Objective This study aims to analyze the standardized residency training (hereinafter referred to as residency training) specialty directory in China and propose optimization recommendations. Methods In 2021, a comparative analysis was conducted between China′s residency training specialty directory and other domestic medical-related directories. A questionnaire survey was also carried out involving 28 staff members from the science and education departments of health administration institutions in 17 provinces, 740 residency training managers from 443 residency training bases across 27 provinces (autonomous regions, municipalities), 15 586 residency training faculty members, 20 240 residents, and 86 experts from the Chinese Medical Doctor Association′s Professional Committee. The selection of the research Methods aimed to ensure the breadth and representativeness of the data. Literature analysis was used to define the research topic and key issues, while the survey questionnaire collected firsthand experiences and perspectives from residency training administrators, instructors, and resident physicians at various levels. This approach allowed for a comprehensive examination of the existing issues in China′s residency training catalog and potential improvements. Descriptive statistical analysis was applied to analyze the relevant data. The study identified existing issues and gathered suggestions for optimizing the residency training specialty directory through practical evaluation. Descriptive statistics were used to analyze relevant data. Results Based on a comparison of the directories and survey results, it was found that the current residency training program directory in China has several issues: certain specialties are inconsistent with other medical directories (e.g., Medical Genetics and Preventive Medicine), and some specialties (e.g., Surgery-Neurosurgery, Surgery-Cardiothoracic Surgery, Oral and Maxillofacial Surgery, and Prosthodontics) are overly specialized at an early stage. Conclusions The residency training directory should align with the professional directories of all stages of medical education, from training to practice. It is recommended to emphasize generalist competencies or broad specialty training in directory development and explore integrated residency and specialty training models for disciplines such as Radiology and Oncology.