Clinical-medicine journal workflow (en-clinmed-journal-workflow)

Purpose

This is the routing skill for the specialty-clinical bundle. It does not replace a single-journal profile; it first classifies the study by specialty, study design, and evidence strength, then routes into the matching per-journal skill for fit and re-framing. It is a sibling to en-natsci-journal-workflow (which holds the general big-four and broad-specialty clinical flagships). These skills are venue-fit aids only — not clinical, diagnostic, or regulatory advice.

Ask four things first

1. Specialty: internal/general medicine, oncology, cardiology, neurology, pediatrics, psychiatry, surgery, respiratory/critical care, nephrology, endocrinology/diabetes, hepatology/GI, allergy/immunology, rheumatology, stroke, radiology, anesthesiology, obstetrics/gynecology, or urology?
2. Study design: randomized controlled trial, prospective cohort / observational study, diagnostic-accuracy study, systematic review / meta-analysis, guideline / consensus, mechanistic/translational study, or narrative/invited review?
3. Evidence strength & impact: practice-changing definitive trial, an important but not definitive result, a hypothesis-generating or exploratory finding, or a synthesis?
4. Audience: the whole specialty (a society/JAMA-Network/Lancet specialty flagship), a sub-specialty community, or a general-medicine audience (route up to the big-four in the natural-science bundle)?

Quick routing

Manuscript signature	Prefer skill
General internal-medicine trial / comparative effectiveness	jama-internal-medicine
Oncology clinical trial / practice-changing	jama-oncology / annals-of-oncology
Authoritative oncology review	nature-reviews-clinical-oncology
Cardiology specialty study	jama-cardiology
Neurology clinical study	jama-neurology
Neuroscience-to-clinical brain disorders, mechanism + clinical	brain
Cerebrovascular / stroke	stroke
Pediatrics	jama-pediatrics
Psychiatry / mental-health (clinical or population)	jama-psychiatry / the-lancet-psychiatry
Surgery / perioperative outcomes	jama-surgery
Respiratory / pulmonary / critical-care medicine	the-lancet-respiratory-medicine / american-journal-of-respiratory-and-critical-care-medicine
Intensive / critical care	critical-care-medicine
Diabetes / endocrinology (clinical or population)	the-lancet-diabetes-and-endocrinology / journal-of-clinical-endocrinology-and-metabolism / diabetologia
Nephrology / kidney disease	journal-of-the-american-society-of-nephrology / kidney-international
Liver disease / hepatology	journal-of-hepatology / hepatology
Gastroenterology (clinical)	american-journal-of-gastroenterology
Allergy / clinical immunology	journal-of-allergy-and-clinical-immunology
Rheumatology / autoimmune	arthritis-and-rheumatology
Public-health / population-health intervention	the-lancet-public-health
Diagnostic imaging / imaging AI	radiology
Anesthesiology / perioperative medicine	anesthesiology
Obstetrics / gynecology	american-journal-of-obstetrics-and-gynecology
Urology	european-urology

Sibling-journal disambiguation

Confusable targets	Decision rule
A JAMA Network specialty title vs the general big-four (NEJM/JAMA/Lancet/BMJ in the natural-science bundle)	A practice-changing, broadly significant trial may belong at the general venue; a strong specialty-relevant result routes to the JAMA Network / Lancet specialty title.
jama-oncology vs annals-of-oncology	Route by audience and society fit (JAMA Network vs ESMO) and re-check current scopes; both take high-quality oncology clinical research.
journal-of-the-american-society-of-nephrology vs kidney-international	Both are top nephrology venues (ASN vs ISN); route by society fit and emphasis and re-check current scopes.
journal-of-hepatology vs hepatology	EASL vs AASLD flagships; route by society fit and audience and re-check current scopes.
the-lancet-psychiatry vs jama-psychiatry	Both are top psychiatry venues; route by family fit (Lancet vs JAMA Network) and the framing/audience.
Specialty journal vs the-lancet-public-health	A population-health/policy intervention routes to public health; a disease-specific clinical result routes to the specialty journal.

Decision rules

• Match the reporting guideline before submitting. RCT → CONSORT + prospective trial registration (number in the manuscript); systematic review → PRISMA; observational → STROBE; diagnostic accuracy → STARD. These are prerequisites, not nice-to-haves, at these venues.
• Evidence hierarchy sets the venue. A definitive randomized trial outranks an observational study, which outranks a single-center case series; route the design to the venue that expects that level of evidence.
• Specialty fit beats prestige. A strong nephrology or rheumatology result is often better served by the society specialty flagship than by a general journal that will desk-reject for limited general interest.
• Review vs primary. Nature Reviews Clinical Oncology and similar are largely invited/commissioned — propose, do not submit unsolicited primary data.
• Ethics, consent, and disclosures (IRB approval, informed consent, ICMJE COI and authorship, data sharing) are gating items at every clinical venue.
• Always enter the single-journal skill's official-submission checklist before submitting; never rely on a stale template.

Output format

[Top journal skill] <skill-name>
[Alt 1] <skill-name> (reason)
[Alt 2] <skill-name> (reason)
[Do not submit to] <journal> (one-line mismatch reason)
[Study design / reporting guideline] <RCT-CONSORT / cohort-STROBE / review-PRISMA / diagnostic-STARD>
[Biggest current gap] evidence-strength / specialty-fit / registration / reporting-checklist / ethics / official requirements
[Next step] invoke <skill-name> for single-venue fit and re-framing