Millennial Leaders: Ready or Not, Here They Come

The problem with labels is that they lead to stereotypes and stereotypes lead to generalizations and generalizations lead to assumptions and assumptions lead back to stereotypes. It’s a vicious cycle, and after you go around and around a bunch of times you end up believing that all vegans only eat cabbage and all gay people love musicals. —Ellen DeGeneres Sir: We read the recent non–peer-reviewed article on leadership with interest.1 We hope it was not the authors’ intention to alienate younger readers. Please allow us to address their concerns. Great leadership transcends gender, sexual orientation, ethnicity, and time. To negatively pick off one of these simply seeks to isolate that group—an eventuality that nobody wants. There is no study demonstrating a dilution of leadership qualities over time or generations. What is obvious is the evolving requirements of leadership to meet the challenges of the age. Mhairi Black, Alexandra Ocasia-Cortez, and Mark Zuckerberg all fall into the category of “millennials” which the authors’ editorial degrades. Each of them strived to overcome challenges, champion innovation, or disrupt the norm—while simultaneously inspiring others in a cause. Many clinicians have demonstrated incredible leadership and innovation in the current pandemic—and age has not been an impediment. Expert educationalists, Jauregui et al. found that applying generational theory deleteriously perpetuates unfounded biases and reinforces power differentials, which have been shown to compromise patient safety.2,3 We implore the readership: let us not do this. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the article was nonsystematic in nature and, if the current geopolitical climate has taught us anything, it is that opinion must not be disguised as evidence. The article significantly underestimates the task of leadership and the qualities of a leader. In assigning “leading” to be the mere act of “having followers,” the authors have confused abject metrics of social media with the art of, as Colin Powell would put it, “solving problems.” Although many inspirational leaders can be found on Twitter, some of us may disagree that all Twitter profiles constitute leadership. Furthermore, the “traits” discussed are not necessarily qualities of a leader but are the values that underpinned broad social choices of that time. The historical identification with job security, organizational membership, and the benefits of institutional loyalty are not valued by the current workforce. Why? Economic instability in their lifetime has demonstrated the fluidity of such institutions, and the lack of stability and security they perhaps bring—a different perspective from that of their forebears. Moreover, many medicolegal circles regularly overlook a responsible body’s opinion.4–7 Modern leaders need versatility to juggle paradoxical demands to “do more with less, cut costs but innovate, think globally act locally.”8 Leaders must navigate these requirements through transforming their colleagues to yield high-performance teams. Forbes furthermore advocates breaking down organizational hierarchies to improve efficacy.9 The removal of this Jedi Master/Padawan approach does not dissipate the respect trainees have for their mentors, and may yield significant benefits to organizations and patient care. The challenges of COVID-19 have demonstrated the scale of the productivity and innovation that is available when humanity is unshackled from its social norms and allowed to work toward a common goal. We would agree that humility, to listen to criticism and understand one’s “Johari Window” or, as Donald Rumsfeld would say, one’s “known knowns,” is a central component of effective leadership. However, the general flaw in the article’s approach lies not in its appraisal of desirable leadership qualities, but in the use of historical metrics of training to underpin the qualities of a good leader. “Poor work etiquette, less interest in member organizations, lack of initiative” resonate blind subservience by trainee surgeons to seniors who were themselves ill equipped to lead. Let us celebrate outgrowing these flawed hierarchies and embrace new directions to improve patient care and work together. Our speciality was borne out of this thirst for