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Jane M. Young, MBBS, MPH, PhD, FAFPHM; Michael J. Hollands, MBBS, FRACS; Jeanette Ward, MBBS, MHPEd, PhD, FAFPHM; C. D'Arcy J. Holman, MBBS, MPH, PhD, FACE, FAFPHM, FAIM

Arch Surg. 2003;138:785-791.

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%, ²₁ = 13.6, P<.001) and clinical practice guidelines (38% vs 24%, ²₁ = 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.

From the Surgical Outcomes Research Centre, Central Sydney Area Health Service, and School of Public Health, University of Sydney (Dr Young), and Division of Population Health, South Western Sydney Area Health Service (Dr Ward), Sydney, and Westmead Hospital, Westmead (Dr Hollands), New South Wales, Australia; and the Centre for Health Services Research, Department of Public Health, The University of Western Australia, Crawley (Drs Young and Holman). Dr Young is now affiliated with the Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales.

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