Mitchell S. Fourman, MD, M.Phil., FAAOS

A history major turned orthopaedic spine surgeon, Mitchell S. Fourman, MD, M.Phil., FAAOS, exemplifies the versatility of a humanities education. Now an Assistant Professor of Orthopaedic Spine Surgery and Director of Spine QA/QI and Education, Dr. Fourman credits his undergraduate training in history with shaping his analytical approach, leadership style, and commitment to education. In this alumni spotlight, he reflects on his academic journey, the value of historical thinking in medicine, and advice for today’s history students.

On Choosing History

1. What drew you to major in history as an undergraduate, and how did that choice shape your academic foundation?

I have always been interested in history. I've been a history nerd since high school! My favorite teachers year after year were all history teachers, who in turn became some of my closest mentors and people who have truly altered how I perceive the world and myself as an academic. My first interaction with Stony Brook was through its history department, when I took courses during the summer semesters after junior year of high school. One of my favorite aspects of studying history was considering context - how historical events were seen in their day vs. how they are now. That consideration led to a significant commitment to the humanities in both undergrad and grad school.

2. Are there specific courses or experiences from your history program that continue to influence your work today?

I - like almost any other who took the class - still think a lot about Professor Barnhart's WW2 simulation course. Beyond the obvious beauty of trying to live a boardgame came my first dose of understanding the nuance of diplomacy and competing priorities. We had to think about not our own sympathies and priorities but those of our assigned character when making decisions. I don't think I had ever taken such a multidimensional course before, and I doubt I ever will again. I still consider lessons learned during that course when interacting with administration and colleagues at the hospital. 

From History to Medicine

3. When did you decide to pursue medicine, and how did you navigate the transition from the humanities to medical training?

I was honest during my interview for the BA-MD program at Stony Brook. I had no idea if I wanted to be a doctor at the time. My father was a physician at Stony Brook so I always considered the hospital a second home, either through watching him practice or volunteering in the clinic myself. I didn't truly settle on becoming a physician until I became a firefighter/EMT with the Stony Brook Fire Department while I was an undergrad. That early dose of patient care and work "in the trenches" as part of a paramilitary organizaion allowed me to understand that the humanities and medicine are one and the same. They are just studying different aspects of humanity. With respect to transitioning from the humanities to medical training, thanks to Stony Brook I never had to make that shift. I was allowed an extra year to earn a masters in Sociology at Cambridge before starting medical school, and the MD with Distinction in the Humanities program allowed me to study bioethics with Dr. Stephen Post and Dr. Andrew Flescher. Even as faculty at Albert Einstein Medical College in the Bronx I spent 2 semesters as a faculty preceptor in their bioethics course. I never transitioned away from the humanities - medicine was just another fold in that cloth. 

4. In what ways did your history education prepare you for medical school and academic medicine?

History is full of people who had early struggles before finding success in their field. The transition to medical school from a social sciences training was a challenge. Taking stock that others had to learn to succeed before doing so themselves gave me some hope, and motivation, to do the same. 

History in Practice

5. Which skills developed as a history major—such as critical analysis, writing, or contextual thinking—do you rely on most in your current role?

Something social sciences majors do that students on a pure pre-med track do not is write, a lot. That writing can sometimes be to directly answer a question, but as a history major we write to analyze and contextualize a question. There is no right answer, but there is reasonable vs. unreasonable thought. I think when discussing surgery, a topic that can bring about an existential crisis for a patient, using the right words - and the right logic - is key to providing the patient with comfort and confidence with a proposed care plan. I don't think there is anything more important to a medical relationship than trust. I think as a history major that trust is easier to build with my patients. 

A second benefit that being a history major provided to my career is that I don't fear writing, and never really did. I run the spine research group for the orthopaedic spine division at Montefiore. Much of what we study is not useful unless it appears in a peer-reviewed journal. I learned how to write from my mentors as a history major, and my research mentors in the school of medicine drove me to hone the craft of writing the concise manuscript. I am immensely appreciative of that teaching. 

6. How has historical thinking informed your approach to patient care, research, or teaching?

Late in my surgical training I spent a year as an orthopaedic oncology fellow at Massachusetts General Hospital, one of the oldest and most storied hospitals in the United States. One thing I learned quickly about Mass General and Harvard Medical School is that they believe in, and often refer back to, the evolution of medicine through their institution. History was a tenet of my training as an orthopaedic oncologist. Mass General served as the origin of incredible surgical milestones, but also hosted many terrible mistakes. My mentors there never stopped reminding us that every successful technique taught at MGH was the result of several that had failed, and failures meant lives lost. This realization of the mortality of medicine and those who practice it promoted humility, and removed the pride that can often blind surgeons from accepting the flaws of their own practice. Historical thinking through my training serves as a constant guide, reminding me that my technique is never polished, my philosophy never set in stone, and my successes only fleeting.  

Leadership & Systems Thinking

7. As Director of Spine QA/QI and Education, how do you approach quality improvement and institutional change?

The biggest change we have seen in medicine is that we are finally working out what "quality" truly is. How should we consider quality when it comes to medical care? Is it based on cost? Length of stay? Success? For that matter, what does success even mean? One thing I've truly enjoyed learning about in my role in Spine QI is how an institution evaluates quality, and how quality means different things to the patient, physician, and corporate office. A struggle in medicine in general is reconciling those often competing viewpoints. I will make no-one mistake that I have the answers for this. However, hoping to find them was one of the motivations I had behind starting an executive MBA at Yale this summer. Their humanities-driven curriculum I think is the ideal for healthcare providers. They too won't have all the answers, but I'm hopeful that I may be better able to interact with our system after this additional training. 

8. Do you see parallels between historical research methods and quality improvement or outcomes-based medical research?

Perhaps the most important quality improvement methodology that we use in the modern era is historical. The Six Sigma method was created as a way to optimize car manufacturing, using specific methodology to maintain balanced production, improve efficiency, and develop[ an optimal work culture committed to continuous improvement. We live that history when committed to that process. 

Advice & Reflection

9. What advice would you give current history majors who are unsure how their degree translates into career opportunities?

In general, I do not think that the exact major you declare in college reliably translates into who you will become. Being a history major doesn't mean that you can't learn how to code, if that's what you want to do. Being a history major doesn't mean that you can't go into business, be a doctor, or be a leader. Being a history major, to me, is just an interest in understanding the most available lessons we have as humans, which are the lessons of the past. Beyond that, there is no limit to what we can seek to become as a learner and a professional. 

 10. Looking back, what do you wish you had known as an undergraduate history student?

I loved my undergrad years and will forever wear Seawolf colors with pride. Stony Brook was where I made some of the closest friendships that I have to this day, where I fell in love for the first time, and where I became brave enough to fail....a lot. However, a mistake I made as a student was always looking towards the next phase of life. It is often scary to be in the present as an undergrad. You have time, friends, sports, relationships, and the imminent fear of the future all coming right at you. I wish that I took more time to pause and really think about the concepts that I learned in class, not just accept course teachings as gospel. As a result, much of the learning that I had as a history major came years after I graduated. Perhaps that's the greatest gift of being a history major - as time goes by we consider our taught concepts in a very different light!