Vancouver system

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The Vancouver system, also known as Vancouver reference style or the author-number system, is a citation style that specifies punctuation, casing of titles, and italics. It is popular in the physical sciences, and is one of two referencing systems normally used in medicine, the other being the author-date, or "Harvard", system.[1][2] This style is used by MEDLINE and PubMed.[3]

Although in use since the nineteenth century, "Vancouver style" was formalized in the document Citing Medicine in 1978 by the International Committee of Medical Journal Editors.[4] It was named because the first meeting of the group took place in Vancouver.

More broadly, some citation styles other than Citing Medicine are given the name Vancouver if they follow the practice of numbering authors. The AMA reference style, which follows the same author number scheme but differs in italics and bracketing, is such an example.


Author-number systems have existed for over a century and throughout that time have been one of the main types of citation style in scientific journals (the other being author-date). In 1978, a committee of editors from various medical journals, the International Committee of Medical Journal Editors (ICMJE), met in Vancouver, BC, Canada to agree to a unified set of requirements for the articles of such journals. This meeting led to the establishment of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (URMs). Part of the URMs is the reference style, for which the ICMJE selected the long-established author-number principle.

The URMs were developed 15 years before the World Wide Web debuted. During those years, they were published as articles or supplements in various ICMJE member journals. These included the 1991 BMJ publication,[5] the 1995 CMAJ publication[6] and the 1997 Annals of Internal Medicine publication.[7] In the late 1990s and early 2000s, journals were asked to cite the 1997 JAMA version[8] when reprinting the Uniform requirements.

In the early 2000s, with the Web having become a major force in academic life, the idea gradually took hold that the logical home for the latest edition of the URMs would be the ICMJE website itself (as opposed to whichever journal article or supplement had most recently published an update). For example, as of 2004, the editors of Haematologica decided simply to invite their authors to visit for the 2003 revision of the Uniform requirements.[9]

Since the early to mid-2000s, the United States National Library of Medicine (which runs MEDLINE and PubMed) has hosted the ICMJE's "Sample References" pages.[10] Around 2007, the NLM created Citing Medicine, its style guide for citation style, as a new home for the style's details. The ICMJE Recommendations now point to Citing Medicine as the home for the formatting details of Vancouver style.[4] For example, in the December 2013 edition of the ICMJE Recommendations, the relevant paragraph is IV.A.3.g.ii. (References > Style and Format).[4]

Sample usage

Labelling citations

References are numbered consecutively in order of appearance in the text – they are identified by Arabic numerals in parentheses (1), square brackets [1], superscript1, or a combination[1].

Placing citations

Several descriptions of the Vancouver system say that the number can be placed outside the text punctuation to avoid disruption to the flow of the text, or be placed inside the text punctuation, and that there are different cultures in different traditions.[11][12] The first method is recommended by some universities and colleges,[13] while the latter method is required by scientific publications such as the MLA[14] and IEEE[15] except for in the end of a block quotaton. (IEEE are using Vancouver style labels within brackets, for example [1] to cite the first reference in the list, but otherwise refer to Chicago Style Manual).[15] The original Vancouver system documents (the ICMJE recommendations and Uniform Requirements for Manuscripts Submitted to Biomedical Journals) do not discuss placement of the citation mark.

Format of citations

Different formats exist for different types of sources, e.g. books, journal articles etc. Author names are abbreviated to at most two initials.[16] Although Citing Medicine does not explicitly mandate merging initials (e.g. "R. K." would be merged into "RK"), the examples used throughout the book do.

Journal articles

Standard journal articles

  • Leurs R, Church MK, Taglialatela M. H1-antihistamines: inverse agonism, anti-inflammatory actions and cardiac effects. Clin Exp Allergy. 2002 Apr;32(4):489-498.
  • Tashiro J, Yamaguchi S, Ishii T, Suzuki A, Kondo H, Morita Y, Hara K, Koyama I. Inferior oncological prognosis of surgery without oral chemotherapy for stage III colon cancer in clinical settings. World J Surg Oncol. 2014 May 10;12(1):145. [Epub ahead of print]

As an option, if a journal carries continuous pagination throughout a volume (as many medical journals do), the month and issue number may be omitted.

  • Thomas MC. Diuretics, ACE inhibitors and NSAIDs – the triple whammy. Med J Aust. 2000;172:184-185.

