medsci-skills 4.9.0 → 4.11.0

package/README.md

@@ -2,14 +2,14 @@
 
 # MedSci Skills
 
-**45 skills that actually work.** Built by a physician-researcher, tested on real publications.
+**51 skills that actually work.** Built by a physician-researcher, tested on real publications.
 
-*MedSci Skills is a submission-grade clinical manuscript workflow, not a generic biomedical skill catalog. Its moat is the compliance layer — 36 reporting guidelines and risk-of-bias tools, reference/citation verification, and deterministic integrity gates, before peer review sees the manuscript. It competes on clinical submission reliability, not skill count.*
+*MedSci Skills is a submission-grade clinical manuscript workflow, not a generic biomedical skill catalog. Its moat is the compliance layer — 38 reporting guidelines and risk-of-bias tools, reference/citation verification, and deterministic integrity gates, before peer review sees the manuscript. It competes on clinical submission reliability, not skill count.*
 
 [![License: MIT](https://img.shields.io/badge/License-MIT-yellow.svg)](LICENSE)
 [![Release](https://img.shields.io/github/v/release/Aperivue/medsci-skills?style=flat-square&color=blue)](https://github.com/Aperivue/medsci-skills/releases/latest)
 [![CI](https://img.shields.io/github/actions/workflow/status/Aperivue/medsci-skills/validate.yml?branch=main&style=flat-square&label=CI)](https://github.com/Aperivue/medsci-skills/actions/workflows/validate.yml)
-![Skills](https://img.shields.io/badge/Skills-45-brightgreen?style=flat-square)
+![Skills](https://img.shields.io/badge/Skills-51-brightgreen?style=flat-square)
 [![npm](https://img.shields.io/npm/v/medsci-skills?style=flat-square&label=npm&color=cb3837)](https://www.npmjs.com/package/medsci-skills)
 [![Watch the 2-min intro](https://img.shields.io/badge/▶_Watch-2--min_intro-FF0000?style=flat-square&logo=youtube&logoColor=white)](https://youtu.be/MclQ_RIofpE)
 [![good first issues](https://img.shields.io/github/issues/Aperivue/medsci-skills/good%20first%20issue?style=flat-square&label=good%20first%20issues&color=7057ff)](https://github.com/Aperivue/medsci-skills/contribute)
@@ -64,6 +64,12 @@ every output requires human-expert verification. New here? See the
 npx medsci-skills install        # copies every skill into your agent's folder
 ```
 
+**Recommended (especially for clinicians):** add `--enable-update-notify` so Claude Code shows a one-line *"update available"* notice when a new version ships — otherwise you stay on the version you installed and are never told. (No terminal at all? The classroom installer below turns this on for you.)
+
+```bash
+npx medsci-skills install --enable-update-notify        # install + in-app update reminders
+```
+
 **Have git?** Install every skill in three commands:
 
 ```bash
@@ -268,48 +274,54 @@ The E2E pipeline (`orchestrate --e2e`) produces everything up to `qc/`. The `sub
 
 ## What's New
 
-**v4.9** — analysis-integrity hardening promoted from real review cycles, plus journal-mechanics additions. Additive and backward-compatible; still 45 skills / 36 guidelines, analysis-integrity detectors **32 → 36**:
+**v4.10** — reviewer-coverage expansion reverse-engineered from high-IF, CC-BY papers (learn-only under the `reverse_engineer/` license firewall), plus a clinician-friendly update path. Additive and backward-compatible; 45 skills / **38 guidelines** / 36 detectors / **15 domain-probe modules** (was 12):
+
+- **Three new reviewer domain-probe modules** (`/peer-review` + `/self-review`, vendored byte-identical): **Mendelian randomization** (MR1–MR8 — IV assumptions, pleiotropy-robust sensitivity suite, Steiger, sample overlap, NLMR, drug-target colocalization), **polygenic risk score** (PG1–PG8 — ancestry portability, base/target leakage, incremental value over the clinical model, screening-vs-discrimination, calibration), and **network meta-analysis** (NM1–NM8 — transitivity, incoherence, SUCRA over-interpretation, CINeMA/GRADE-NMA, component-NMA additivity). Plus observational **O17** (agnostic many-exposure-scan multiplicity: ExWAS/EWAS/MWAS).
+- **Two reporting-guideline checklists** (36 → 38): **STROBE-MR** and **PGS-RS / PRS-RS**, with study-type routing. Four new `/analyze-stats` analysis guides (multiplicity, MR, PRS, NMA) and a `/clean-data` implausible-value + cross-field validity reference.
+- **Clinician-friendly update reminders** — the classroom installers enable the in-app "update available" notice + one-click Desktop updater by default; the `npx`/manual paths print how to turn it on; the install guide recommends `npx medsci-skills install --enable-update-notify`.
+
+**v4.9** — analysis-integrity hardening promoted from real review cycles, plus journal-mechanics additions. Additive and backward-compatible; still 45 skills / 38 guidelines, analysis-integrity detectors **32 → 36**:
 
