Reply: Women in Leadership and Their Influence on the Gender Diversity of Academic Plastic Surgery Programs (2022)

We read with interest the authors’ comment regarding our article, “Women in Leadership and Their Influence on Gender Diversity of Academic Plastic Surgery Programs.”1 We appreciate their commentary on the need for positive female mentorship and the successful leadership styles employed by women. As such, we now expand on these topics further. It is well-established that leadership gender diversity is critical to success in business and medicine. Studies have shown that leadership styles employed by women can be more effective. Eagly et al. found that women embody more transformational leadership styles than men, who more often utilize transactional and laissez-faire styles; these female leadership styles are positively correlated with effectiveness, in contrast with male leadership styles.2 This is oversimplified, however. More recent studies reveal that “new-generation employees” (defined as workers who perform jobs with new-age concepts, social rules, and techniques, and who prefer diversity, flexibility, and intangible motivators versus predefined, concrete rules) currently represent the majority of the workforce.3 With workforce evolution, leadership styles, too, must advance. One emerging style is inclusive leadership—a combination of transformational, transactional, authentic, and shared leadership styles, with a focus on employee recognition, mutual respect, and encouragement. This style significantly and positively correlates with employee innovation and psychological capital.3 Furthermore, mindfulness in leadership (defined by attention and acceptance)—specifically, being present and attentive to internal/external stimuli and approaching others with a nonjudgmental attitude—improves leader-follower relationships, communication, and satisfaction.4 Although these leadership styles require further investigation across genders, it is important to highlight that the elements of effective leadership are constantly evolving; it is imperative that all leaders, both male and female, adapt to the needs and desires of those they lead. Though many studies focus on leadership effectiveness, it is equally—if not more—important to focus on leadership emergence. How are we training women medical students, residents, and junior faculty to become effective leaders? We must shift the focus of our discussion from evaluating not only current women leaders but also women who have yet to reach the highest leadership positions. In our opinion, two important components in leadership emergence are mentorship and sponsorship. Mentorship primarily involves guidance and advising; sponsorship involves advocating for and advancing a mentee’s career. Although overlap exists, both are critical for career advancement and leadership training. They are particularly important for women, given established gender differences in self-promotion. Studies show women underestimate their abilities, creating a personal glass ceiling and confidence gap. At Hewlett-Packard, women were noted to apply for promotions only if they believed they met 100 percent of job criteria, but men applied if they thought they met 60 percent.5 Interestingly, self-criticism is an important leadership quality to identify and improve gaps. Providing women with strong, positive mentorship and sponsorship will hopefully close the confidence gap and enhance female leadership emergence. As we mentor, sponsor, and train future women leaders, it is critical to train them with mindfulness and inclusiveness so they, in turn, can be inclusive, mindful, and empowering leaders. ACKNOWLEDGMENTS Research reported in this article was supported by the National Institute of Neurological Disorders and Stroke under award no. K08NS096232 (to A.K.S.-W.). The funding sources had no involvement in study design; in the collection, analysis, and interpretation of data; in writing of the report; or in the decision to submit the article for publication. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. Alexandra M. Keane, M.D.Susan E. Mackinnon, M.D.Alison K. Snyder-Warwick, M.D.Division of Plastic and Reconstructive SurgeryDepartment of SurgeryWashington UniversitySt. Louis, Mo.