Communication styles of undergraduate health students

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Communication styles of undergraduate health students

Ted Brown a,⁎, Brett Williams b, Malcolm Boyle b, Andrew Molloy a, Lisa McKenna c, Claire Palermo d,Liz Molloy e, Belinda Lewis f

a Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University — Peninsula Campus, Frankston,Victoria, Australiab Department of Community Emergency Health and Paramedic Practice, School of Primary Health Care, Faculty of Medicine, Nursing & Health Sciences, Monash University — PeninsulaCampus, Frankston, Victoria, Australiac School of Nursing & Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University — Peninsula Campus, Frankston, Victoria, Australiad Department of Nutrition and Dietetics, Southern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Clayton, Victoria, Australiae Centre for Medical and Health Science Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australiaf School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University — Peninsula Campus, Frankston, Victoria, Australia

⁎ Corresponding author.E-mail addresses: [email protected] (

[email protected] (B. Williams), Mal.(M. Boyle), [email protected] (A. [email protected] (L. McKenna), Claire(C. Palermo), [email protected] (L. [email protected] (B. Lewis).

0260-6917/$ – see front matter © 2010 Elsevier Ltd. Aldoi:10.1016/j.nedt.2010.06.006

Please cite this article as: Brown, T., et al., Cnedt.2010.06.006

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a r t i c l e i n f o

Article history:

Accepted 15 June 2010Available online xxxx

Keywords:Communicator Style MeasureHealth scienceStudentsEducation

Background: Few empirical studies have been undertaken on the communication styles of specific health-related disciplines. The objective of this study is to identify the communication styles of undergraduatehealth students at an Australian university.Methods: A cross-sectional study using a paper-based version of the Communicator Style Measure (CSM) wasadministered to a cohort of students enrolled in eight different undergraduate health-related courses. Therewere 1459 health students eligible for inclusion in the study.Results: 860 students (response rate of 59%) participated in the study. Participants overall preferred theFriendly and Attentive communicator styles and gave least preference to the Contentious and Dominant styles.

There was considerable similarity between participants from each of the health-related courses. There wasno statistical difference in relation to communicator styles between the age of the participant or the yearlevel they were enrolled in.Conclusion: These results show a preference for communicator styles which are facilitative of a client-centredapproach, empathetic, and positive with interpersonal relationships. The lack of significant difference incommunicator styles by year level further suggests that people disposed to such communicator styles aredrawn to these health-related courses, rather than the specific field of study affecting their style.

© 2010 Elsevier Ltd. All rights reserved.

Introduction

Communication is a fundamental aspect in the provision ofhealthcare and as a topic it has received considerable interest overthe years with there being strong concern in the literature thatmedical and healthcare professionals often lack effective communi-cation skills (Bhasale et al., 1998; Meyer and Arnheim, 2002).Communication research in itself is a broad field, but wherecommunication has been researched in relation to healthcareprofessionals, the focus has predominately been on physicians andcomparatively little attention has been given to variety of otherhealthcare professions (Alvarez and Coiera, 2006; Sutcliffe et al.,

T. Brown),[email protected]),[email protected]),

l rights reserved.

ommunication styles of unde

2004). Accordingly this study explored the communication styles ofeight health disciplines at one Australian university: EmergencyHealth (Paramedics), Nursing, Midwifery, Occupational Therapy,Physiotherapy, Health Science, and Nutrition and Dietetics. Thesimilarities and differences between undergraduate students enrolledin the healthcare disciplines were identified to gain insights into thecommunication style(s) students adopt, with a view to tailoring theeducation and training to promote effective communication styles foruse in clinical settings.

