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What’s Your Style? Enhanced Interprofessional Communication and Practice Using the Communication Wheel

Schwartz, Lisa, EdD; El-Banna, Majeda, PhD, RN, CNE; Conroy, JoAnn Fitzgerald, DNP, RN; Browne, Julia, MSEd

doi: 10.1097/NNE.0000000000000509
Feature Articles

Today’s health care environment requires collaborative teams to provide safe, effective care. This study assessed the extent to which a face-to-face workshop increased nursing and premedical students’ awareness of varying communication styles and their potential impact on interprofessional communication and practice. A self-assessment tool was administered before, immediately after, and 1 month after the workshop. Significant increases in familiarity working on interprofessional teams, identifying different communication styles, and ability to apply communication strategies were found immediately after and 1 month after the workshop.

Author Affiliations: Assistant Professor (Dr Schwartz), Department of Integrated Health Sciences, and Director, Postbaccalaureate Premedicine Certificate Program, George Washington University School of Medicine and Health Sciences; and Assistant Professor and Director of Nursing Advancement (RN to BSN/MSN) Program (Dr El-Banna) and Assistant Clinical Professor (Dr Conroy), George Washington University School of Nursing, Ashburn, Virginia; and Associate Director for Industry Coaching (Ms Browne), George Washington University Center for Career Services, Washington, DC.

The authors declare no conflicts of interest.

Correspondence: Dr Schwartz, George Washington University, Enterprise Hall, 44983 Knoll Square, Ashburn, VA 20147 (Lschwartz@gwu.edu).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.nurseeducatoronline.com).

Accepted for publication: December 13, 2017

Published ahead of print: February 2, 2018

Cite this article as: Schwartz L, El-Banna M, Conroy JF, Browne J. What’s your style? enhanced interprofessional communication and practice using the Communication Wheel. Nurse Educ. 2019;44(1):20-24. DOI: 10.1097/NNE.0000000000000509

Effective communication among different disciplines of health care providers, including physicians and nurses, is critical to collaborative patient care and safety.1 Working on interprofessional teams requires that health care professionals are able to understand and adapt to diverse, and often conflicting, communication styles and preferences so that miscommunication does not result and compromise patient outcomes. Knowing one’s own communication style allows an individual to better understand his/her own preferences when communicating with others. In turn, by recognizing differing communication styles of team members, providers may be better able to adjust their communication to improve collaborative practice.2

Yeakley3 and Clack et al4 noted that differences in personality type are associated with difficulties in interpersonal relationships, in particular, communication, and that individuals with similar personality types are better able to effectively communicate with each other. Based on Yeakley’s work, Thompson developed the Communication Wheel as a training method for a wide variety of students and professionals.5 The tool, based on the Myers-Briggs Type Indicator (MBTI), creates a visual representation of communication preferences related to the 16 personality types derived from Carl Jung’s theories.6 The MBTI is a tool that allows one to become aware of personal preferences across the 4 dimensions of Katherine Briggs and Isabel Briggs-Myers’ personality theory: person’s favorite world, extroversion or introversion; perceiving function, sensing or intuition; decision-making function, thinking or feeling; and lifestyle preference, judging or perceiving. Thompson created the Communication Preference Questionnaire (CPQ), a powerful self-assessment tool that determines an individual’s primary language, based on his/her perceiving function (sensing or intuiting) or his/her decision-making function (thinking or feeling), and dialect, a combination of one’s primary and secondary languages, which is preferred when engaged in a conversation with another person.7 The CPQ can be particularly beneficial in training future health care practitioners to prevent poor communication health-care–related errors.8

Historically, educational preparation for both nurses and physicians has been conducted separately and has not included training in interprofessional communication (IC). Moreover, learning the basics of IC has been left to on-the-job observation and assimilation of nurse-physician interactions with a wide variation in modeling behavior.9 Communication skills training has been shown to increase health care professionals’ self-awareness and recognition of others’ communication styles that differ.10 The Interprofessional Education Collaborative report11 stressed the importance of development of 4 interprofessional core competencies including (a) IC, (b) values/ethics for interprofessional practice, (c) roles and responsibilities, and (d) teams and teamwork during academic preparation of health care providers using an interactive approach where students learn together.

