Objective To analyze the effectiveness of the assessment feedback model grounded in milestone-based competency assessment standards in the neurology fellowship training. Methods In 2023, all 14 neurology specialists (including 6 doctoral students and 8 physicians from the hospital, with varying numbers of specialists from different training years) who underwent standardized training at the Department of Neurology, Peking University Third Hospital, from 2019 to 2022 were enrolled. The milestone-based competency assessment standards established earlier were applied, and a continuous follow-up was conducted using the assessment-feedback-training cycle model to evaluate the effectiveness of the specialist training. Chi-square test and Kruskal-Wallis tests were used to analyze the relevant data. Results As the seniority of the specialists increased, their competency scores increased annually in all competency dimensions. However, the proportion of meeting standards fluctuated and did not match the increased consistency with the scores [for example, in the clinical teaching dimension, the scores of the specialists from the first year of specialized training to the third year were 2.0 (2.5), 4.0(1.2), and 6.0(1.2), respectively, and the differences in ratings between adjacent years were statistically significant (all P<0.05), while the proportion of meeting standards were 4/10, 3/10, and 3/6, respectively]. Dynamic follow-up radar charts for individuals indicated that the trajectories of competency improvement among different specialists were significantly different. Conclusions The assessment feedback model grounded in milestone-based competency assessment standards can be used for the assessment and monitoring of the competency development among neurology specialists, and targeted training can be conducted based on these results. During the training process, it is not only necessary to focus on the development of the overall level but also to pay attention to the individual differences among specialists, tailoring teaching according to their individual aptitude. Assessing specialists based on the level they need to achieve in different years of seniority can increase the sensitivity of the assessment and promote the enhancement of competency.