The NLM lists all authors for all articles, because it is appropriate for capturing all authors and all of their publications in the MEDLINE database to be found by searches. However, in the reference lists of articles, most journals truncate the list after 3 or 6 names, followed by "et al." (which most medical journals do not italicize):

  • Guilbert TW, Morgan WJ, Zeiger RS, Mauger DT, Boehmer SJ, Szefler SJ, et al. Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med. 2006 May 11;354(19):1985-1997.

Optionally, a unique identifier (such as the article's DOI or PMID) may be added to the citation:

  • von Itzstein M, Wu WY, Kok GB, Pegg MS, Dyason JC, Jin B, et al. Rational design of potent sialidase-based inhibitors of influenza virus replication. Nature. 1993 Jun 3;363(6428):418-423. PMID 8502295.

NLM elides ending page numbers and uses a hyphen as the range indicating character (184-5). Some journals do likewise, whereas others expand the ending page numbers in full (184-185), use an en dash instead of a hyphen (184–5), or both (184–185).

Virtually all medical journal articles are published online. Many are published online only, and many others are published online ahead of print. For the date of online publication, at the end of the citation NLM puts "[Epub Year Mon Day]" (for online-only publication) or "[Epub ahead of print]" for online ahead of print (with the month and day following the year in its normal position). In contrast, AMA style puts "[published online Month Day, Year]" at the end of the article title. It no longer uses the term "Epub" and no longer includes the words "ahead of print". It omits the year from its normal location after the journal title abbreviation if there is no print data to give (online-only publication).

The titles of journals are abbreviated. There are no periods in the abbreviation. A period comes after the abbreviation, delimiting it from the next field. The abbreviations are standardized. The standardization was formerly incomplete and internal to organizations such as NLM. It is now formalized at the supraorganizational level by documents including Citing Medicine at Appendix A: Abbreviations for Commonly Used English Words in Journal Titles, ANSI Z39.5, ISO 4: Information and documentation -- Rules for the abbreviation of title words and titles of publications, and the List of Title Word Abbreviations (LTWA).

Articles not in English

As per journal articles in English:

  • Forneau E, Bovet D. Recherches sur l'action sympathicolytique d'un nouveau dérivé du dioxane. Arch Int Pharmacodyn. 1933;46:178-191. French.

The NLM adds an English translation of the title enclosed in square brackets right after the title. The language is specified in full after the location (pagination), followed by a period.


Personal author(s)

  • Rang HP, Dale MM, Ritter JM, Moore PK. Pharmacology. 5th ed. Edinburgh: Churchill Livingstone; 2003.

Editor(s) or compiler(s) as authors

  • Beers MH, Porter RS, Jones TV, Kaplan JL, Berkwits M, editors. The Merck manual of diagnosis and therapy. 18th ed. Whitehouse Station (NJ): Merck Research Laboratories; 2006.

Authored chapter in edited publication

  • Glennon RA, Dukat M. Serotonin receptors and drugs affecting serotonergic neurotransmission. In: Williams DA, Lemke TL, editors. Foye's principles of medicinal chemistry. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2002.

Electronic material


  • [homepage on the Internet]. Indianapolis: Indiana University Department of Medicine; 2003 [updated 17 May 2006; cited 30 May 2006]. Available from:


  1. Reference styles: Harvard and Vancouver [archived 2013-03-13; Retrieved 2013-03-01].
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  5. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals.. BMJ (Clinical research ed.). 1991;302(6772):338–341. doi:10.1136/bmj.302.6772.338. PMID 2001512.
  6. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals.. Canadian Medical Association Journal. 1995;152(9):1459–1473. PMID 7728695.
  7. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. [Free full text]. Annals of Internal Medicine. 1997;126(1):36–47. doi:10.7326/0003-4819-126-1-199701010-00006. PMID 8992922.
  8. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals.. JAMA: the journal of the American Medical Association. 1997;277(11):927–934. doi:10.1001/jama.277.11.927. PMID 9062335.
  9. International Committee Of Medical Journal Editors (ICMJE). Uniform Requirements for Manuscripts Submitted to Biomedical Journals: writing and editing for biomedical publication [Free full text]. Haematologica. 2004;89(3):264. PMID 15020262.
  10. International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Sample References [Retrieved 2006-12-24].
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External links

Many medical institutions maintain their own style guides, with information on how to cite sources: