Step 4. Customize

Skills are just text files. Anyone can modify them or create new ones.

The easy way — Just ask Claude

You don't need to open any files yourself. Tell Claude what you want changed:

Modify an existing skill

"Change check-reporting so it always outputs results in Korean"

Create a new skill

"Create a new skill called radiology-report that generates structured radiology reports following ACR guidelines"

Update to the latest version

"Update MedSci Skills by running npx medsci-skills@latest install, then remind me to restart Claude Code"

Claude will edit the SKILL.md files, create folders, and handle everything for you. Below is a reference for what happens behind the scenes.

REFERENCE: MANUAL EDITING

Anatomy of a Skill

Every skill lives in a single folder as a SKILL.mdfile. This file tells Claude "here is how you should behave in this situation."

SKILL.md basic structure

---
name: my-custom-skill
description: Use when I ask for a report in my hospital's format. Fills the template below from the findings.
metadata:
  triggers: "report, template"
---

# Rules

1. When the user requests a report, follow the template below.
2. De-identify all patient information.
3. Conclusions must always include supporting evidence.

# Template

## Title
## Findings
## Conclusion
## References

name — Skill name (should match the folder name)

description— When to use the skill, then what it does. Claude reads it to decide when to load the skill, so start with "Use when …" and keep it short (every MedSci Skills description is under 300 characters)

metadata.triggers — Optional keywords, a MedSci Skills convention. Claude decides from the description, not from this list

Body — Specific instructions for Claude (plain language)

Modifying an Existing Skill

1. Open the skill folder you want to edit inside ~/.claude/skills/.

2. Open SKILL.md in any plain-text editor (Notepad, TextEdit, VS Code).

3. Edit the parts you need. For example:

  • Change the default output language
  • Adjust formatting to match a specific journal style
  • Add rules that reflect your institution's policies

4. Save the file and restart Claude Code Desktop.

Creating Your Own Skill

1. Create a new folder inside ~/.claude/skills/.

~/.claude/skills/my-report-template/

2. Add a SKILL.md file inside it, following the structure shown above.

3. Restart Claude Code Desktop and your new skill will be loaded automatically.

Tip

The fastest way is to duplicate an existing skill and modify it. For instance, copy the check-reportingfolder, rename it, and adjust the checklist to match your hospital's standards.

Updating Skills

MedSci Skills are continuously improved. To update to the latest version:

1. In a terminal, run npx medsci-skills@latest install. If you used the classroom installer, double-click the "Update MedSci Skills" icon on your Desktop instead.

2. Restart Claude Code.

The installer copies any skill you changed to ~/.medsci-skills/backups/ before replacing it. Updating by hand from a new ZIP instead? Copying adds files but never removes them, so back up your edits first and follow MIGRATION-v6.md for the skills renamed in v6.

The Role of Orchestrate

The orchestrate skill acts as a traffic controller for all other skills. It figures out what you need and automatically routes your request to the right skill.

When you add your own skills, orchestrate picks them up automatically. Just make sure its description says clearly when to use it.

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