Abstract: As a pivotal initiative to elevate the quality of Traditional Chinese Medicine (TCM) classical education, the reform logic and driving mechanisms behind the Traditional Chinese Medicine Classics Competency Grading Examination require thorough investigation. Guided by Kingdon's multiple streams framework, this study systematically analyzes the reform process of this examination from 2016 to 2025. The findings indicate that the problem stream encompasses regional disparities in the quality of TCM classical education, insufficient student emphasis on TCM canonical texts, and the declining efficacy of traditional assessment methods. The policy stream originates from institutional practices of tiered examinations and expert consensus, while the political stream is driven by the national policy directive of “Inheriting the essence, upholding authenticity, and fostering innovation” along with growing public demand for the preservation and development of TCM culture. These three streams converged at the policy window opened during the 2019 National Chinese Medicine Conference, leading to the establishment of the standardized examination. This analytical model, grounded in the multiple streams framework, clearly explains the dynamic connections between problem identification, solution development, and political mobilization in medical education reform. It helps to better understand the underlying logic and driving mechanisms of changes in medical education policy.

Key words: Education, medical, Traditional Chinese Medicine Classics Competency Grading Examination, Multiple streams framework, Examination reform