innovation, so we cannot stifle it in our next generation of surgeons, however uncomfortable it may feel. When we listen to fellow trainees, mentors, and established leaders discuss their approaches to building teams, we can only be filled with desire to be better and strive for more. As Bill Gates said, “As we look ahead into the next century, leaders will be those who empower others.” The question really is, how can we better empower each other? One hundred forty-four clinicians signed this letter (Table 1). Table 1. - These 144 Clinicians Signed This Letter Name Grade Institution Specialty Harry Claireaux SHO University of Oxford Research Barbara Jemec Consultant The Royal Free Plastic surgery Chris Hoo Consultant Belfast City Hospital Plastic surgery Juan E. Berner Microsurgery fellow The Newcastle upon Tyne Hospitals NHS Trust Plastic surgery Katie Young Registrar Ospedale San Giuseppe Plastic surgery Waheed-Ul-Rahman Ahmed Medical student University of Oxford Genetics Katarina Arandjelovic Basic trainee The Royal Melbourne Hospital Anesthesia Louise Gurowich SHO Great Western Hospitals NHS Trust Academic: clinical teaching fellow Ebba Lindqvist Consultant plastic surgeon Karolinska University Hospital, Stockholm, Sweden Plastic surgery Jonathan Guckian Core medical trainee Leeds Teaching Hospitals Medicine Miguel G. Bravo M.D. Cirumed Clinic, Marbella, Spain Plastic surgery Thomss Mackrell GpST2 Leeds Teaching Hospitals NHS Foundation Trust General practice Ian King Reconstruction fellow London Deanery Plastic Surgery Training Rotation Plastic surgery Nabilah Mayat 4th-year medical student Barts and the London School of Medicine and Dentistry Medical student Gemma Batten Junior clinical fellow St Thomas’ Hospital Plastic surgery Shirley Chan Consultant Medway Maritime Hospital, Kent Colorectal surgery Federico Barbera M.D., plastic surgery trainee Humanitas Research Hospital–Milan Plastic surgery Antonia Myatt ST3 Leeds General Infirmary Trauma and orthopedics Alexander J. Baldwin Foundation doctor Stoke Mandeville Hospital Intensive care medicine Edward Miles ST6 North Bristol NHS Trust Anesthesia Francisco Moura Core surgical trainee year 2 Wythenshawe Hospital Plastic surgery James Olivier SPR Severn deanery, United Kingdom General surgery Alex Goubran ST8 Royal Devon and Exeter Hospital Trauma and orthopedics William Bolton Foundation year 2 Leeds Teaching Hospitals General surgery Nikita Joji ST3 Queen Victoria Hospital, East Grinstead Plastic surgery Joanna Bovis ST4 St George’s Hospital, London Plastic and reconstructive surgery Asmat Din Consultant St Thomas’ Hospital Plastic surgery Matthew H. V. Byrne Foundation year 3 University of Cambridge, Department of Surgery, Addenbrooke’s Hospital Urology Dominic Furniss Consultant Oxford University Plastic surgery Nadine Hachach-Haram Consultant Guy’s & St Thomas’ Hospital Plastic surgery Nicholas Wilson Jones Consultant Welsh Centre for Burns and Plastic Surgery, Swansea Plastic surgery Ryan Kerstein ST8 Oxford Plastic surgery Chris West Consultant Leeds Teaching Hospitals NHS Trust Plastic surgery Max Stewart Academic foundation doctor Oxford University Hospitals General medicine Joshua Totty ST3 Health Education Yorkshire and Humber Plastic and reconstructive surgery Salma Eltoum Elamin ST5 Salisbury NHS Foundation Trust Plastics surgery Adam Reid Consultant University of Manchester Plastic surgery Justin Wormald ACF ST5 Stoke Mandeville Hospital, United Kingdom Plastic surgery David Izadi ATP hand fellow United Hospitals Derby and Burton NHS Foundation Trust Plastic surgery Claudia Eichenauer Medical student University College London N/A Mohamed Reza Sheikh Foundation year 1 Surrey & Sussex Healthcare NHS Trust Geriatric medicine Nancy Baxter Professor University of Melbourne Colorectal surgery, scientist Ruth Mitchell Surgeon Walter and Eliza Hall Institute Neurosurgeon Sheikh Momin Foundation year 2 doctor Barts Health NHS Trust Accident and emergency Adam Gilmour Consultant Canniesburn Plastic Surgery Unit, Glasgow Plastic, reconstructive, and aesthetic surgery Christian Greenstreet ST3 Salford Royal Hospital Nephrology/general internal medicine Nick Murch Consultant Royal Free London Acute medicine Baljit Dheansa Consultant Queen Victoria Hospital, East Grinstead, United Kingdom Plastic surgery Zarina