---
name: jama-cover-letter
description: Use when drafting the editor-facing cover letter that pitches a JAMA manuscript's general medical importance and confirms compliance. Frames the pitch and declarations; it does NOT write the manuscript or the abstract.
---

# Cover Letter (jama-cover-letter)

## When to trigger

- The manuscript is ready and you need the editor-facing cover letter
- You must state why this work matters to JAMA's broad readership
- You need to confirm originality, registration, and disclosure status up front
- The submission portal asks for a letter to the editor-in-chief

## What the cover letter must do

The editors triage on **general medical importance** first. The letter is a short, specific pitch — not a summary of the abstract. One page.

1. **Address it** to the JAMA editors (verify the current editor-in-chief / addressing convention on the journal site rather than naming a specific person from memory).
2. **State the question and the headline result in 2–3 sentences**, with the primary outcome's effect size and 95% CI.
3. **Make the importance case**: who the finding affects, how it changes practice or guidelines, and why a broad clinician audience — not just a subspecialty — should care.
4. **Name the design and reporting standard** (e.g., "a multicenter randomized clinical trial reported per CONSORT").
5. **Declarations**: the work is original and not under consideration elsewhere; the trial was prospectively registered (give the identifier); IRB approval and consent obtained; all authors meet ICMJE criteria; conflicts and funding disclosed; a data-sharing statement is included.
6. **Article type and any requests**: state the intended JAMA article type; note suggested or non-preferred reviewers if the portal allows.

## Skeleton

```
Dear Editors,

We submit "[title]" for consideration as a [article type] in JAMA.

In this [design] of [N] [participants/patients] at [setting], [intervention/exposure]
[result for the primary outcome: estimate, 95% CI]. [One sentence: why this changes
practice / guidelines for a broad clinician audience.]

The study is reported in accordance with [CONSORT/STROBE/PRISMA/STARD]; the
[trial/protocol] was prospectively registered ([registry] [identifier]). The work is
original, not under consideration elsewhere, and approved by [IRB]. All authors meet
ICMJE authorship criteria; conflicts of interest and funding are disclosed, and a
data-sharing statement is included.

[Optional: suggested reviewers / reviewers to exclude, per portal options.]

Sincerely,
[Corresponding author, on behalf of all authors]
```

## Checklist

- [ ] One page, addressed per the journal's current convention
- [ ] Headline result with effect size + 95% CI stated
- [ ] Explicit general-medical-importance argument (broad audience)
- [ ] Design and reporting standard named
- [ ] Originality + not-under-consideration declared
- [ ] Trial/protocol registration identifier stated
- [ ] IRB/consent, ICMJE authorship, COI, funding, data-sharing all affirmed
- [ ] Intended article type stated

## What the JAMA editor extracts from the letter

The cover letter is the first thing a Journal of the American Medical Association editor reads, and triage at this AMA / JAMA Network flagship turns on one question: does this change practice or policy for a broad clinician audience? Make four things extractable at a glance — general-medical not subspecialty; the headline effect with its precision (absolute effect, 95% CI); the design and reporting standard (CONSORT/STROBE/PRISMA/STARD); and compliance (registration ID, IRB, ICMJE, COI, funding, data-sharing).

## Worked example: the importance paragraph (illustrative)

Vignette (illustrative): a multicenter randomized clinical trial, N = 3,800 adults with acute ischemic stroke, extended-window thrombectomy; pre-specified primary outcome 90-day functional independence (modified Rankin 0-2), absolute risk difference 7.7 percentage points (95% CI, 3.1-12.3).

Importance sentence: "In this multicenter randomized clinical trial of 3,800 patients reported per CONSORT, extended-window thrombectomy increased 90-day functional independence by an absolute 7.7 percentage points (95% CI, 3.1-12.3), informing an everyday acute-stroke triage decision for emergency physicians, neurologists, and hospitalists." It gives the absolute effect with its CI, names the design and standard, and argues broad relevance.

## Reviewer / editor pushback and the JAMA fix

- "Importance reads as subspecialty interest." Fix: name the broad clinician audience and everyday decision, not the mechanism.
- "Letter just restates the abstract." Fix: cut background; lead with the practice-changing claim and the headline number.

Calibration anchors (hedge where uncertain): the one-page norm, importance-first triage, and registration/disclosure affirmations are durable; the editor name and addressing convention are volatile — confirm against the journal's current author guidelines rather than naming a person from memory.

## Anti-patterns

- Rehashing the abstract instead of arguing importance
- Naming a specific editor-in-chief from memory (verify, or address "Editors")
- Overclaiming ("the first ever," "definitive") without support
- Omitting registration / disclosure affirmations the editors expect
- A multi-page letter padded with background
- Framing importance only for one subspecialty

## Output format

```
【Importance pitch (broad audience)】present / weak: ...
【Headline result + 95% CI】...
【Design + reporting standard named】yes / no
【Registration + disclosures affirmed】yes / gaps: ...
【Article type stated】...
【Length】one page / trim: ...
【Next skill】jama-submission
```