Doctors should have the feelings of pursuing the earth

【Medical Master Talk】

Doctors should have the pursuit of the sky and the feelings of standing on the ground. What is the sky? Do high learning, solve complex difficult diseases, and innovate major scientific and technological issues; what is the ground? Serve the community, provide the public with services such as prevention, diagnosis and treatment, rehabilitation, chronic disease management, and elderly care, and build a health medical service system covering the full -scale, full population, full -cycle, and full -dimensional dimension.

The country attaches great importance to health science and technology innovation. Scientific and technological innovation must adhere to the "four aspects", that is, for the forefront of the world technology, the main battlefield of the economy, and the major needs of the country. The fourth "orientation" refers to the health of the people's life and the flag for scientific and technological innovation in the medical field.

The paradigm of scientific research needs to be transformed urgently

■ From knowledge -driven to problem -driven transformation

■ It is necessary to reverse the situation that China ’s scientific and technological innovation input is not competent

Paradigm refers to the collection of academic elements such as values, basic theories, law rules, law rules, law rules, laws of law, technical standards, and effective imitation examples that a scientific community. There are currently two main paradigms in the field of medical research: the research paradigm of knowledge -driven research paradigms and problem -driven types.

The so -called knowledge -driven type is also known as the discipline -driven type. Its innovative motivation mainly comes from the curiosity and curiosity of scholars. The purpose of this research paradigm is to continuously create knowledge and iterative sublimation knowledge, so as to build a more complete knowledge system, without utilitarianity, not to solve specific social and economic development problems. In the early stages of scientific development, the innovation of knowledge -driven types promoted the active development of science and society. For example, the proposal of evolution and cytology, all brought a series of principles and methods for subsequent medical research.

However, in recent years, the model of knowledge -driven research has begun to encounter bottlenecks. It has inherent isolation in organizational forms in the discipline as the boundary. The ability to innovate and solve scientific problems has been repeatedly restricted. Make scientific analysis. In addition, the evaluation criteria of this type of model are relatively single. Based on the evaluation criteria of the dissertation, education, academic title and other indicators, restricting the development of disciplines in various fields.

In the problem -driven research paradigm, the internal motivation of innovation is the problem that needs to be solved in the real world. This model has strong social attributes and utilitarian colors. Focusing on realistic needs, we aimed at developing novel and practical technology products. The organizational form is open and encouraged multi -disciplinary cross -integration. Different from the knowledge -driven research paradigm aimed at the improvement of a single disciplinary knowledge system, the problem -driven research paradigm is to solve the problems in socio -economic development, and at the same time naturally issue new knowledge and theories, thereby promoting the rapid development of the entire discipline. Essence

The research paradigm of the problem -driven type has multiple evaluation standards, not only the thesis factors, but also the academic value, social value, and economic value of the research results. The so -called "no innovative research is blind, no product research is in vain." This sentence fully reflects the core concept of the problem -driven research paradigm. If the future medical research institutions always advertise their rankings, the number of papers, and influence factors, they are actually unconfident. It should be dependent on what kind of value it really brings to the patients and what kind of creation for the health medical service system of society. benefit.

The current investment in medical research in China ranks third in the world, but from the proportion of Chinese high -end medical device imports and domestic production, most of the middle and high -end physiological monitor and ventilator are imported. 80%of the CT machines are imported imports. 90%of ultrasonic instruments are imports, 90%of magnetic resonance are imports, and 90%of ECG is imported ... The import of drugs is still on the rise. The output of my country's current thesis has ranked second in the world, but the quantity of a single papers is still behind the world. Essence

Taking knowledge -driven research paradigms to changes to the problem -driven research paradigm is to encourage cooperation research in multi -disciplinary and multi -field, strengthen the evaluation of value -oriented results. The ultimate purpose of scientific research is to serve social and economic development, not just to achieve some publications. Scholar of thesis.

