To develop a milestone-based evaluation system for the core "knowledge and skills" competency of neurology residents that is tailored to China's medical context, so as to provide precise guidance for their training and assessment.

Using the Delphi method, the study first constructed an initial framework through literature review, on-site investigation and expert-group discussion. Two rounds of expert consultation were then conducted among specialists in neurology education across China. Indicators were screened and optimized according to the mean score, agreement rate and coefficient of variation (CV), ultimately finalizing the system.

The expert response rates in both rounds were 100%. The group authority coefficients were 0.97 and 0.98, with Cronbach's α of 0.90 and 0.88, respectively. The mean scores of all indicators ranged from 3.88 to 5.00, agreement rates from 62.50 % to 100 %, and CVs from 0 to 0.21. The finalized framework comprises one first-level indicator, three second-level indicators and 17 third-level indicators.

The milestone evaluation system for core competencies in "knowledge and skills" of neurology residents developed in this study is scientific and reasonable, providing a standardized and scientific assessment tool for the standardized training of neurology residents.