Literature review

Healthcare professionals rely on effective communication skillswhen interacting with patients and other healthcare professionals.Good communication is essential in establishing medical histories,explaining medical conditions, establishing trust and rapport, com-forting, reassuring, and establishing treatment regimes with all typesof people. Effective communication has been linked to improvedpatient satisfaction, better health outcomes, fewer mistakes related topatient treatment, and a reduced risk of malpractice litigation

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2 T. Brown et al. / Nurse Education Today xxx (2010) xxx–xxx

(Ambady et al., 2002; Kaplan et al., 1989; Reader et al., 2007; Van EssCoeling and Cukr, 2000; Williams et al., 1998). Poor communicationhas also been cited as a contributing factor in the death of patients(Leonard et al., 2004; Meyer and Arnheim, 2002). Among healthcareprofessionals, communication is essential for coordinating roles,effective collaboration, and facilitating patient handovers (Owen etal., 2009; Van Ess Coeling and Cukr, 2000). Elsewhere it has beenfound that addressing communication in students' education canimprove their communication and ultimately the client care theyprovide (Makoul and Curry, 2007). Communication is a corecompetency or capability in each of the eight courses from whichstudents are sampled for this study.

To explore communication, the Communicator StyleMeasure (CSM)has been frequently used (Norton, 1978; 1983). According to Norton(1978), one's communicator style is “broadly conceived to mean theway one verbally and paraverbally interacts to signal how literalmeaning should be taken, interpreted, filtered, or understood” (p. 99).With this concept of communication in mind, the CSM measures tendifferent communicator styles. The Dominant communicator style ischaracterized by a desire to take control of conversations. Dramaticinvolves exaggerating, understating, and otherwise stylizing one'sconversation. Contentious is characterized by being argumentative.Attentive involves making sure others know that they are being listenedto. The Animated style involves using many non-verbal, physical cues,such as hand gestures or nodding. Impression Leaving is a memorablestyle of communication. Relaxed is characterized by a lack of anxietywhen communicating. Open is characterized by being affable, unre-served, extraverted, and approachable. Friendly ranges from not beinghostile through to deep intimacy and, finally, Precise involves a focus onaccuracy and detail in conversations. The CSM also includes a constructcalled Communicate Image, which is a measure of the participants'perception of their ability to communicate; however, this construct isnot relevant for this study.

A person is not found to have one communicator style, but ratherpreferences for different combinations, to the extent that Norton(1983) suggests the styles are multi-collinear. In developing the CSM,Norton (1978) described six clusters of communication styles whichgroup together statistically and conceptually. These were combina-tions of communicator styles which were likely to be found together.For instance, the Dramatic and Animated styles were found to clustertogether. Studies using the CSM have not limited themselves tocommunicator styles outlined by Norton. Buller and Buller (1987)grouped the CSM's items into two groups called Affilitative andDominance when analyzing the communication styles of a cohort ofphysicians. The Affilitative style, characterized by a desire to establishpositive patient–physician relationships, was found to have a positiverelationship with patient satisfaction. In contrast the Dominance style,which was characterized by the physician maintaining control overthe physician–patient relationship, was negatively related to patientsatisfaction.

Similar results to Buller and Buller's results have been found inother studies. Infante et al. (1996) found that an argument wasreceived better if an affirming tone was used, which is characterizedby the Attentive, Friendly, and Relaxed communicator styles. Van EssCoeling and Cukr (2000) found better perceptions of collaborationbetween nurses and physicians who adopted a strong preference forthe Attentive style. Infante and Gorden (1989) also found superiors tohave a greater level of satisfaction with subordinates when anAffirming style was used. Similarly, Baker and Ganster (1985) foundsubordinates were more satisfied when their superiors had strongerpreferences for the Open, Friendly, Relaxed, and Attentive communi-cator styles. In another study by Norton and Pettegrew (1977),respondents reported they were more physically attracted to a personwho was perceived to exhibit the Dominant and Open styles. Thesestudies are all consistent in showing that communicator style isimportant in how one relates to and is perceived by others.

