Step 5: Specify essential skills and knowledge

Learning interventions should be based on the essential skills and knowledge that learners must have to perform each major job task identified in Step 4. This breakdown of major job tasks into essential skills and knowledge provides the foundation for writing performance-based learning objectives.

Process

Use Tool #8 Essential Skills and Knowledge Worksheet to identify the essential training content.

1. For each major job task, ask:
   • "What does the health worker have to be able to do to perform the job task?" To answer this question, break down each major job task into steps and list them in the order they are performed based on up-to-date guidance. These step are the essential skills.
   • "What does the health worker have to know to perform the job task?" To answer this question, list what the health worker has to know to do the step. This is the essential knowledge.
   The answers to these questions are the skills and knowledge components of the job, and they make up the essential training content that should be included in the learning intervention.
2. Remove any skills or knowledge on the list if you cannot answer YES to these questions:
• "Does the health worker absolutely HAVE TO BE ABLE TO DO this to perform the job task to the established standard?"
• "Does the health worker absolutely HAVE TO KNOW this to perform the job task to the established standard?"
Be vigilant in eliminating content that is "nice to know" but not necessary. Vigilance in this step keeps the learning intervention focused on performance rather than becoming an overly general course, or "bloated" with content that is not essential.
3. When attitudes are important (e.g., non-discrimination toward persons living with HIV), list the behaviors, steps or skills that show the attitude. Attitudes or beliefs can often be written in the context of interpersonal skills or self-management skills but may have a knowledge component as well.
   
   If changing attitudes or increasing motivation is critical, additional interventions to address motivation, incentives or feedback may be necessary to bring about change.

Box 10: Sample behaviors and skills that demonstrate attitudes
Sample behaviors (These behaviors also include a knowledge component.)	Attitude
Ensures privacy and that the client is comfortably seated Encourages the client to indicate if she becomes too uncomfortable during the procedure	Positive attitude and interaction with clients
Appeals to a variety of preferences about learning Creates an accepting rather than defensive climate for learning	Training that encourages learning
Changes practices that let a person's HIV status become known (segregating clients, color coding records, etc.) Models respectful treatment of persons with HIV during all client care	Decreased stigma or discrimination against a particular group

4. Check the skills and knowledge with experts, one or two stakeholders and persons who have been trained in this job task. These persons may further reduce the content. However, they may also add missing content. ONLY add content if it is essential for performing the job tasks. When possible, it may be helpful to talk with persons who have participated in similar trainings to establish which skills and knowledge they are currently using. This can help determine what is essential and why (e.g., they are critical steps, frequently used, universally applicable).
   
   Avoid adding non-essential skills and knowledge. There is a tendency to add information that is not necessary. Keeping the learning intervention focused on essential skills and knowledge makes it clearer to the learners what they need to learn.
   
   The training content (skills and knowledge to do the job tasks) should be considered final when the tasks are completely described.

Helpful Hints

• Refer to current technical resources (e.g., training materials, service protocols and reference manuals, locally available resources and guidelines from standard-setting bodies such as the World Health Organization and professional organizations). If no up-to-date resources or standards exist, consider if they must be created and coordinate development of training with development of standards.
• During this process, be alert for problems in performance that may be related to other root causes, especially attitudes and motivation. While solving these problems may be beyond the immediate scope of the person in charge of developing the learning intervention, the chances of successfully improving performance are greater when all performance factors are addressed.

Tools

8. Essential Skills and Knowledge Worksheet -- /