In a review of training programs in communication skills for health care professionals, communication skills training was noted to be most effective when participants understand their own communication style.12 Prasad13 conducted a literature review of the use of the MBTI in health professions, including medical students and residents, physicians, dentists, nurses, dietitians, physical therapists, speech-language pathologists, and pharmacists. Prasad noted that, most often, the MBTI had been used to determine whether there was a personality preference associated with health career choice or specific specialization within medicine, yet no studies focused specifically on personality type and communication. The primary purpose of this study was to assess the extent to which an interactive, face-to-face workshop focused on communication styles increased nursing and premedical students’ awareness of varying communication styles and their potential impact on IC and practice.

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Methods

Design, Setting, and Sample

In this repeated-measures design, an interactive workshop to increase awareness of varying communication styles and the impact on IC was conducted for 10 postbaccalaureate premedicine (PBPM) students from the School of Medicine and Health Sciences and 76 students in the accelerated BSN (ABSN) program in the School of Nursing in a private university located in the eastern United States. Seventy-four completed the study measures, which included a self-assessment administered before, immediately after, and 1 month after the workshop. The PBPM program is a 12-month certificate for students changing careers who have already earned a bachelor’s degree but must take core science courses necessary to apply to medical school. Similarly, the ABSN is a 15-month program intended for individuals with a bachelor’s or higher degree in another field who want to pursue a nursing career. Both programs currently incorporate professional career development into their curriculum, yet this workshop was the first of its kind to explore the use of joint programming where students from both disciplines learn in an interactive environment.

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Procedure

Because the PBPM and ABSN programs are both offered at a satellite campus of the university, faculty from both programs sought to incorporate interprofessional education (IPE) into their respective curricula. A mutually available time within both programs’ weekly schedules was identified at which to conduct a 2-hour workshop to help students identify the 4 communication languages and 8 dialects included in the Communication Wheel, articulate their own communication preference, and identify at least 2 strategies to be used when working with others who have different communication styles. At the beginning of the workshop, students completed a demographic survey, the CPQ, and an author-developed instrument to evaluate the effectiveness of the workshop. The latter instrument was administered before the workshop to assess participants’ baseline familiarity with interprofessional teamwork, communication styles, and strategies to improve communication. The instrument was again administered directly and 1 month after the workshop, with additional questions assessing satisfaction with the workshop. The study was approved by the university institutional review board. Demographic and study questionnaires were collected on paper.

After a communication preference profile was generated for each participant via the CPQ, an interactive presentation that focused on communication styles using the Communication Wheel Workbook, which included case studies, was provided by one of the investigators who is a career coach and certified in MBTI steps I, II, and III.8 After the presentation, 1 PBPM student and 4 to 6 ABSN students were divided into 10 groups. The interprofessional groups, formed randomly, included a mixture of communication languages and dialects, as measured by the CPQ. The groups were given 15 minutes to discuss a scenario and prepare a summary of their discussion about communication preferences related to a potential clinical setting, which was presented to the entire group. Immediately after and 1 month after the workshop, students completed a slightly modified version of the aforementioned self-assessment. The 1-month follow-up questionnaire was distributed to the premedical and nursing students in separate classes, but within the same time frame. Financial support was provided by the university career services center to purchase the Communication Wheel Workbook and CPQ instruments.

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Measures

Demographic Survey

The students completed a demographic survey including gender, marital status, number of children, race, and number of years of previous work experience. Because students from both the ABSN and PBPM programs are career-changers, a categorization of their first degree as science, social science, or arts and humanities was collected, as well as the grade point average (GPA) of their first degree (>3.7 or <3.7). The last 4 digits of their cell phone number were also collected to allow for statistical analyses across a single participant for multiple completed surveys, while maintaining anonymity of the respondents.

