The Beijing Children’s Hospital “4+4” project (4 years non-medical bachelor’s + 4 years medical doctorate) focuses on interdisciplinary elite cultivation. The exposure of Dong Xi Ying’s case in 2025 revealed her reliance on family background (medical/scientific research lineage) to gain entry into the program, raising concerns about the ambiguity of her qualifications, allegations of plagiarism in her dissertation, and exposing contradictions between its elite recruitment model and fairness, as well as ongoing debates regarding shortened study durations and clinical internship training.

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Writing a blog: Harmony 4+4 Origin and Development, Core: A Corner of Tian Gong, Seen by Mortals, Dong Xiaojie’s Family Background, Normal Medical Doctor Cannot Graduate in Eight Years, Dong Xiaojie’s Family Background & Educational Background

Harmony 4+4: Deconstructing Medical Education’s “Tiangong” (Heavenly Palace)

The “4+4” project at the Beijing Union Medical College, launched in 2018, has been viewed as China’s “Tiangong” (Heavenly Palace) in medical education. This project, designed to mimic the American medical education system, adopted the philosophy of “nurturing multidisciplinary individuals, those who love medicine, and talents from across the nation.” It aimed to create a rift within traditional Chinese medical education by focusing on: replacing the traditional 5+3+3 (five-year bachelor’s degree + three-year master’s degree + three-year doctoral degree) model with four years of non-medical undergraduate education plus four years of medical doctorate training, to cultivate cross-disciplinary leadership talent in medicine.

This model’s “Tiangong” attribute is reflected across three dimensions:

1. Elite Recruitment: Early on, applicants were required to come from universities ranked within the top 50 by QS/Times/US News or among the top 10 (e.g., Barnard College) in US News’s liberal arts and sciences rankings. Although later relaxed to the top 100, a GPA of 3.6 or higher, or ranking within the top 30 of their class, was still required.

2. Internationalized Training Pathways: The project utilized American-style organ-system integrated courses and PBL (Problem-Based Learning) teaching methods. Students were expected to complete core courses such as anatomy and pathology within four years and participate in clinical internships.

3. Controversial Quality Output: Despite a slightly lower passing rate on the physician licensing exam (95.2%) compared to the traditional eight-year model (98.5%), graduates predominantly entered Union Medical College hospitals, with their career development showing no significant difference from traditional pathways.

Dong Xiyi Incident: Peering Through the “Heavenly Palace” Crack – A Glimpse of Privilege

In April 2025, the extramarital affair involving Xiao Fei, a thoracic surgeon at the China-Japan Friendship Hospital, triggered an investigation into the “mysterious veil” surrounding the Covariance 4+4 project. The background and credentials of Dong Xiyi, the central figure in the scandal, sparked three key questions:

1. Ambiguity Regarding Educational Background:

   • Dispute Over Undergraduate Institution: Dong Xiyi claimed to have graduated from Columbia University, but her actual enrollment was at Barnard College (ranked 14th among top liberal arts colleges according to US News in 2025). Despite the college meeting Covariance’s requirement of “top 20 liberal arts schools,” her diploma simultaneously listed both “Barnard College” and “Columbia University,” which could easily be misinterpreted as a Columbia University graduate within the domestic recruitment market.
   • Dispute Over Professional Field: An economics undergraduate degree combined with a clinical medicine doctorate is considered to align with the 4+4 project’s positioning of “multi-disciplinary background,” but it has been questioned for lacking foundational pre-medical courses. Her doctoral dissertation, “Research on Multi-modal Image Fusion Technology in Medical Imaging Analysis,” was alleged to closely resemble a patent developed by North Korea Tech, raising concerns about academic misconduct.

2. Special Characteristics of Family Background:

   • Monopoly of Academic Resources: Her father served as Secretary of the China Metallurgical Construction Research Institute, and her mother was Deputy Director of the North Korea Tech Engineering Technology Institute. Her grandfather was a professor in Covariance’s imaging field, and her paternal grandparents were foreign professors in the materials field. This “medical + research + university” composite family background provided her with implicit resources such as recommendation letters (requiring recommendations from two biomedical associate professors) and research collaborations (such as North Korea Tech patents).
   • Jump in Career Path: She switched from thoracic surgery during internship to urology, and her research direction spanned bone and joint, digestive system, and imaging fields, raising questions about “paved the way for resources.”

3. Magnified Dispute Over Length of Study:

   • Rationality of Time Compression: Traditional medical doctorates require 11 years (5+3+3), while the 4+4 project compressed this time to 8 years. Although Covariance emphasized “course integration” and “early clinical practice,” some doctors pointed out that her clinical internship period (12 months) was less than the traditional eight-year program (18 months), potentially hindering skill accumulation.
   • Dispute Over Reduced Internship: Some internship bases allowed 4+4 graduates to reduce their internship by one year, raising concerns about disrupting industry fairness.

The Medical Education Quagmire Behind the Controversy

The Dong Xiying incident reflects deep contradictions within Chinese medical education:

1. Conflict Between Elitism and Equity:

   • The “application-assessment” model of the 4+4 program is essentially a transplant of the American medical school model, but China lacks standardized exams like MCAT, relying instead on subjective evaluations such as letters of recommendation and research experience, which are susceptible to influence from family background.
   • Data shows that in the 2023 graduating class of 4+4 students, 30% came from Qingbei Fuzhou (Jilin, Beijing, Zhejiang), and 25% from overseas top universities; the impact of family background on applications is significant.

2. The Reality of Curriculum Reform:

   • The Cost of Time Compression: 4+4 students produce significantly fewer research outputs (such as the number of papers) than traditional eight-year programs, and are accused of “prioritizing clinical work over research.”
   • Division in Industry Recognition: Three-class hospitals prioritize the reputation of Covance (commonly known as “Kohe”), while基层医院 (jīchéng yīyuàn - primary care hospitals) maintain a cautious attitude towards the clinical abilities of 4+4 graduates.

3. The Misguided Pursuit of International Alignment:

   • The American 4+4 model requires passing the MCAT exam and completing 3-7 years of residency, while China’s 4+4 program simplifies both admission and residency stages, leading to “form resembling substance but lacking true substance.”
   • Data from the Ministry of Education shows that in 2024, the national enrollment of medical doctors under the 4+4 program was less than 5%, and its large-scale promotion still faces resistance.

Conclusion: Reconstructing the “Tiangong” Order for Medical Education

The controversy surrounding the Keho 4+4 project fundamentally represents a collision between elite education and public expectations. When a corner of “Tiangong” (the Palace of Heaven) was glimpsed by mortals, it exposed not just isolated instances of flaws, but deeper contradictions within the entire medical education system. Future reforms must focus on three levels:

1. Implement Transparent Selection Mechanisms: Introduce standardized exams (such as a Chinese version of MCAT) to reduce the influence of subjective factors like letters of recommendation.
2. Extend Clinical Training Cycles: Restore clinical training cycles for 4+4 graduates to 3 years, ensuring that clinical competence is achieved.
3. Strengthen Process Oversight: Establish an academic integrity review mechanism and conduct rigorous originality verification for interdisciplinary research.

Medical education’s “Tiangong” should not be the privilege of a few; it should truly be a cradle for nurturing medical elites. Only when fairness in selection mechanisms, rigor in the training process, and norms in professional development are comprehensively guaranteed will this “Tiangong experiment” in medical education truly take root and flourish.