Please cite this article as: Brown, T., et al., Communication styles of undenedt.2010.06.006

Studies using the CSM have also found that gender and ethnicityare very weak factors in explaining differences in participants'perceptions of their communicator styles (Gudykunst and Lim,1985; Montgomery and Norton, 1981; Staley and Cohen, 1988).These similarities are likely to be a function of the CSM asking forparticipants' perceptions rather than measuring actual communicatorstyles. For instance, a study which analyzed the taped interactionsbetween patients and physicians in a number of clinical settings foundsignificant differences between how male and female physicianscommunicated, with female physicians talking longer, and engagingin more positive talk than male physicians (Roter et al., 1991). It hasalso been found that one's perception of their own communicatorstyle does not always accord with other's view of their communicatorstyle (Lamude and Daniels, 1984). It therefore needs to be kept inmind that this study is measuring health science students' perceptionsof their own communicator styles.

This study explored the communication styles of eight healthdisciplines: Emergency Health (Paramedics), Nursing, Midwifery,Occupational Therapy, Physiotherapy, Health Science, and Nutritionand Dietetics, with the objective of identifying similarities anddifferences between undergraduate students enrolled in healthcaredisciplines.

Method

Design

A cross-sectional study using a paper-based Communicator StyleMeasure (CSM)was administered to a cohort of undergraduate healthstudents.

Participants

All students enrolled in any year of undergraduate EmergencyHealth (Paramedic), Nursing, Midwifery, Occupational Therapy,Physiotherapy, Health Science, Nursing/Emergency Health doubledegree and Nutrition and Dietetics courses at Monash University inMarch 2009 were eligible to participate. There were 1459 studentseligible for inclusion in the study.

Instrumentation

The Communicator Style Measure (CSM) is an instrumentdesigned to assess ten styles of communication and one's perceptionof their communication ability (Norton, 1978, 1983). The instrumentconsists of 51 items; however, once the filler items and items relatedto communication image—which are not relevant to this study— areput aside, each communication construct consists of four items, whichare rated on a 5-point Likert scale (YES! = 5, yes = 4, ? = 3, no = 2,NO! = 1), of which three items were reversed for analysis. Theconstructs derived from the CSM have scores ranging from 4 to 20,with higher scores indicating a stronger preference for that commu-nication style. The CSM takes respondents approximately 10 min tocomplete. Examples of the CSM's ten styles of communication itemsare located in Table 1.

The CSM has sufficient internal consistency as measured byCronbach's alpha for each construct: Friendly (α=0.60), ImpressionLeaving (α=0.65), Relaxed (α=0.74), Contentious (α=0.71),Attentive (α=0.41), Precise (α=0.54), Animated (α=0.46), Dra-matic (α=0.63), Open (α=0.70) and Dominant (α=0.72). Despitethree constructs having alphas which are lower than commonlyaccepted, this is an acceptable level of internal consistency as eachconstruct consists of only four items (Nunnally and Bernstein, 1994;Pett et al., 2003; Streiner and Norman, 1995). Furthermore, otherstudies have reported similar internal consistencies (Graham, 2004).Evidence of content validity, criterion-related validity, and construct

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Table 1Examples of Communicator Style Measure items.

Communicatorstyle

Example 1 Example 2

Friendly I readily express admiration forothers.

To be friendly, I habituallyacknowledge verbally other'scontributions.

Attentive I can always repeat back to aperson exactlywhat was meant.

I really like to listen very carefullyto people.

Animated My eyes reflect exactly what Iam feeling when Icommunicate.

I tend to constantly gesturewhen I communicate

ImpressionLeaving

What I say usually leaves animpression on people.

I leave a definite impression onpeople.

Precise I am a very precisecommunicator.

In arguments I insist upon veryprecise definitions.

Open I am an extremely opencommunicator.

I readily reveal personal thingsabout myself.

Dramatic I dramatize a lot. Regularly I tell jokes, anecdotesand stories when Icommunicate.

Relaxed I am a very relaxedcommunicator.

Under pressure I come across asa relaxed speaker.

Dominant In most social situations Igenerally speak veryfrequently.

I am dominant in socialsituations.

Contentious When I disagree withsomebody I am very quick tochallenge them.

I am very argumentative.