 - **Four new gates** — a **duplicate-bibliography** check (`check_reference_duplication.py`) for the hybrid `[@key]` + hand-typed `## References` build that renders the list twice; a **cross-script binning / composite-indicator** consistency check (`check_binning_consistency.py`, `BINNING_DRIFT` / `DERIVED_DEF_DRIFT`) for a derived categorical or composite indicator defined inconsistently across analysis scripts; a **float citation-order** check (`check_citation_order.py`) for numbered Tables/Figures not first cited in ascending order per series; and an **audit-dump leak** gate (`/sync-submission`) that blocks a `/check-reporting` output mistakenly attached as a submission file.
 - **KJR technical-check conventions + percentage-decimal style**, reader-allocation-under-burden and generative-image-as-study-object reporting (`/design-ai-benchmarking`, `/check-reporting`), and a **Liver International** CSL with that journal's submission mechanics (`/manage-refs`).
 
-**v4.8** is the **review-harvest batch** — deterministic detector hardening promoted from real-manuscript review cycles. Additive and backward-compatible; still 45 skills / 36 guidelines, analysis-integrity detectors **30 → 32**:
+**v4.8** is the **review-harvest batch** — deterministic detector hardening promoted from real-manuscript review cycles. Additive and backward-compatible; still 45 skills / 38 guidelines, analysis-integrity detectors **30 → 32**:
 
 - **Two new gates** — `check_supplement_hygiene.py` lints the rendered supplement / tables / caption files (not just the manuscript) for §-labels, placeholders, build markers, response-letter framing, and unresolved body↔supplement cross-references; `check_null_calibration.py` flags a headline negative/equivalence claim made without a minimum-detectable-effect / power / equivalence statement.
 - **Four detector false-positive fixes** — gates no longer fire on a recommended colorblind-safe palette, author-footnote `§` daggers, a correctly-hedged disclaimer, or a tier-label digit; each with a regression fixture and three newly CI-wired test suites.
 - **Nine reviewer-side domain probes** (SR/MA, observational, diagnostic, AI-overclaiming, survival) plus a `/design-study` design-stage ceiling gate for perceptual/reader-AI studies and a reusable confidence-weighted-rating→AUC monotonicity template.
 
-**v4.7** is the **self-update foundation** — physician-researchers stay current without GitHub, git, or a terminal. Additive and backward-compatible; still 45 skills / 36 guidelines / 30 detectors:
+**v4.7** is the **self-update foundation** — physician-researchers stay current without GitHub, git, or a terminal. Additive and backward-compatible; still 45 skills / 38 guidelines / 30 detectors:
 
 - **Transactional, crash-recoverable installer.** Each install runs through a durable journal state machine recovered on the next run (roll back / forward-clean / fail-closed), with per-target SHA-256 inventories — your modified or third-party skills are backed up and never clobbered or auto-deleted.
 - **One-click self-updater** (`~/.medsci-skills/updater/`, `install.py --check-update`). Verifies the download against the github.com API digest and **never `extractall()`s** (per-entry rejection of traversal / symlink / duplicate / zip-bomb + an allowlist & per-file hash). The release pipeline injects a verified `provenance.json`, attests build provenance, runs on a protected `release` environment, and verifies each ZIP round-trips through the updater's own safe-extract before publishing.
 - **Opt-in update notice (off by default):** `install.py --enable-update-notify` shows a one-line "update available" message at Claude Code session start — no telemetry, reads nothing about your session, installs nothing. `--disable-update-notify` / `MEDSCI_NO_UPDATE_CHECK=1` turn it off. *(Honest scope: the digest/attestation detect transport tampering, not a compromised publisher account — see `SECURITY.md`.)*
 
-**v4.6** is a maintainability, governance, and review-depth release — still 45 skills / 36 guidelines; analysis-integrity detectors **28 → 30**, domain probes 11 → 12:
+**v4.6** is a maintainability, governance, and review-depth release — still 45 skills / 38 guidelines; analysis-integrity detectors **28 → 30**, domain probes 11 → 12:
 
 - **Fairness / equity / subgroup-performance probe (EQ0–EQ6)** for AI/prediction/diagnostic studies that claim cross-population performance, plus two new detectors: an **AI-disclosure + data/code-availability** check (`/sync-submission`) and a **structured-summary-box conformance** check (`/academic-aio`).
 - **Governance + answer-engine layer:** `ROADMAP.md`, `MAINTAINERS.md`, `SECURITY.md`, a maintainer workflow + release checklist, an AEO/GEO `docs/faq.md`, a "Start here: 3 workflows" + "Validation status" section in this README, and a new `maturity` field (official / experimental / community) on every skill.
 - **Token diet (pilot):** `write-paper` Phase 7 integrity audits moved to a load-on-demand reference (~2,559 tokens saved per invocation). Positioning now leads with the compliance moat rather than skill count.
 
-**v4.5** deepens the review + submission surface with no new skill or reporting-guideline count (still 45 skills / 36 guidelines); analysis-integrity detectors **27 → 28**:
+**v4.5** deepens the review + submission surface with no new skill or reporting-guideline count (still 45 skills / 38 guidelines); analysis-integrity detectors **27 → 28**:
 
 - **`/clean-data` + `/analyze-stats` — reverse-coded-item / negative-alpha detector.** A multi-item Likert scale with a negatively-worded item must be recoded `(min+max) − x` before the scale total or Cronbach's alpha is computed; left un-recoded, the item correlates negatively with the rest of the scale and alpha collapses (often negative). A negative alpha is a coding bug, not a "multidimensional construct." New stdlib-only `check_reverse_coding.py` returns `REVERSE_CODING_LIKELY` / `REVERSE_CODING_SUSPECT` / `OK` from per-item item-rest correlations + raw alpha; the Likert summary template gains a `--reverse-items` recode flag.
 - **`/peer-review` + `/self-review` — SR/MA + DTA + prediction-model probe batch.** `sr_ma.md` **P12** risk-of-bias table row-sum ↔ traffic-light figure-matrix reconciliation and **P13** included-study ↔ reference-list completeness; `diagnostic_accuracy.md` **D7** index-test-as-enrollment-criterion circularity; `clinical_prediction_model.md` **CP5** intended-use horizon leakage and **CP6** development/CV vs held-out/external validation-nomenclature conflation. Vendored byte-identical into `/self-review`.
 - **`/sync-submission` — embedded absolute-path leak scan.** A `word/*.xml` attribute (e.g. a pandoc-embedded image's `<pic:cNvPr descr="…">`) carrying an absolute home-dir path (`/Users/…`, `/home/…`) is a username leak invisible to a rendered-text scan; now flagged as `docx_embedded_abs_path` under `check_asset_anonymization.py`.
 
-**v4.4** adds reviewer/analysis depth with no new skill or reporting-guideline count (still 45 skills / 36 guidelines / 27 detectors):
+**v4.4** adds reviewer/analysis depth with no new skill or reporting-guideline count (still 45 skills / 38 guidelines / 27 detectors):
 
 - **`/author-strategy` — trajectory-archetype classification (optional).** Classifies a queried author's PubMed trajectory into abstract career archetypes (A1 infrastructure builder, A2 methodology rule-maker, A3 clinical→AI hybrid, A4 SR/MA volume engine, A5 large-consortium participation, A6 device/technique depth, + a computed composite) as an **explainable, multi-label, confidence-scored heuristic — not an objective verdict**. The rubric is a single canonical YAML (the narrative doc is generated from it); scores exclude `unavailable` signals (h-index/citation/venue-tier → `[VERIFY]`, never fabricated); a **disambiguation gate** binds an approved `corpus_manifest.json` to the CSV (csv + PMID-set hashes) so a surname alone never classifies, and target-author attribution never borrows a co-author's ORCID/affiliation.
 - **`/peer-review` + `/self-review` — Image-Synthesis / cross-modality probe (IS1–IS4)** for studies that synthesize one imaging modality from another and claim the output carries the target's information, plus a reviewer-side reference-integrity spot-check.
 - **`/verify-refs` — OpenAlex tertiary index** recovers conference-proceedings / non-DOI citations (NeurIPS/ICLR/ACL) that fall through PubMed and CrossRef, the free analogue of a portal's second index.
 
-**v4.3** hardens the **cross-sectional / observational cohort** review surface end-to-end, much of it reverse-engineered from real CC-BY cohort papers (learn-only under the license firewall) — no new skill or reporting-guideline count (still 45 skills / 36 guidelines); analysis-integrity detectors **25 → 27**:
+**v4.3** hardens the **cross-sectional / observational cohort** review surface end-to-end, much of it reverse-engineered from real CC-BY cohort papers (learn-only under the license firewall) — no new skill or reporting-guideline count (still 45 skills / 38 guidelines); analysis-integrity detectors **25 → 27**:
 
 - **Observational probes O1 → O14** (`/peer-review` + `/self-review`, vendored) — over-adjustment / analysis-unit clustering / outcome construct-validity (O7–O9), overlapping-subset gradient (O10), **complex-survey design & weighting** for NHANES/KNHANES (O11), **data-driven threshold / "inflection-point" mining** (O12), **cross-sectional mediation** temporal-order & sequential-ignorability (O13), and **interaction scale** — additive RERI/AP/S vs multiplicative (O14). Plus a new **clinical-prediction-model** probe module **CP1–CP4** and survival **S9** (panel-data / multistate variance).
 - **Two new detectors (25 → 27)** — `check_wordcount_cap.py` (the revision-inflation trap: body vs journal cap) and `check_paren_spans.py` (em-dash→paren conversions that wrap a whole sentence). Plus a `check_confounding_completeness.py` upgrade (DB-code↔prose alias map, SMD-from-mean±SD, exposure-defining-covariate exemption), a `check_cohort_arithmetic.py` `ANALYSIS_UNIT_UNDISCLOSED` check, a `check_scope_coherence.py` cross-sectional-yield lexicon, and a verify-refs corporate/collective-author render-abort fix.
 - **Analysis & submission tooling** — `/analyze-stats` gains **mediation** and **interaction & effect-modification** guides; `/sync-submission` gains `assemble_supplement.py` (S{N} index↔file integrity) and a `/revise` body-word-count exit gate; `/render-pdf-doc` gains a `scan_glyph_coverage.py` xelatex silent-glyph-drop scan.
 
-**v4.2** builds out the case-report capability end-to-end, grounded in real CC-BY case reports (learn-only under the license firewall) — no new skill or reporting-guideline count (still 45 skills / 36 guidelines); journal profiles **68 → 73**:
+**v4.2** builds out the case-report capability end-to-end, grounded in real CC-BY case reports (learn-only under the license firewall) — no new skill or reporting-guideline count (still 45 skills / 38 guidelines); journal profiles **68 → 73**:
 
 - **Case-report + case-series writing** — `/write-paper` gains a CARE narrative + 150-word-abstract case-report exemplar, a **case-series** paper type (methods-light mini-cohort, all-cases summary table, counts-not-rates), and **adverse-event/pharmacovigilance** (Naranjo/WHO-UMC causality) and **diagnostic-pitfall/mimic** subtypes.
 - **Radiology / imaging-led track** — a dedicated `exemplar_case_report_radiology.md` (per-modality technique→findings→impression, structured-reporting lexicons BI-RADS/LI-RADS/PI-RADS/TI-RADS/Lung-RADS/O-RADS, quantitative threshold honesty, an interventional-radiology procedure/complication subtype, DICOM de-identification) plus a `/make-figures` annotated multimodality imaging-panel exemplar.
@@ -433,12 +445,18 @@ ma-scout -> search-lit -> fulltext-retrieval -> design-study ──> write-proto
 | **search-lit** | PubMed + Semantic Scholar + bioRxiv search with anti-hallucination citation verification. Token-efficient error handling -- CrossRef failures are silently batched, not repeated. BibTeX output tags each entry with `verified`/`verified_by`/`verified_on` fields so downstream skills can trust the citation provenance. |
 | **verify-refs** | Pre-submission reference audit for `.md`, `.docx`, `.bib`, or `.tsv` inputs. Extracts references, verifies DOI/PMID via CrossRef/PubMed when available, and writes `qc/reference_audit.json` as the sole output — row-level status (OK / MISMATCH / UNVERIFIED / FABRICATED) lives inside the JSON `records[]` block. `/search-lit` produces candidate BibTeX; `/lit-sync` owns `manuscript/_src/refs.bib`. |
 | **fulltext-retrieval** | Batch open-access PDF downloader. Unpaywall → PMC → OpenAlex → CrossRef pipeline. OA-only -- no paywall bypass. Input: DOI list or TSV. Optional PDF→Markdown conversion via [pymupdf4llm](https://pymupdf.readthedocs.io/en/latest/pymupdf4llm/) for token-efficient LLM analysis of academic papers. |
-| **check-reporting** | Manuscript compliance audit against 36 reporting guidelines and risk of bias tools (STROBE, STARD, STARD-AI, TRIPOD, TRIPOD+AI, TRIPOD-LLM, PRISMA, PRISMA-DTA, PRISMA-P, MOOSE, ARRIVE, CONSORT, CONSORT-AI, CARE, SPIRIT, SPIRIT-AI, CLAIM, DECIDE-AI, SQUIRE 2.0, CLEAR, GRRAS, MI-CLEAR-LLM, SWiM, AMSTAR 2, QUADAS-2, QUADAS-C, RoB 2, ROBINS-I, ROBINS-E, ROBIS, ROB-ME, PROBAST, PROBAST+AI, NOS, COSMIN, RoB NMA). Machine-readable JSON summary with `compliance_pct` and `fixable_by_ai` flags for automated pipeline integration. |
+| **check-reporting** | Manuscript compliance audit against 38 reporting guidelines and risk of bias tools (STROBE, STROBE-MR, STARD, STARD-AI, TRIPOD, TRIPOD+AI, TRIPOD-LLM, PGS-RS, PRISMA, PRISMA-DTA, PRISMA-P, MOOSE, ARRIVE, CONSORT, CONSORT-AI, CARE, SPIRIT, SPIRIT-AI, CLAIM, DECIDE-AI, SQUIRE 2.0, CLEAR, GRRAS, MI-CLEAR-LLM, SWiM, AMSTAR 2, QUADAS-2, QUADAS-C, RoB 2, ROBINS-I, ROBINS-E, ROBIS, ROB-ME, PROBAST, PROBAST+AI, NOS, COSMIN, RoB NMA). Machine-readable JSON summary with `compliance_pct` and `fixable_by_ai` flags for automated pipeline integration. |
 | **analyze-stats** | Statistical analysis code generation (Python/R) for diagnostic accuracy, DTA meta-analysis (bivariate/HSROC), inter-rater agreement, survival analysis, demographics tables, regression (logistic/linear), propensity score (matching/IPTW/overlap weighting), and repeated measures (RM ANOVA/GEE/mixed models). Calibration mandatory for prediction models. |
 | **meta-analysis** | Full systematic review and meta-analysis pipeline (8 phases). DTA (bivariate/HSROC) and intervention meta-analysis. Protocol to submission-ready manuscript with PRISMA-DTA compliance. |
 | **make-figures** | Publication-ready figures and visual abstracts: ROC curves, forest plots, PRISMA/CONSORT/STARD flow diagrams, Kaplan-Meier curves, Bland-Altman plots, confusion matrices, and journal-specific visual/graphical abstracts (python-pptx template-based). Communication-first design principles (Nat Hum Behav 2026 — key message, audience, cognitive load, figure-vs-table decision) and five flow-diagram production lessons (official-template fidelity, VML fallback PDF export, docx XML escape, sequential placeholder mapping, version freeze); critic rubric Section G adds 5 communication-first checks. `--study-type` auto-generates the full required figure set; structured `_figure_manifest.md` output for downstream pipeline consumption; D2 enforced as default for flow diagrams. |
 | **design-study** | Study design review: identifies analysis unit, cohort logic, data leakage risks, comparator design, validation strategy, and reporting guideline fit. |
