Objective To explore the influencing factors of the satisfaction of the national traditional Chinese medicine (TCM) classics proficiency level examination and the internal relationships among them, so as to inform the examination reform and the training of TCM practitioners. Methods In this study, the questionnaire method was used and a self-designed questionnaire with 19 entries in 4 dimensions (knowledge, practice, values, appraisal) and satisfaction was used. The questionnaire was administered to 3 369 students who took the examination in 40 medical schools across the country in august 2022, and the results were analyzed with descriptive statistics and structural equation modeling. Results Students scored (15.66±3.64) points for students' knowledge dimension, (15.69±3.63) points for practice dimension, (20.61±4.45) points for value dimension, and (11.25±2.50) points for appraisal dimension. The satisfaction score was (11.99±2.57). The score of practice, value and appraisal dimension had positive effects on satisfaction score (β=0.353, 0.432, 0.190, P<0.001). The score of practice dimension had positive effects on the value dimension and test paper quality dimension (β=0.470, 0.732, P<0.001). “appraisal” dimension score had positive effects on students' value dimension scores (β=0.420, P<0.001). The score of students' knowledge dimension had a positive effect on the score of practice dimension (β=0.979, P<0.001). Conclusions Students have high satisfaction with exams. The stronger the students' practical ability and the higher their evaluation of the examination, the higher their satisfaction with the examination. It is recommended to cultivate students' ability in stages and continuously improve the construction of the national traditional Chinese medicine classics proficiency level examination to enhance the quality of the examination.