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Communication Preference Questionnaire

The CPQ is a self-assessment tool used to determine the language and dialect an individual prefers to use when engaged in a conversation with another person. This instrument consists of 11 communication characteristics items, including 10 forced-choice pairs of statements and 1 forced-choice selection among 4 words, and provides a quick method of determining communication style and preference. The CPQ identifies preferences for the 4 languages of sensing, intuiting, thinking, and feeling, which correspond to 2 of the 4 dimensions of the MBTI perceiving and decision-making functions. Sensors and intuitives are opposite languages, as are thinkers and feelers. Sensors refer to the present, are based in reality, and are action oriented, practical, and concrete. Alternatively, intuitives are focused on the “big picture,” and creativity is their hallmark. Thinkers are naturally critical, intellectual, and analytical, often appearing businesslike and direct in their communication. In contrast, feelers present as warm, caring, and people oriented. The CPQ further identifies 8 communication dialects that are a combination of an individual’s primary and secondary language preferences. Similar to foreign languages, individuals with the same dialect may be able to understand each other with minimal difficulty, yet those with different languages may struggle to communicate. The CPQ has a 0.51 correlation (P < .001) with the language spoken and has a test-retest reliability of 0.96. It is a relatively short instrument available both on paper and online. The paper version used in this study took approximately 5 minutes to complete and provided participants immediately with their personal communication style or dialect.14 Students’ CPQ results were transferred to the Communication Wheel that visually represents the 4 languages and 8 dialects.

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Familiarity Working With Teams and Communication Questionnaires

Two questionnaires were developed by the research team and administered to all participants: one at the beginning of workshop and the other administered immediately after and 1 month after the workshop. The Table includes the 9 items to which students responded across all 3 data collection points and the 5 items that were included directly and 1 month after the workshop. The questionnaires contained Likert-based items focused on students’ perception of familiarity working with teams and communication. Response scales ranged from 1 (very unfamiliar) to 5 (very familiar) or 1 (strongly disagree) to 5 (strongly agree), with neutral represented by 3 for all items.

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Data Analysis

The data were analyzed using IBM SPSS Statistics, version 22 (IBM Corp, Armonk, New York). Demographic and survey data were described with means, standard deviations, percentages, and ranges, as appropriate. A 1-way repeated-measures analysis of variance (ANOVA) was conducted to compare for differences between instrument items measured (before, immediately after, and 1 month after the workshop). Post hoc pairwise comparison tests were used to determine where changes had occurred. For bivariate analyses, the independent t test was used to compare the means of students’ responses directly after the workshop and after 1 month on 5 items that were not included in the preworkshop instrument.

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Results

Eighty-six students (76 nursing and 10 premedical) attended the communication workshop; 74 completed the study surveys, representing an 86% response rate. Most of the sample was female (84%), single (69%), without children (89%), and white (60%); spoke English as their first language (87%); had science as their first degree major (50%); and earned a GPA in their first degree lower than 3.7 (73%). The participants reported their years of working experience (mean [SD], 6.3 [5.3]).

Repeated-measures ANOVA (Table) showed significant differences between before, immediately after, and 1 month after the workshop on instrument items including familiarity with working as part of interprofessional teams, disagreement that it is nearly impossible to train individuals how to be better communicators, familiarity with different communication styles, ability to name different communication styles, and knowledge of how to apply at least 2 strategies to communicate with someone who has a different communication style from his/her own style. The results of the pairwise post hoc analyses for the 5 significant F tests showed that the differences were between the time before the workshop and after the workshop and between before the workshop and 1 month after the workshop (Supplemental Digital Content 1, http://links.lww.com/NE/A457, Table). All items showed an increase from before to 1 month after the workshop. These increases also were from directly after to 1 month after the workshop, with the exception of the ability to name different communication styles and ability to train individuals how to be better communicators.

Table

Table

For the items collected only directly after and 1 month after the workshop, 73% agreed or strongly agreed that the workshop was a valuable learning experience, and this remained true after 1 month (Table). Respondents felt more confident in their ability to communicate effectively directly after and 1 month after the workshop. In addition, students’ answers remained positive about the workshop directly after and after 1 month on the following items: feedback session being a valuable learning exercise, ability to work on a multidisciplinary team as a result of this session, and recommending the workshop to other students.