 | **design-ai-benchmarking** | Design and validity review for benchmarking AI system(s) against a human-expert panel: evaluation-question and arm definition, decoupled multi-dimensional rubrics with anchors, planted calibration probes (positive-control / known-bad / instability / mechanism-contradiction), reviewer-panel construction with per-reviewer randomization, inter-rater reliability targets with separate control-item reliability, LLM-as-judge vs human-as-judge adjudication, construct-independence guards, and a structured JSON rating-export schema. Locks the rubric before data collection. |
+| **model-validation** | Design or audit the clinical-validation study for an engineer-built medical-imaging model (segmentation / classification / detection): patient-level split disjointness and the data-leakage taxonomy, tuning-on-test, internal vs genuine external validation, comparator design, single-run vs multi-seed variance, task-correct metric selection (Metrics Reloaded), test-set sizing, and CLAIM 2024 / TRIPOD+AI / STARD-AI reporting fit. Ships a deterministic split-leakage gate that proves patient disjointness by set arithmetic on the emitted split table. Integrates with MONAI / nnU-Net — does not replace them. |
+| **model-scaffold** | Generate a reproducible, runnable PyTorch training repo for a medical-imaging segmentation task — the missing middle link between choosing an architecture and validating a trained model. Emits a patient-level seed-locked split as an auditable artifact, a configurable U-Net, train/evaluate scripts that seed every RNG and infer under eval mode, a config, requirements, a reproducibility record, and a Methods stub with VERIFY placeholders (no fabricated numbers). Reproducibility holds by construction; ships a `check_training_hygiene` AST gate + a network-free build→validate challenge. Integrates with MONAI / nnU-Net / TorchIO — does not reimplement them. |
+| **architecture-zoo** | "Which architecture for which research question" decision tool: maps task (classification / segmentation / detection / transfer), modality, data scale, and class imbalance to a paper-grounded architecture shortlist. Curates the foundational curriculum (ResNet / DenseNet / EfficientNet / ViT / Swin; U-Net / 3-D U-Net / Attention & Residual U-Net / nnU-Net / Mask R-CNN; SAM/MedSAM / TotalSegmentator / BiomedCLIP / DINO / MAE / SimCLR) — each with core idea, when-to-use, medical-imaging use, reference implementation, validation setup, and the matching model-scaffold template. Advisory; teaches archetypes, not a live SOTA leaderboard. |
+| **model-card** | Generate the documentation an engineer-built medical-imaging model must carry — a Model Card (Mitchell et al. 2019), a Datasheet for its dataset (Gebru et al. 2021), and a METRIC-informed data-quality pass — filled from user-supplied facts (never fabricated), then verify every required section is present and non-empty with a deterministic completeness gate (`check_model_card_complete`). Model Card / Datasheet are documentation standards vendored as templates, not counted reporting checklists. |
+| **model-evaluation** | Compute and report task-correct held-out metrics for a trained medical-imaging model — segmentation (Dice + a boundary metric HD95/NSD, per structure), classification (AUROC + AUPRC + sensitivity/specificity with bootstrap CIs at the deployment prevalence), or detection (FROC/mAP with a stated IoU criterion) — plus calibration and subgroup slices. Emits a per-case table for analyze-stats and gates the metric choice against Metrics Reloaded / CLAIM 2024 (`check_metric_reporting`). Numbers come only from executed code. |
+| **mllm-eval** | Model-agnostic evaluation harness (closed API or open weights) for an LLM/MLLM on a clinical task — radiology report generation, VQA, clinical text extraction — covering the adjudicated reference standard, clinical-efficacy metrics (RadGraph-F1 / CheXbert-F1 beyond BLEU/ROUGE), faithfulness/hallucination, pretraining-contamination, prompt sensitivity, and a reader study; gates the plan with `check_mllm_eval_completeness` and routes the reviewer audit to the MLLM probe. |
 | **intake-project** | Classifies new research projects, summarizes current state, identifies missing inputs, and recommends next steps. |
 | **grant-builder** | Structures grant proposals: significance, innovation, approach, milestones, and consortium roles. |
 | **present-paper** | Academic presentation preparation: paper analysis, supporting research, speaker scripts, slide note injection, and Q&A prep. |
@@ -497,6 +515,8 @@ After unzipping:
 - Windows: double-click `installers/install-windows.cmd`
 - macOS: double-click `installers/install-macos.command`
 