Table 2Demographics.

Health professional course Number Percentage

Emergency health (paramedic) 114 13.3%Nursing 200 23.3%Midwifery 84 9.8%Nursing/emergency Health (paramedic) 59 6.9%Occupational therapy 211 24.5%Physiotherapy 61 7.1%Health Science 14 1.6%Nutrition and dietetics 117 13.6%Total 860 100%

Year Number Percentage

First year 358 41.6%Second year 175 20.3%Third year 243 28.3%Fourth year 84 9.8%Total 860 100%

Age Number Percentage

b21 years 431 50.1%21-25 years 281 32.7%26-30 years 48 5.6%21-35 years 42 4.9%36-40 years 35 4.1%41-45 years 14 1.6%N45 years 9 1.0%Total 860 100%

Gender Number Percentage

Female 750 87.2%Male 110 12.8%

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validity of the CSMhas been reported (Duran and Zakahi, 1987; Haileyet al., 1984; Norton, 1978; Norton and Pettegrew, 1979). The CMS hasalso been used previouswith studies involving health care professions(Van Ess Coeling and Cukr, 2000; Lawson, 2002; Schrader andSchrader, 2005).

Procedures

At the conclusion of a lecture for each year level of each course,students were invited to participate in this study. Students wereprovided an explanatory statement and informed that participationwas voluntary and anonymous. A non-teaching member of stafffacilitated the process and participants were administered a ques-tionnaire containing the CSM and a brief set of demographicquestions. The questionnaire took approximately 10 min to completeand consent was implied by completion of the questionnaire. Ethicsapproval for the study was obtained from the Monash UniversityStanding Committee on Ethics in Research Involving Humans(SCERH).

Students taking part in the study were known to the investigatorsif they were enrolled in the same discipline. In order to minimize aperception of obligation and coercion on the part of the students tocomplete the questionnaires as part of a study being completed byacademic researchers who potentially taught courses they wereenrolled in, several steps were taken. As mentioned above, ethicscommittee approval was sought and obtained from Monash Univer-sity to ensure that the way the study was conducted met ethicalresearch standards. As well, data collection was completed by a non-teaching member of staff and the individual research investigatorswere not present when the students completed the questionnaires.Students were also reminded that their participation was voluntaryand that there were no negative consequences if they chose not totake part in the study. This information was given to the students inthe form of plain language statement as well as verbally by the non-teaching member of staff. Students were not asked to report anypersonal information (e.g., date of birth, name, and address) thatcould identify them. Finally, if an individual student felt that he/shehad been pressured or coerced to take part in the study, he/she couldalways contact the Monash SCERH.

Please cite this article as: Brown, T., et al., Communication styles of undenedt.2010.06.006

Data analysis

The Statistical Package for the Social Sciences (SPSS; Version 17.0)was used for data storage, tabulation, and the generation of statistics.Means, ANOVA and MANOVA were used to analyze the differencesand similarities between the health courses, gender, age, and year ofenrolment. The results were considered statistically significant if the pvalue wasb0.05.

Results

Demographics

A total of 860 students participated in this study with a responserate of 59%. The number of participants enrolled in each of the eighthealth courses represented in this study is presented in Table 2. Mostof these courses are three years in length, with the exceptions beingoccupational therapy, physiotherapy, and nutrition and dieteticswhich are four year courses. Thus, considering that only three courseshave fourth year students, this sample is a representative cross-section of students. The majority of participants were female (87.2%).Participants were also predominately young adults, with half (50.1%)being 21 years of age or younger and a third (32.7%) between 21 and25 years of age.

Communication styles

The communicator style with the strongest preference amongstparticipants was Friendly, followed by the Attentive and Animatedstyles. The least preferred communication styles amongst theundergraduate student cohort were the Contentious, Dominant, andRelaxed styles. The complete list of styles and their means are reportedin Table 3.

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Table 3Communicator Style Measure mean scores.

