AMA citation style uses superscript numbers in the text, assigned in the order sources are first cited, and a numbered reference list at the end. It is set out in the AMA Manual of Style, now in its 11th edition.
AMA is used by many medical journals and health-sciences programs. This guide covers in-text citations, the reference list, the author rule and examples for common source types.
AMA Style in Four Rules
- Cite with a superscript number, numbered in order of first citation.
- Reuse a source's number every time you cite it again.
- List references numerically in citation order, not alphabetically.
- List up to six authors; with seven or more, list the first three, then "et al".
In-Text Citations
Place a superscript number where you use the source. In AMA, the superscript goes outside full stops and commas but inside colons and semicolons, with no space before it.
Early recognition of sepsis improves survival.1 Two later trials confirmed the benefit of a time-limited treatment bundle,2,3 although adherence in primary care remains low4; further work is needed.
Several Sources at Once
- Separate sources: commas with no spaces, 1,3,5
- A continuous range: a hyphen, 2-4 rather than 2,3,4
- A mix: 1,4-6,9
Quoting with a Page Number
For a direct quotation, add the page in parentheses within the superscript, after the reference number.
The authors describe delayed escalation as "the most preventable failure in ward care."3(p214)
Medical writing quotes sparingly. Paraphrasing and synthesizing several studies, each with its number, usually reads better and shows understanding.
The Reference List
Under the heading References, list sources numerically in citation order. In the list, the numbers sit on the line, not in superscript.
| Element | AMA rule |
|---|---|
| Author names | Surname then initials, no full stops or spaces: Smith JR |
| Number of authors | Up to six listed; seven or more, first three then et al |
| Article title | Sentence case, no quotation marks, not italic |
| Journal name | Abbreviated (NLM style) and italic: N Engl J Med |
| Book title | Title case and italic |
| Publisher location | Omitted in the 11th edition |
| DOI | doi:10.xxxx at the end, no space, preferred over a URL |
| Web sources | Include "Accessed Month Day, Year" before the URL |
The punctuation does a lot of work: a full stop after the title, a semicolon between year and volume and a colon before the pages. Copy it exactly.
AMA Reference Examples
Journal Article
1. Okonkwo A, Ruiz M, Patel S. Early mobilization after abdominal surgery: a pilot trial. Br J Surg. 2021;108(6):712-719. doi:10.1093/bjs/znab123
Journal Article with Seven or More Authors
2. Smith J, Lee K, Adeyemi T, et al. Sepsis recognition in primary care. Lancet. 2022;399(10330):1123-1134.
Book
3. Marieb EN, Hoehn K. Human Anatomy & Physiology. 11th ed. Pearson; 2019.
Chapter in an Edited Book
4. Patel R. Wound healing. In: Adeyemi T, ed. Principles of Surgical Nursing. 3rd ed. Wiley; 2020:142-158.
Web Page
5. Sepsis: recognition, diagnosis and early management. National Institute for Health and Care Excellence. Updated March 2024. Accessed May 4, 2025. https://www.nice.org.uk/guidance/ng51
Report from an Organization
6. World Health Organization. Global Report on the Epidemiology and Burden of Sepsis. World Health Organization; 2020. Accessed May 4, 2025. https://www.who.int
Examples use illustrative details; check the real publication data for your own sources. A web page with no named author begins with its title.
AMA Compared with Vancouver and APA
| Feature | AMA 11th | Vancouver | APA 7th |
|---|---|---|---|
| In-text | Superscript number | Number in brackets or superscript | (Author, Year) |
| List order | Citation order | Citation order | Alphabetical |
| Many authors | Seven or more: first three, et al | More than six: first six, et al | Up to 20 listed; 21 or more: first 19, ellipsis, last |
| Typical fields | Medicine and health journals | Medicine, nursing | Social sciences, nursing |
AMA and Vancouver are close relatives, so students often switch between them. The two differences to remember are AMA's superscript numbers and its author rule.
Reference Managers and PubMed
Because numbering depends on order, inserting a new source shifts every later number in both text and list. A reference manager such as Zotero, Mendeley or EndNote with an AMA style renumbers automatically.
PubMed exports give you correct author formats and journal abbreviations, the two most error-prone parts of an AMA entry. Never abbreviate journal names by guesswork.
Common AMA Mistakes
- Using Vancouver's six-author rule instead of AMA's "first three, et al" for seven or more.
- Listing references alphabetically.
- Giving a source a new number when it is cited again.
- Putting article titles in quotation marks or title case.
- Writing journal names in full instead of the standard abbreviation.
- Adding full stops or spaces in initials, such as "Smith J. R." instead of "Smith JR".
- Placing the superscript before a full stop instead of after it.
- Leaving out the accessed date on web sources.
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Frequently Asked Questions
Yes. Superscript numbers in the text, assigned in citation order, with a matching numbered reference list.
Up to six. With seven or more, list the first three followed by "et al".
No. They are numbered in the order each source is first cited.
Outside full stops and commas, inside colons and semicolons.
No. The 11th edition gives the publisher and year only.
Use the DOI when a journal article has one, written as doi:10.xxxx with no space and no full stop at the end. Use a URL, with an accessed date, only when there is no DOI.
Yes. The abbreviated journal name is italic, while the article title is in plain text and sentence case.
The AMA Manual of Style, 11th edition, published in 2020.