While large language models show promise in medical applications, achieving expert-level clinical reasoning efficiently remains challenging due to the need for massive amounts of manually labeled data and large-scale models. To address this challenge, we propose Clinical-Oriented Reinforcement Learning (CORL), the first fully open-source, end-to-end reinforcement learning training pipeline in the clinical reasoning domain, incorporating a Reasoning-Oriented Data Strategy (RODS) based on topological synthesis, CoT cold-start, and two-stage reinforcement learning. Through CORL, we trained the Fleming-R1 series of models. Among them, Fleming-R1-7B significantly outperforms models of comparable size while approaching or even surpassing certain 32B and 72B models. Fleming-R1-32B achieves near-parity with GPT-4o and outperforms the strongest open-source alternatives up to 671B in MedXpertQA. This demonstrates that in clinical reasoning field, a meticulously designed training pipeline holds greater importance than scaling model size alone. Data and Models are available at https://github.com/UbiquantAI/Fleming-R1 and https://huggingface.co/collections/IQuestLab/fleming.