Communicator style Mean SD

Friendly 15.47 2.41Attentive 14.31 2.39Animated 13.85 2.80Impression leaving 12.93 2.55Precise 12.00 2.63Open 11.98 3.16Dramatic 11.78 2.99Relaxed 11.63 3.04Dominant 11.26 2.99Contentious 11.11 3.44

4 T. Brown et al. / Nurse Education Today xxx (2010) xxx–xxx

A one-way multivariate analysis of variance (MANOVA) wasperformed to compare differences in communicator style preferencebetween the individual health science courses, which found astatistically significant difference between the courses (pb0.001;partial eta squared=0.025). Further analysis using a Bonferroniadjusted alpha level of 0.005 found only a preference for the Relaxedcommunicator style to be significantly different between the courses(pb0.001; partial eta squared=0.040). A post hoc analysis usingTamhane's T2 test revealed participants enrolled in Emergency Health(mean=12.42, SD=3.23) and Nursing/Emergency Health(mean=12.83. SD=3.04) to have a significantly higher preferencefor the Relaxed communicator style than participants enrolled inNursing (mean=11.07, SD=3.04) or Occupational Therapy(mean=11.28, SD=2.65). Participants enrolled in Health Sciencereported the highest preference for the Relaxed style (mean=13.64,SD=4.01); however, the low sample size (n=11) meant that as agroup they lacked statistical power.

Another MANOVA was performed to compare the differences incommunicator styles between the genders, showing a statisticallysignificant difference (pb0.001; partial eta squared=0.044). The onlydependent variable to have statistical significance with a Bonferroniadjusted alpha level of 0.005 was the Animated communication style(pb0.005; partial eta squared=0.011). The Animated style had astronger preference amongst female students (mean=14.04,SD=2.74) than male students (mean=13.21, SD=2.28).

The analysis of variance (ANOVA) found no statistically significantdifferences between students enrolled in different year levels of theircourse or their age for any of the ten communicator styles.

Discussion

There was an overall consistency in communicator style prefer-ence amongst participants in this study. The strongest preference wasgiven to the Friendly communicator style, which is characterized byanything from intimacy through to a lack of hostility. In the originalstudy that developed the CSM, Norton (1978) suggested clusteringthe Friendly style with the Attentive style. Indeed, the secondpreference amongst participants was for the Attentive style, support-ing this notion that the two communication styles conceptuallycluster together. The Attentive style involves letting one's conversa-tion partner know that they are being listened to. Furthermore, activelistening is an important aspect of client-centred therapy andempathy (Hojat, 2007; Rogers, 1975). These results show participantsto have a preference for the Friendly and Attentive styles and are, bymany accounts, a positive result for healthcare students to display. Inaddition to this, the Dominant and Contentious styles, which Nortonsuggested clustering together, were the least preferred communicatorstyles. The health students in this study rated the Relaxed style as alow preference and, as a calm style of communicating, is potentiallyone that needs reinforcing amongst students as it can be beneficial inclinical settings that become emotionally charged.

Please cite this article as: Brown, T., et al., Communication styles of undenedt.2010.06.006

Other studies have demonstrated that the CMS Friendly andAttentive styles are linked to improved client outcomes and increasedperceptions of collaboration between health care practitioners. Forexample, in a study by Schrader and Schrader (2005), reasons for theincorrect usage of oral contraceptive pills were explored by examiningthe relationship between patients' abilities to comprehend and/orrecall information presented to them by nurse practitioners and thecommunicator style of their nurse practitioners. Findings indicatedthat Attentive and Friendly communicator styles were positivepredictors and the communicator image and Dramatic styles werenegative predictors of comprehension. Van Ess Coeling and Cukr(2000) investigated whether usage or non-usage of three of Norton'sCommunicator Styles (Dominant, Contentious, and Attentive) wereassociated with interactions described by nurses as: a) collaborative,rather than non-collaborative in nature, b) improving the quality ofcare, and/or c) increasing nurse satisfaction. Findings indicated thatboth physician and nurse usage of an Attentive style and non-usage ofa Contentious or Dominant style resulted in significantly greaterperceptions of collaboration, improved quality of care, and increasednurse satisfaction. In contrast, Lawson (2002) investigated theinterpersonal communication styles of nurse practitioners andphysicians and the effects on patient outcomes. Communicationpatterns were examined to determine whether the practitioner'spredominant style was informational or controlling and whether thestyle affected patient satisfaction and perceived autonomy support.All providers used predominantly informational styles of communi-cation and were more controlling in their communication patternswhen attempting to make decisions and plan patient care. Thisnegatively impacted patient satisfaction and perceived autonomy.

