1. Submission: The author submits the paper to the editorial department of the journal.

2. Preliminary review: the editorial department conducts a preliminary review of the paper, including the review of format, content and quality. If the paper does not meet the requirements of the journal, it may be rejected directly.

3. Peer review: If the paper passes the preliminary review, it will be assigned to two or more experts in related fields for peer review. These experts will evaluate the contents, methods, results and conclusions of the paper in detail, and put forward suggestions for revision.

4. Revision and reply: The author revised the paper according to the opinions of peer review, and wrote a reply letter detailing the handling of the comments.

5. Final review: The revised paper will be submitted to the editorial department again for final review. If the paper meets the requirements, it will be accepted for publication; Otherwise, it may be rejected or need further modification.

In addition, some top journals will adopt a double-blind evaluation system, that is, the reviewer does not know the identity of the author, and the author does not know the identity of the reviewer. This system aims to ensure the fairness and objectivity of the evaluation process.

In a word, the evaluation process of top medical journals is strict and complicated, aiming at ensuring the published articles have high quality and scientific value.