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Background: Citation analysis has become an important tool for researchperformance assessment in the medical sciences. However, different areas ofmedical research may have considerably different citation practices, evenwithin the same medical field. Because of this, it is unclear to what extentcitation-based bibliometric indicators allow for valid comparisons betweenresearch units active in different areas of medical research.  Methodology: A visualization methodology is introduced that revealsdifferences in citation practices between medical research areas. Themethodology extracts terms from the titles and abstracts of a large collectionof publications and uses these terms to visualize the structure of a medicalfield and to indicate how research areas within this field differ from eachother in their average citation impact.  Results: Visualizations are provided for 32 medical fields, defined based onjournal subject categories in the Web of Science database. The analysis focuseson three fields. In each of these fields, there turn out to be largedifferences in citation practices between research areas. Low-impact researchareas tend to focus on clinical intervention research, while high-impactresearch areas are often more oriented on basic and diagnostic research.  Conclusions: Popular bibliometric indicators, such as the h-index and theimpact factor, do not correct for differences in citation practices betweenmedical fields. These indicators therefore cannot be used to make accuratebetween-field comparisons. More sophisticated bibliometric indicators docorrect for field differences but still fail to take into account within-fieldheterogeneity in citation practices. As a consequence, the citation impact ofclinical intervention research may be substantially underestimated incomparison with basic and diagnostic research.

Citation analysis may severely underestimate the impact of clinical research as compared to basic research