The preferences for communicator styles are broadly similar acrossthe different healthcare disciplines included in this study, despite astatistically significant difference being reported. Only 2.5% of thevariation in communicator style was explained by the course aparticipant was enrolled in and was therefore very weak. Furtherexploration of the differences found that only the Relaxed style out ofthe ten communicator styles was significantly different betweenparticipants from different healthcare professions. Again, only 4% ofthe variation in the Relaxed style was explained by the undergraduatecourse in which a participant was enrolled. Of note, however, was thepost hoc analysis that revealed the participants enrolled in either ofthe Emergency Health courses, which are pathways to becoming aparamedic, were significantly more likely to have a preference for theRelaxed style than participants enrolled in Occupational Therapy andNursing. This would, therefore, suggest that either the professionattracts certain types of people or encourages certain styles ofcommunication amongst its students.

Paramedics are more likely to be involved in emotionally chargedsituations where an injury or emergency has just occurred, whereasoccupational therapists and nurses generally become involved afterthe initial injury in situations that are more controlled. Thus theRelaxed style, which is characterized by calmness and a lack of anxiety,is of comparatively greater importance to a paramedic. Thus, in termsof curriculum development and employability, it is important tounderstand whether the emergency health courses attract orencourage students to adopt the Relaxed communication style. Thatthe preference for Relaxed style decreases slightly over the duration ofthe course would, however, suggest that the course does notencourage this style, although this would need to be confirmed in alongitudinal study to discount differences between the students ineach of the three year levels. Even though the Relaxed style was foundto be a factor that differentiated the health science student groups, nodoubt nursing students would utilize this type of communication stylein contexts such as the emergency department and in mental healthpractice contexts.

A statistically significant difference was found between the twogenders in their communicator preference, but this relationship was

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also very weak. Only 4.4% of the variation in communicator styles wasexplained by gender. Further inquiry into these results revealed thatonly the Animated style out of the ten styles was significantlydifferent, with females expressing a greater preference for this stylethan males. These results are in concordance with the results of otherstudies in that males and females have a very similar perception ofhow they communicate. Where they are likely to differ is in females'stronger preference for the Animated style and males' strongerpreference for the Precise style (Montgomery and Norton, 1981;Staley and Cohen, 1988). Similarly, the results of this study foundmales to have a stronger preference for the Precise style, however, thisresult was not statistically significant.

Given the differences between the healthcare disciplines includedin this study, a greater variation than expected was found incommunicator style preferences between the participants enrolledin each of the courses. As such it is hypothesized that because they areall undergraduate students, these participants share more similaritiesthan differences and that once exposed to the pressure and influencesof their chosen healthcare profession they will then express greaterdifference in communicator style preference. Accordingly, it would beinformative to track changes in a longitudinal study of participants'communication style as they progress from their undergraduatedegrees into theworkforce. Such an extension of this studywould alsoshed light on the whether a causal relationship between communi-cation style and healthcare profession exists. This study is unable toexplainwhether students share similar communication styles becausetheir education facilitates the development of such styles or becausepeople with personalities that predispose them to pursue healthcareprofessions are also predisposed to have a preference for suchcommunication styles. It is plausible, based on the communicatorstyle preferences reported in the results of this study, that thepersonalities of these participants predispose them to both caringprofessions and Friendly and Attentive communicator styles.

