Change the focus of degree evaluation from "whether the paper has been published" to "whether the clinical problem has been solved, and whether the solution has reached an academic level"
A young doctor’s path to breaking through barriers
The 7-year-old girl is beautiful and lively, but due to congenital cervical scoliosis, her neck is tilted nearly 40 degrees to the left. In January 2024, Tie Dazhao first saw the girl in the orthopedic ward of Peking University Third Hospital. When he was a child, he thought, "If her neck is straight, she will be a very confident and good-looking girl when she grows up."
At that time, Tie Dazhao had just started studying for a doctorate at Peking University School of Medicine. This girl became the starting point of Dr. Tie Dazhao's project. At the end of June this year, Tie Dazhao's doctoral graduation project was officially reviewed and approved by the Peking University Degree Evaluation Committee. He became the first doctor in the medical field in my country to obtain a degree based on practical results rather than a thesis.
Tie Dazhao paved a new path for those who came after him: the growth of young medical students does not have to be limited to scientific research papers. Young doctors are the backbone of building a healthy China. In 2015, the Fifth Plenary Session of the 18th Central Committee of the Communist Party of China proposed "promoting the construction of a healthy China" for the first time; in 2017, the 19th National Congress of the Communist Party of China elevated "implementing the Healthy China Strategy" to a national strategy. In the past ten years, the Healthy China strategy has gone from top-level planning to implementation, and many young doctors like Tie Dazhao have embedded their own growth in it.
Tie Dazhao's mobile phone contains the WeChat messages of nearly a hundred parents of children with congenital cervical scoliosis. During his three-year PhD, he continued to follow up on these children. Tie Dazhao faced a lot of pressure while completing his doctoral project. It was the recovery and growth of these children that made him feel that no matter how difficult it was, it was worth persevering.
World-class difficult surgeries now have different types
Because it is the first of its kind in China, Tie Dazhao's defense format is also different from other students. In order to let the review experts better understand his practical results, Tie Dazhao also prepared a video. In the video, there are comparisons between preoperative and postoperative results of 5 children with congenital cervical scoliosis. Before surgery, children's cervical vertebrae deviate from the midline, and ordinary movements such as looking straight ahead and balancing shoulders may be a big challenge for them.
In the "Healthy China Action (2019-2030)", there is a special maternal and child health promotion action, emphasizing that "maternal and child health is the foundation of national health" and pointing out that "birth defects not only seriously affect the life health and quality of life of children, but also affect the health quality of the population." Congenital cervical scoliosis is a relatively rare birth defect.
In recent years, the Department of Orthopedics of Peking University Third Hospital has performed more than 130 surgeries in this area. The onset of congenital cervical scoliosis is in the neck. The surgical operation is adjacent to important structures such as the brainstem and cervical spinal cord. It is extremely difficult. A slight difference can lead to paralysis or even death of the patient. For a long time, there has been a lack of systematic case accumulation and classification guidance internationally, and clinical decision-making mostly relies on doctors' personal experience. How to accurately classify and formulate individualized plans is an urgent clinical problem that needs to be solved in this field.
Tie Dazhao still remembers that the operation on the 7-year-old girl lasted 11 hours. The surgery was performed by Mr. Tie Dazhao’s teacher, Sun Yu, a well-known expert in spinal surgery. While watching, Tie Dazhao wondered if there was any way to reduce the difficulty of this operation so that young doctors like him could master it faster.
After several months of preparation, Tie Dazhao's idea of clinically classifying more than 130 cases gradually took shape. After screening, only 100 cases met the research needs. Tie Dazhao selected 70 cases for classification research and the remaining 30 cases for verification. The median age of these 70 patients was 10 years old.
"This rare disease is extremely heterogeneous. There are more than 130 cases, and almost no two cases have similar imaging manifestations." Tie Dazhao said that the essence of classification is to refine and classify the clinical experience in the minds of top experts.
The top expert Tie Dazhao mentioned was Sun Yu. Sun Yu is one of the first experts in China to perform this type of surgery. Decades of clinical experience have allowed him to develop a systematic scientific understanding of this rare disease.
While working on the project, Tie Dazhao often participated in surgical plan discussions hosted by Sun Yu, listened to image analysis, and learned the logic behind the key steps next to the operating table. During this period, his typing work was also continuously iterated.