Shaikh consultant Royal Cornwall hospital Oral and maxillofacial surgery Alexander Armstrong ST7 Oxford Plastic surgery Michael Gallagher CT1 Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom Plastic surgery Anair Beverly Registrar Oxford University Anesthetics Rhiannon Harries Consultant surgeon and past president of the Association of Surgeons in Training Swansea Bay University Health Board, United Kingdom General and colorectal surgery Thomas Lewis ST4 Lewisham and Greenwich NHS Trust Trauma and orthopedics Jennifer Graystone Consultant Oxford University Hospitals Oral and maxillofacial surgery Eishaan Kamta Bhargava Senior clinical fellow Evelina London Children’s Hospital/Guy’s and St. Thomas’ NHS Foundation Trust Pediatric ear, nose, and throat Abhinav Singh Specialty registrar Northwick Park Hospital Trauma and orthopedics Jonathan B. T. Herron SHO Queen Elizabeth Hospital Plastics Natalie Redgrave CT2 Royal Free Hospital, London Plastic surgery Anushka Aubeelack Specialty doctor Barking Havering and Redbridge University Trust Anesthetics and intensive care unit Laura Jayne Watson ST6 Health Education North East General surgery Giovanni Briganti CT1 Brussels Teaching Hospital CHU Brugmann Psychiatry Jordan Oldbury ST3 Ninewells Hospital, Dundee Plastic surgery Lucy E. Homer ST3 Health Education East Plastic surgery William Taylor ST6 Health Education North East Gastroenterology Rose Gnap ST3 Nottingham University Hospitals Trauma and orthopedics Rachel Howes ST6 Salisbury Hospital Plastic surgery Thomas Bowers ST3 Addenbrooke’s Hospital, Cambridge Histopathology Andrew J. Beamish ST7 Health Education and Improvement Wales General surgery Rhea Liang Consultant/associate professor Gold Coast Health General and breast surgery Megan Rutter ST6 Dudley Group of Hospitals NHS Trust Rheumatology/general internal medicine Rebecca Fisher SHO and M.Ed. student in surgical education Imperial College London General surgery Liana Yamanouchi Foundation year 1 doctor Guy’s and St Thomas’ NHS Foundation Trust General surgery Francis P. Henry Consultant Imperial College Healthcare NHS Trust Plastic and reconstructive surgery Simon Denning Post-CCT fellow The Hospital for Sick Children, Toronto Anesthesia Tharusha Gunawardena SPR Norfolk and Norwich University Hospital Cardiology Kasia Bera ST4 Thames Valley Deanery General surgery J. Aaron Barnes PGY4 Dartmouth-Hitchcock Medical Center Vascular surgery James K.-K. Chan Consultant Stoke Mandeville Hospital & Oxford University Reconstructive plastic surgery Benjamin Dean Post-CCT fellow Nuffield Orthopaedic Centre, Oxford Orthopedics Anenta Ramakrishnan ST5 research fellow Imperial College London Cardiology Suzanne Murphy ST6 Addenbrooke’s Hospital Plastic surgery Vikram Devaraj Consultant Exeter Plastic surgery Cleo Ngadimin MS3 Imperial College London Medical student; president of Imperial College Plastic Surgery Society Rujuta Roplekar Bance Specialty registrar Addenbrooke’s Hospital Ear, nose, and throat David McGill Consultant Glasgow Royal Infirmary Plastic surgery Alexander Woywodt Consultant, clinical professor Lancashire Teaching Hospitals NHS Foundation Trust, UK Medicine Rituja Kamble Foundation year 1 Brighton Sussex University Hospitals NHS Trust Foundation training Elizabeth Sigston Consultant M.B.B.S., F.R.A.C.S., Ph.D., Member of ASOHNS National Training Board Monash Health/Monash University Otolaryngology head and neck Naveen Cavale Consultant King’s College Hospital, London Plastic surgery James Glasbey ST3 Queen Elizabeth Hospital Birmingham General surgery Jo Brown Consultant Royal College of Psychiatrists Forensic psychiatry Adam Peckham-Cooper Post-CCT fellow Director, Association of Surgeons in Training Esophagogastric surgery Nathan Walker Academic teaching fellow St George’s Hospital NHS Foundation Trust Surgery Alex Wilkins ST5 Hull Royal Infirmary General surgery Josh Burke Speciality trainee, general surgery Leeds Teaching Hospital Trust President, Association of Surgeons in Training Stella Vig Consultant surgeon CHS Vascular and general surgery Kirsty Milne Specialty registrar Victoria Hospital Kirkcaldy Trauma and orthopedics Grant Nolan CT1 Whiston Hospital, North West Deanery Plastic surgery Liz Dex AS Imperial Plastic surgery Radhika Dua ST3 King’s College Hospital Oral and maxillofacial surgery