The results of this study should be interpreted with cautionbecause there are limitations with this research methodology. Animportant confounding factor discussed by Sypher (1980) withspecific focus on the CSM is called the systematic distortionhypothesis. This hypothesis begins with the issue of the CSM beingartifactual, as the ten communication styles are constructs used togeneralize communication behavior. This, therefore, means animplicit theory underlies the instrument and, if asked, participantswould be able to group together the instruments' constituent itemsinto logical groups. Further, because participants are asked toremember how they communicate in order to provide answers ratherthan the instrument directly measuring their actual communicationstyle, their answers are open to distortion. In recollecting, so thehypothesis runs, participants are drawing on the implicit theorywhich underlies the instrument, thus their responses are guided anddistorted, particularly as items they are asked to consider may notnecessarily fit with actual behavior. As such, the reported ‘underlyingbehavioral consistency... may be tapping semantic similarity ratherthan actual communication behavior’ (Sypher, 1980, p. 84). If thishypothesis is correct, the extent of the distortion affects thegeneralizability of the results produced. This does not invalidate theresults, but it does mean the results need to be interpreted within thecontext of the measure being used.

A further limitation of the CSM being a self-report questionnairesurrounds the issue of perception. The instructions at the beginning ofthe questionnaire clearly state ‘there is no such thing as a “correct”style of communication’ and the study is anonymous. Thus there is noincentive to provide false answers. Nevertheless, the questionnaireasks for participants' perception of their own communication stylewhich is not necessarily the same their actual communication style. Astudy by Lamude and Daniels (1984) using the CSM showedparticipants do not necessarily have a perception of their owncommunication style that accord with others perceptions of it. Nor

Please cite this article as: Brown, T., et al., Communication styles of undenedt.2010.06.006

is their perception necessarily in accordance with overt behavior.Perception is subjective, particularly with a complex process such ascommunication. Thus it needs to be kept in mind that these results arepersonal perceptions and not actual communication styles. Very few,if any, participants are likely to have reported fanciful answers, thustheir perceptions of their own communication style will be based onreality and accordingly will not be too far removed from the actualbehavior. Thus the CSM can still provide a solid overview ofparticipants' communication styles. The limitation only restricts theability of this study to draw strong inferences.

Finally the generalizability of these results is also limited. Thisstudy was conducted using convenience sampling. Those studentswho self-select themselves to participate in this study may be of aparticular type and thus it is possible that this sample is not anaccurate representation of health students, although the sample sizeand demographic profile do allay such concerns. A greater restrictionin the generalizability of these results, however, is that this study wasconducted at only one university, limiting the ability to generalizethese results to health students Australia-wide.

Recommendations for future research include investigating thecommunication styles of newly graduated health care students,comparing the communication styles of health students with thoseof other fields such as engineering, business, education, law, orinformation technology, comparing the communication styles ofstudents completing graduate entry education in the health-relatedcourses with students completing undergraduate health programsand finally, exploring communication styles further including cross-sectional studies with students from other universities and non-healthcare disciplines or a longitudinal study.

Conclusion

All eight health-related courses from which participants weredrawn include communication skills as a core competency. This studysuggests that the communication styles between students from eachof the health-related courses are similar. The strong preference for theFriendly and Attentive communication styles overall suggests that alleight courses attract people who already have these communicationstyles, rather than the course promoting these styles because therewas no statistically significant difference between the communicatorstyles of students enrolled at different stages of their courses;however, a longitudinal study would need to be undertaken toconfirm this. A comparison against health students from otheruniversities or healthcare professionals in the workplace would alsobe instrumental in further explaining these results, as caution iscurrently required in extrapolating these results to healthcareprofessionals more broadly. Nevertheless, the communication stylepreferences this cohort reported show these students to have anappropriate style for adopting a client-centred approach to healthcareand more broadly, a style which facilitates positive relationships withpatients and other healthcare professionals.

Acknowledgements

The undergraduate health science students who took the time tocomplete the questionnaire are thanked for their input.

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