Doctors need scientific research driven by clinical clinical

■ Create clinical+multidisciplinary research

■ Thesis is just a by -product of scientific research

■ Clinicians play a dominant role in the CDR paradigm

As a place where patients are directly serving patients, the hospital has the unique advantage of driving the problem -driven scientific research. At the same time, it is also the most qualified to evaluate the value of scientific research results. A better scientific evaluation system should be established to encourage doctors to do valuable research.

Beijing Tsinghua Changgeng Hospital practice the CDR paradigm (Clinic-Driven Research (Research on Clinical Problems). This paradigm guides clinicians with actual clinical problems and defines clinical issues as scientific issues or technical issues to academic problems academic problems to academic problems. Research. In the process, the technical and knowledge that clinicians do not have, and can be combined with scientists and engineers to study and solve them, forming a cross -study of "clinical+multidisciplinary", including transformation of medicine, social sciences, and humanities. Essence Such as the study of health big data, the protection of personal privacy and data on different centers, etc., will need to be a joint legal expert ...

Clinicians establish partnerships with experts and scholars in related fields to form a solution, and many key problems in many health medical systems can be solved. This scheme can be a standard specification of disease diagnosis and treatment, a practical guide, or an innovative drug or medical equipment, all collectively referred to as scientific research products. The paper belongs to the by -product of it. Doctors do not exclude papers, because with the scientific research results and products of thesis and products, they can be applied by more doctors and peers, and they can more extensive benefits to patients and society. The value of medical research can be reflected through papers, but it cannot be used as the sole measure. The solution in the CDR paradigm will return to the clinic and test it through specific applications. The new problems that appear will continue to be studied and optimized, so as to form a closed -loop research idea, which is very different from the knowledge -driven research. The latter relies on massive literature. Designing and researching, it is easy to produce research routines. Even if the output of high -quality papers, the design of scientific research routine may not be a problem faced in the real world.

Clinicians should play a dominant role in the CDR paradigm and assume responsibility for the mission. First of all, we must have a pair of wise eyes that find problems, and can condense into scientific or technical problems, and then find a partner such as scientists, engineers, sociologists, and humanistic scholars. Docking integration and joint research. Secondly, we must guide the entire research process from clinical needs, and finally propose strategies and solutions to benefit patients.

Clinicians have a lot of promise under the entire CDR paradigm. We cannot be satisfied with the use of existing knowledge to take care of patients. We must create knowledge, create technology, and solve the problems and pain points in existing health medical services. The clinical business such as outpatient clinics, surgery, and inspection is busy. It cannot become an excuse for clinical doctors in innovation. It shoulders the responsibility of innovating and health care service systems and improving health medical services. It is the attitude of clinicians.

Seeking multi -target optimization surgical intervention

■ The new rule of "three elements balance"

■ Visualization, quantified and controllable certainty surgical intervention technology

I am a liver and gallbladder pancreatic surgeon. I want to share with you a little about it -the surgery cannot be used as the ultimate goal. The ultimate goal of the operation is to maximize the health income of patients. Therefore, it is necessary to take into account the protection of the patient's organs and the control of the patient's whole body, thereby achieving the safety, efficiency, and minimally invasive surgical intervention, and the best solution to the disease. This is the rule of "three element balance".

To achieve a technical balance of three elements, it is necessary to rely on visualization, quantified and controllable certainty surgical intervention technology. Specifically, we have studied computer -aided surgery planning systems, relying on artificial intelligence to allow doctors to observe the relationship between liver structure, liver lesions, and the relationship between liver lesions and anatomical structures. It took about 2 hours to make a patient's liver surgery plan in the past. It only takes 15 minutes to use this system now, which greatly improves efficiency. On the basis of visualization, we have studied the quantitative analysis of the liver reserve function. It is clear how much liver must be kept when the liver is removed, and the patient can be safe and allows the doctor to "count under the knife." In terms of controllable technologies, such as controlling liver blood flow bleeding, in the past, the blood flow of the entire liver was completely blocked, which inevitably caused liver ischemia. We have studied selective door vein blocking, so that we can control the liver and blood flow, but also avoid damage caused by liver ischemia; we also study the safety time of the liver into the liver ischemia, which is designed to optimize the liver surgery. The liver blood flow control solution provides theoretical basis, etc. These are the problem -driven studies we do.