+This turnkey install also **turns on in-app update reminders** and adds an **"Update MedSci Skills"** Desktop icon, so you are told when a new version ships and can update with one click — no terminal needed (see [Updating](#updating)).
+
 Then restart Claude Code Desktop, Codex Desktop, or Cursor and test with:
 
 ```text
@@ -548,19 +568,22 @@ See [docs/classroom_distribution_plan.md](docs/classroom_distribution_plan.md) a
 
 MedSci Skills updates often. You do **not** need GitHub, git, or the command line to stay current.
 
-- **One click (recommended for the classroom install).** After installing, an updater is placed at
-  `~/.medsci-skills/updater/` (and, if you chose `--desktop-launcher`, an **"Update MedSci Skills"**
-  icon on your Desktop). Double-click it: it downloads the latest release from GitHub, verifies it,
-  and re-installs — transactionally, so an interrupted update never corrupts your install.
+- **One click (recommended for the classroom install).** The classroom installer (Option 1) now
+  sets this up for you automatically — it places an updater at `~/.medsci-skills/updater/`, drops an
+  **"Update MedSci Skills"** icon on your Desktop (`--desktop-launcher`), and **turns on the in-app
+  update reminder** (below). Double-click the icon: it downloads the latest release from GitHub,
+  verifies it, and re-installs — transactionally, so an interrupted update never corrupts your install.
 - **Already installed an old copy?** Re-download the latest classroom ZIP **once** and double-click
   the installer; from then on the one-click updater is in place for every future update.
 - **Terminal users:** `npx medsci-skills@latest install` always installs the latest.
 - **Just checking:** `python3 installers/install.py --check-update` reports whether a newer version
   is available and installs nothing.
-- **Get reminded (opt-in, Claude Code):** `python3 installers/install.py --enable-update-notify`
-  shows a one-line *"update available"* notice when a Claude Code session starts. It is **off by
-  default**, checks at most once a day, reads nothing about your session, and never installs
-  anything. Turn it off with `--disable-update-notify`, or silence it with `MEDSCI_NO_UPDATE_CHECK=1`.
+- **Get reminded (Claude Code):** `python3 installers/install.py --enable-update-notify` (or
+  `npx medsci-skills install --enable-update-notify`) shows a one-line *"update available"* notice
+  when a Claude Code session starts. **The classroom installer enables this for you;** for the
+  `npx`/manual paths it is **off by default** (the installer prints how to turn it on). It checks at
+  most once a day, reads nothing about your session, and never installs anything. Turn it off with
+  `--disable-update-notify`, or silence it with `MEDSCI_NO_UPDATE_CHECK=1`.
 - **Claude Code plugin marketplace:** third-party marketplace **auto-update is off by default** —
   enable it in Claude Code or run a manual plugin update.
 
@@ -591,8 +614,8 @@ Projects declare their source-of-truth layout in `SSOT.yaml`, and a `qc/migratio
 ### Meta-Analysis Failure Modes
 `/meta-analysis` ships empirical failure-mode references (data integrity, review orchestration, submission package drift, post-submission release ops) with four automation hooks: `scripts/prisma_5way_consistency.py` (DI-6 PRISMA number consistency), `scripts/extraction_consensus_log_init.py` (DI-1 dual-extraction scaffold), `scripts/tag_cleanup_gate.sh` (DI-8 placeholder tag gate), and `scripts/verify_package_integrity.py` (SPD SHA-256 manifest for submission bundles).
 
-### 36 Reporting Guidelines & RoB Tools Built-in
-`check-reporting` includes bundled checklists for 36 guidelines and risk-of-bias tools: STROBE, STARD, STARD-AI, TRIPOD, TRIPOD+AI, TRIPOD-LLM, PRISMA 2020, PRISMA-DTA, PRISMA-P, MOOSE, ARRIVE, CONSORT, CONSORT-AI, CARE, SPIRIT, SPIRIT-AI, CLAIM, DECIDE-AI, SQUIRE 2.0, CLEAR, GRRAS, MI-CLEAR-LLM, SWiM, AMSTAR 2, QUADAS-2, QUADAS-C, RoB 2, ROBINS-I, ROBINS-E, ROBIS, ROB-ME, PROBAST, PROBAST+AI, NOS, COSMIN, RoB NMA. Includes Results/Discussion section boundary checks and machine-readable JSON summary for pipeline integration.
+### 38 Reporting Guidelines & RoB Tools Built-in
+`check-reporting` includes bundled checklists for 38 guidelines and risk-of-bias tools: STROBE, STROBE-MR, STARD, STARD-AI, TRIPOD, TRIPOD+AI, TRIPOD-LLM, PGS-RS, PRISMA 2020, PRISMA-DTA, PRISMA-P, MOOSE, ARRIVE, CONSORT, CONSORT-AI, CARE, SPIRIT, SPIRIT-AI, CLAIM, DECIDE-AI, SQUIRE 2.0, CLEAR, GRRAS, MI-CLEAR-LLM, SWiM, AMSTAR 2, QUADAS-2, QUADAS-C, RoB 2, ROBINS-I, ROBINS-E, ROBIS, ROB-ME, PROBAST, PROBAST+AI, NOS, COSMIN, RoB NMA. Includes Results/Discussion section boundary checks and machine-readable JSON summary for pipeline integration.
 
 ### Publication-Ready Output
 `analyze-stats` generates reproducible Python/R code for 13 analysis types -- including regression, propensity score, and repeated measures -- with mandatory calibration for prediction models. `make-figures` produces journal-specification figures (300 DPI, colorblind-safe palettes, proper dimensions), visual/graphical abstracts, and a tool selection guide (D2 for flow diagrams, matplotlib for data plots). `--study-type` auto-generates the complete figure set for each study design.