Communication preference based on the self-administered CPQ was indicated anonymously during breakout groups and documented as hash marks on a blank Communication Wheel, with a total of 72 hash marks being recorded. The communication styles were thinking (52%), feeling (48%), sensing (63%), and intuiting (36%).

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Discussion

Interprofessional communication is 1 of the 4 core competencies for interprofessional practice.11 The results of this study showed that awareness of varying communication styles, and their possible impact on IC and practice, could be significantly improved through the use of experiential-learning–based communications training similar to the ones found in Sargeant et al.15 The training session could enhance the efficacy of interprofessional interactions, which frequently involve the exchange of critical, time-sensitive data.

The student participants in this study reported that this training helped them to be better communicators and be more confident in their ability to communicate effectively. In addition, there was a significant increase in their ability to recognize different communication styles and apply specific communication strategies across diverse interactions both immediately and 1 month after the workshop. Previous research results confirmed that students from 6 professional programs’ pretest and posttest self-assessments of an interprofessional hybrid learning experience showed a significant increase in their perceived ability in, appreciation of, and comfort in working successfully with others.16

The distribution of the preferred communication styles in this study was not identified by the students’ program to maintain confidentiality because of the limited number of participants from the PBPM program. Yet, the overall distribution among the student groups—thinking (52%), feeling (48%), sensing (63%), and intuiting (36%)—was similar to the national distribution (45%, 55%, 70%, and 30%, respectively).14 However, Kim and Han17 compared the MBTI profiles of a group of nursing students with those of medical students from a previous study18 and found a wide diversity of personality types, with a preference among nursing students to include extrovert (65.1%) versus introvert (34.9%), sensing (74.3%) versus intuition (25.7%), feeling (58.7%) versus thinking (41.3%), and judging (70.6%) versus perceiving (29.4%). Those results were also confirmed by Saylor et al19 who reported anecdotal differences in communication styles between the nursing and medical participants. Medical participants led most conversations with the patient and family, whereas nurses tended to use less medical terminology and periods of silence with the patients. The differences in communication styles may affect both IC and communication with patients. However, in this study, the workshop was determined to help participants to know how to use at least 2 strategies to communicate with someone who has a different communication style from their own styles. This not only may improve physician-nurse communication but also plays an important role in improving communication between health care professionals and their patients.

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Implications

This pilot study is the first attempt, to our knowledge, to address IC between premedical and nursing students by raising awareness of different communication styles based on the Myers-Briggs personality types. The communication workshop provided the basis on which students from both programs could assess their own communication styles and be more aware of the potential impact of diverse styles on IC. This workshop was integrated into the “Transition to Profession” courses in both programs, yet similar workshops could be included at any point into any health profession program. Ultimately, we anticipate that now, armed with an increased awareness of varying communication styles and ways to mitigate differences in communication styles, students can apply what they have learned through the workshop as they enter clinical training and professional practice.

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Limitations

The study used a small convenience sample of students from 1 institution, which limits the generalizability of the results. Because the PBPM program was small, the interdisciplinarity of the sample, both as a whole and within groups formed during the workshop, is also limited. In addition, because both academic programs are geared for students who are changing careers, the participants may have had previous experience and training in IPE, which may have influenced the study’s findings.

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Conclusion

This pilot project integrated IC training into nursing and premedical professional programs. Significant increases in familiarity working in interprofessional teams and awareness of different communication styles were found immediately after the workshop from preworkshop to postworkshop and were maintained 1 month later. In addition, students’ self-assessed ability to apply communication strategies across different styles increased significantly. Most participants agreed or strongly agreed that the workshop was a valuable learning experience, and this remained true after 1 month. Both groups had a positive opinion of IPE before the workshop, which remained positive immediately after and 1 month after the workshop. An increase in awareness of communication styles may help students improve the efficacy of their future professional interactions with other health care practitioners as well as with their patients.

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References

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Keywords:

interprofessional communication; interprofessional education; nursing students; personality inventory; premedical students

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