Through a series of new technologies that can be visualized, quantified, and controllable to achieve the three elements of "lesions", "protection of organs" and "damage control", the concept of precision surgery and accurate hepatobiliary surgery have been formed. It has been widely accepted and promoted.

Gentle ditch of cross -basic medical research and clinical research

■ Team construction: multi -dimensional medical team and talent training

■ Platform construction: Medical and workers cross -combined service clinical drive -type medical research

■ System construction: layout system thinking methods, innovative academic evaluation system

At present, there is still a gap between basic research and clinical research. To break through, it is necessary to rely on the organizational mechanism, that is, to do a good job of team building, platform construction, and system construction, to create a role that can give full play to the role of clinicians, promote clinical and foundation, science and engineering combination Clinical -driven medical research system.

The medical sciences of the General University must first establish three medical research teams, scholars, full -time research teams, and part -time research teams from life sciences, basic medicine, and science and engineering subjects. At the same time, we must improve the three support teams, that is, technical support teams, conversion support teams, and administrative support teams. At present, Beijing Tsinghua Changgeng Hospital is building such a structure, hoping to use the mechanism for the coordinated governance of medical and administrative division of labor, thereby building a scientific research platform at a high level and high quality.

In terms of talent training, we need to deploy graduate training including medical workers. At different development stages of doctors, the depth and height of their academic research intervention are different. Although the doctors' personal efforts are the most important, they also need institutional support. At present, the Beijing Tsinghua Chang Gung Hospital has established a doctor's development center to provide a staged and continuous support for the professional development and academic development of the physician, so that every physician can get a stable career development. In terms of platform construction, a research center and clinical research laboratory that set up cross -medical workers and workers to build a large platform for the entire medical worker. At the same time, a series of medical workers with the basic principle of "dual PI" were established. "Double Pi" is a clinician who knows the pain points of the field at the same time, and a non -clinical medical field to form a research group to obey the needs of clinical issues -driven medical research.

In the data era, clinical medical research must also be transformed in methodology, including thinking methods and technical methods. The reason why medical research encountered bottlenecks was largely restricted by thinking and methods. Now we have entered the era of intelligent science, or we hope it is a era of systematic medicine. One of the characteristics of this era is that we already have the ability to process massive data processing, high -speed computing power, and artificial intelligence technology. You can find data through intelligent algorithms to find data The relationship between meters is combined with medical research to find causal relationships. Therefore, we should use systemic thinking to solve the perception of the essence of complex diseases of the human body, and then innovate the entire health medical theory and technical system.

The development path and classification evaluation system of doctors also need to be continuously promoted. Tsinghua University Clinical Medical College has taken the lead in reforming the personnel system of clinical medical disciplines in China. Physicians based on personal interests and organization development needs, and in academic doctors (Academic Clinician) Colinician Educator or Research Doctor (Clinician Scientist). Performance assessment. Promote the comprehensive capabilities of the entire clinical teacher team, and achieve the goal of high -level medical construction. At the same time, the professional expertise and academic characteristics of the physician have been fully developed. In the end The individual specialty has formed a complementary advantage in the group, and the coordinated and powerful long -term effects have achieved the academic ecology that is perfectly combined with the perfect combination of the physician group and the individual expertise.

Focus on the academic innovation theory and technical methods, highlight its value to change clinical practice and teaching practice, establish a multi -value evaluation system, and promote the research driven by clinical issues. In the university, it is necessary to implement the regulations on intellectual property management, increase the enthusiasm of physicians and cooperative experts, and eventually set up a rainbow between clinical medicine and basic medicine research.

(Author: Dong Jiahong, an academician of the Chinese Academy of Engineering, Dean of Tsinghua Chang Gung Hospital, Beijing)

【Edit: Tian Boqun】

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