During this period, Tie Dazhao was still serving as the chief resident physician - like a housekeeper, managing the ward work in every detail. Starting at 7 o'clock in the morning, Tie Dazhao spins like a top all day long. Sometimes he doesn't get off work until 7 or 8 o'clock in the evening. Parting work can only be done after get off work.
However, the work of chief resident physician gave Tie Dazhao a different perspective. Because he participated in almost the entire patient management process, he saw many children come in with crooked necks and were discharged happily after surgical correction.
After they are discharged from the hospital, Tie Dazhao will continue to follow up on them. In order to better demonstrate the practical results at the defense site, Tie Dazhao hoped that parents would take some videos of their children, and the parents agreed. In the final video, the children who once looked at the world with their necks crooked have straightened their necks. They are playing scooters, riding bicycles through puddles, rock climbing, skipping rope...happy and confident.
After more than 10 versions of iteration, Tie Dazhao’s parting work finally took shape. With the assistance of AI technology, he and his team further developed intelligent preoperative planning software based on this classification system. After the doctor inputs the patient's imaging data, the system can assist in analyzing the deformity characteristics, provide reference for preoperative planning, and make the judgment of complex cases more standardized.
Paving a new path for those who come after you
The "Degree Law of the People's Republic of China" (hereinafter referred to as the "Degree Law"), which will be implemented in January 2025, clarifies for the first time from a legal perspective that both practical results and dissertations can be used as important basis for applying for a degree.
According to Zhou Feifei, Tie Dazhao's teacher and leader of the cervical spine professional group of the Department of Orthopedics at Peking University Third Hospital, this is a major benefit for professional degree doctoral students (hereinafter referred to as "experts") and professional degree master's students.
In 2025, many universities such as Tsinghua University will already have doctors who have obtained degrees based on practical results, but there is no precedent in the medical field.
What kind of practical results can meet the requirements for doctoral graduation is the core question to be answered.
Tie Dazhao is a doctor specializing in clinical medicine. Compared with doctoral students with academic degrees, professional doctorate requires longer clinical rotations, and the ability to cultivate is more focused on clinical skills and disease diagnosis and treatment. In March this year, many experts, including the deputy director of Peking University Health Science Center, the vice presidents in charge of teaching at Peking University First Hospital, Peking University Third Hospital, and Peking University People's Hospital, gathered together. They jointly check whether Tie Dazhao's practical results can be used to apply for a doctorate.
After a full morning of discussion, the conclusion became increasingly clear: Tie Dazhao could use this classification result to apply for a doctorate. Zhou Feifei said that this gave him a lot of confidence.
The blind review is the next difficulty. At that time, the vice dean and head of the degree office of the Graduate School of Peking University Health Science Center formed a group with Zhou Feifei and Tie Dazhao. Whenever an expert's blind review result comes back, the person in charge of the Degree Office will notify the group immediately.
The result of the first blind review expert came back, 95 points. Immediately afterwards, the second, third... five experts all gave more than 90 points! This is a very good result, because according to Peking University’s previous requirements for doctoral dissertations, if all blind review scores exceed 90 points, you can apply for the school’s outstanding doctoral thesis.
The defense committee is led by Tang Peifu, an academician of the Chinese Academy of Engineering, and consists of seven authoritative experts in the field of orthopedics in China. The relevant persons in charge of the Ministry of Education and the National Medical Degree Graduate Education Steering Committee provide on-site supervision and guidance. Finally, through a secret vote, the defense committee unanimously approved the defense.
"We have shifted the focus of degree evaluation from 'whether the paper has been published' to 'whether the clinical problem has been solved and whether the solution has reached an academic level.'" Xu Ming, deputy dean of the Graduate School of Peking University and executive deputy dean of the School of Medicine, said that this is not only a new requirement after the implementation of the "Degree Law", but also an exploration of Peking University Medical School to promote the reform of classified training.
As Xu Ming said, this exploration "is not about lowering the academic threshold, but about redefining 'academic' - making clinical problems themselves become academic propositions."
This exploration also makes "people's health as the center" fall into the aspect of talent evaluation - solving patients' clinical problems is the best academic proposition.
China Youth Daily·China Youth Daily reporter Liu Changrong
