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Role for opinion leaders in promoting evidence-based surgery
Jane M Young1, Michael J Hollands, Jeanette Ward
1Surgical Outcomes Research Centre, Central Sydney Area Health Service, and School of Public Health, University of Sydney, New South Wales, Australia. jyoung@email.cs.nsw.gov.au
Hypothesis:
"Opinion leaders" can be identified by surgeons from among their peers, and opinion leaders have a role in promoting best surgical practice.
Design:
Postal survey.
Setting And Participants:
Four hundred eighteen (77% response fraction) randomly selected fellows of the Royal Australasian College of Surgeons.
Main Outcome Measures:
Number of opinion leaders identified locally, statewide, and nationally; ratings of 22 possible attributes in conferring status as an opinion leader; and views about and ratings of the role of opinion leaders.
Results:
Most respondents were unable to identify a local colleague whom they considered to be an opinion leader in their own specialty (mode, 0; and median, 1) or in surgery in general (mode, 0; and median, 0). Estimated numbers of opinion leaders were significantly higher at the state and national levels for the respondents' own specialty and for surgery in general (P<.001 for all). Surgical expertise and teaching skills were rated most highly as conferring status as an opinion leader. Academic and professional contributions received the lowest ratings. Most surgeons (88%; 95% confidence interval, 84%-91%) agreed that opinion leaders could influence them to change their practice. Opinion leaders were rated as "very influential" by significantly more surgeons than clinical audit (38% vs 27%, chi21 = 13.6, P<.001) and clinical practice guidelines (38% vs 24%, chi21 = 21.4, P<.001) (McNemar test for both).
Conclusions:
Australian surgeons support the concept of opinion leaders. Although few local colleagues whom they consider as fulfilling such a role can be identified, opinion leaders are evident at a national level. Once opinion leaders are identified using attributes ranked in our survey, interventional studies will further delineate their influence in improving evidence-based surgical practice.