they are meant to serve as examples to guide performance assessments for students, trainees, educators, and pre- ceptors. The competencies, along with their corresponding performance indicators, are intended to assist with: • structuring field assignments, • achieving consensus for the expectations of trainees and preceptors, •providing opportunities for learners to assess their own needs or gaps in training, • showcasing the expertise of children’s envi- ronmental health specialists to potential employers, and • identifying potential resources and fund- ing sources for supporting the field (Lane et al., 1995).
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June 2024 • Journal of Environmental Health
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