Standardized and institutionalized policies for the training of Traditional Chinese Medicine (TCM) resident doctors are crucial for nurturing high-quality TCM practitioners who meet national and societal demands. In the context of China′s evolving national conditions

using a historical institutionalism approach based on structural and historical perspectives offers a new lens to examine the 30-year evolution of TCM resident training policies in China. The policy changes can be categorized into three phases: incremental policy change period

transitional policy change period

and radical policy change period. The evolution of these policies reflects how external temporal processes and spatial structures constrain policy changes. These changes occur amidst complex interactions among institutions

environments

and actors

forming a self-reinforcing path dependency that evolves progressively

thereby continuously influencing and reshaping the TCM residency training system. Therefore

optimizing and improving the TCM resident training system requires attention to the influences of external environments and actors. Starting from the policy′s intended guidance

increased resource incentives are necessary. Regions and institutions should deepen their policy understanding

continuously strengthen TCM characteristics

enhance training quality

and from an individual level

promote efficient and high-quality implementation of policies

safeguarding the training of TCM talent.