Nicholas Cereceda Monteoliva Core surgical trainee Imperial College Healthcare Trust Ear, nose, and throat Kirstie Taylor Registrar Queen Victoria Hospital, East Grinstead Plastic surgery Emma Barlow Core surgical trainee Wales Deanery General surgery Judith Hunter Consultant Imperial Plastic surgery Deborah Verran Consultant surgeon Ramsey Healthcare Australia General and transplant Rachel A. Khaw Foundation doctor Newcastle upon Tyne Hospitals Trust General surgery Daniel Baker Academic foundation doctor Sheffield Teaching Hospitals General surgery Elizabeth Yeung ST7 King’s College Hospital Oral and maxillofacial surgery Samuel Brown Medical student, 4th year University of Leicester Medical student Sanchita Bhatia Medical student Cardiff University STARSurg Steering Committee Isobel Trout Medical student University of Birmingham N/A Victoria Murray Medical student University of Leeds Medical student Jon Simmons Consultant Imperial College Healthcare NHS Trust Plastic surgery Rebekah Overend Nurse educator Bristol Royal Hospital for Children Pediatrics Kenneth A. McLean Foundation year 3/clinical research fellow University of Edinburgh General surgery William Cambridge Medical student University of Edinburgh Medical student Luke Allen 5th-year medical student University of Leeds School of Medicine Medical education Emily C. Mills Foundation interim year 1 doctor Brighton & Sussex University Hospitals Trust Foundation program Sonia Fullerton VMO Peter MacCallum Cancer Centre Palliative Martin King CT2 Western Health and Social Care Trust, Northern Ireland Trauma and orthopedics Mohamed Rabie ST6 Norfolk and Norwich University Hospital General surgery Conor Jones Academic foundation doctor North Bristol NHS Trust Medicine Teresa Chan Consultant physician/assistant dean, Program for Faculty Development McMaster University Emergency medicine Alexander Light Foundation year 1 Bedfordshire Hospitals NHS Foundation Trust Colorectal Roxanna Zakeri Specialty registrar University College London Hospital General surgery Clare Skerritt Registrar Birmingham Children’s Hospital Pediatric surgery Ailbhe Kiely CT1 Royal Stoke University Hospital Plastic surgery Charlie William GP partner Aneurin Bevan University Health Board General practice Roxanna Registrar Imperial College Healthcare NHS Trust Plastic surgery William Kitchen Medical student University of Cambridge, United Kingdom Medical student Thangasamy Sankar Regional medical director and consultant plastic surgeon SK:N Clinics Plastic surgery Foiz Ahmed Consultant Lister Hospital, Stevenage Plastic surgery Samuel Lawday CT1 North Bristol NHS Trust General surgery A. G. C. Hay-David Registrar Queen Elizabeth University Hospital Trauma and orthopedics Sita Clark B.Med.Sc.(Hons.) University of Auckland Otorhinolaryngology Alexander Kamali Specialist Karolinska University Hospital in Stockholm, Sweden Reconstructive plastic surgery Jonathan Dunne Consultant Imperial Plastic surgery Georgina Williams ST7 Imperial College NHS Healthcare Trust Plastic surgery Tinna Harper Arnardóttir M.D. Academic Hospital, Uppsala, Sweden Plastic surgery registrar Rose Penfold ACF ST1 Guy’s and St Thomas’ NHS Foundation Trust ACF in geriatric medicine Ali Arnaout ST5 Cambridge University Hospitals Plastic surgery Shirley Potter Consultant plastic and reconstructive surgeon Mater Misericordiae University Hospital, Dublin, Ireland Plastic and reconstructive surgery SHO, senior house officer; GpST2, general practice specialty trainee year 2; ST, specialist trainee; SPR, specialist registrar; ACF, academic clinical fellow; N/A, not applicable; CT, clinical trainee; CCT, certification of completion of training; ASOHNS, Australian Society of Otolaryngology Head & Neck Surgery; VMO, visiting medical officer; GP, general practitioner. DISCLOSURE The authors have no financial conflicts of interest. Robert M. T. Staruch, M.R.C.S.Botnar Research CentreUniversity of OxfordOxford, United Kingdom Simon Fleming, M.R.C.S.Department of Trauma and OrthopaedicsBarts Health NHSLondon, United Kingdom Ebba Lindqvist, M.D.Department of Plastic and Reconstructive SurgeryNHS LothianEdinburgh, United Kingdom Vimal Gokani, M.R.C.S.Department of Plastic and Reconstructive SurgeryImperial College NHS TrustLondon, United Kingdom

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