package/installers/install-macos.command

@@ -6,10 +6,19 @@ cd "$(dirname "$0")/.."
 echo "MedSci Skills Installer for macOS"
 echo
 
+PY=""
 if command -v python3 >/dev/null 2>&1; then
-  python3 installers/install.py --target all
+  PY=python3
 elif command -v python >/dev/null 2>&1; then
-  python installers/install.py --target all
+  PY=python
+fi
+
+if [ -n "$PY" ]; then
+  "$PY" installers/install.py --target all --desktop-launcher
+  # Turn on the in-app "update available" reminder for this turnkey install so you are told when a
+  # new version is out (no terminal needed afterward). Best-effort; turn off later with
+  # `install.py --disable-update-notify` or MEDSCI_NO_UPDATE_CHECK=1.
+  "$PY" installers/install.py --enable-update-notify || true
 else
   echo "Python was not found."
   echo "Install Python 3 from https://www.python.org/downloads/ and run this installer again."

package/installers/install-windows.cmd

@@ -7,13 +7,17 @@ echo.
 
 where py >nul 2>nul
 if %errorlevel%==0 (
-  py -3 installers\install.py --target all
+  py -3 installers\install.py --target all --desktop-launcher
+  rem Turn on the in-app "update available" reminder for this turnkey install (disable later with --disable-update-notify).
+  py -3 installers\install.py --enable-update-notify
   goto done
 )
 
 where python >nul 2>nul
 if %errorlevel%==0 (
-  python installers\install.py --target all
+  python installers\install.py --target all --desktop-launcher
+  rem Turn on the in-app "update available" reminder for this turnkey install (disable later with --disable-update-notify).
+  python installers\install.py --enable-update-notify
   goto done
 )
 

package/installers/install-windows.ps1

@@ -5,9 +5,12 @@ Write-Host "MedSci Skills Installer for Windows"
 Write-Host ""
 
 if (Get-Command py -ErrorAction SilentlyContinue) {
-    py -3 installers/install.py --target all
+    py -3 installers/install.py --target all --desktop-launcher
+    # Turn on the in-app "update available" reminder for this turnkey install (disable later with --disable-update-notify).
+    try { py -3 installers/install.py --enable-update-notify } catch {}
 } elseif (Get-Command python -ErrorAction SilentlyContinue) {
-    python installers/install.py --target all
+    python installers/install.py --target all --desktop-launcher
+    try { python installers/install.py --enable-update-notify } catch {}
 } else {
     Write-Host "Python was not found."
     Write-Host "Please install Python 3 from https://www.python.org/downloads/ and run this installer again."

package/installers/install.py

@@ -286,6 +286,19 @@ def main() -> int:
         except Exception as exc:  # noqa: BLE001
             log(f"\n[updater] could not install the one-click updater ({exc}); updates still work via re-running the installer.", log_lines)
 
+    # One-time nudge: if the in-app update reminder is not enabled, surface how to turn it on.
+    # (The classroom installers enable it automatically; this covers npx / manual installs so a
+    # clinician who installed via "install this repo" is told how to get update notices.) Read-only.
+    if not args.dry_run:
+        try:
+            import update  # noqa: PLC0415
+            if not update.session_hook_enabled(medsci_txn.state_home(), update.default_settings_path()):
+                log("\n[update reminders] OFF — Claude Code will not tell you when a new version is out.", log_lines)
+                log("  Turn on with:  npx medsci-skills install --enable-update-notify", log_lines)
+                log("  (or:           python3 installers/install.py --enable-update-notify)", log_lines)
+        except Exception:  # noqa: BLE001 - nudge is best-effort, never block the install
+            pass
+
     if failures:
         log(f"\nCompleted with errors on: {', '.join(failures)}. Other targets are fully installed.", log_lines)
         log("If this happened during class, send the install log to the instructor.", log_lines)

package/installers/update.py

@@ -517,6 +517,25 @@ def register_session_hook(home: Path, settings_path: Path) -> str:
     return "enabled"
 
 
+def session_hook_enabled(home: Path, settings_path: Path) -> bool:
+    """Read-only: True iff our SessionStart update-notify hook is currently registered in
+    settings.json. Never writes; tolerant of an absent/empty/unreadable settings file (False).
+    Used by the installer to decide whether to print the one-time enable-reminders nudge."""
+    try:
+        if not settings_path.is_file():
+            return False
+        settings = _load_settings(settings_path)
+        if not isinstance(settings, dict):
+            return False
+        hooks = settings.get("hooks")
+        ss = hooks.get("SessionStart") if isinstance(hooks, dict) else None
+        if not isinstance(ss, list):
+            return False
+        return any(_entry_owns_hook(e, home) for e in ss)
+    except Exception:  # noqa: BLE001 - read-only nudge gate, never block install
+        return False
+
+
 def unregister_session_hook(home: Path, settings_path: Path) -> str:
     """Opt-out: remove ONLY our SessionStart hook (even if it shares an entry with other hooks),
     preserving everything else; drop emptied containers. Returns 'disabled' or 'not-enabled'."""