Objective To construct an evaluation index system for the clinical ability of students in the ″5+3″ integrated program of traditional Chinese medicine during the standardized residency training (hereafter referred to as residency training) stage based on the Miller pyramid model. Methods In December 2023, based on the Miller Clinical Competency Pyramid model as the theoretical foundation, the evaluation system indicators were initially established through literature analysis and semi-structured interview methods. From January to March 2024, the Delphi method was used to conduct two rounds of expert consultations with 13 experts. The priority graph method and the percentage weight method were adopted to establish the index weights. Results All 13 questionnaires were collected in both rounds of expert inquiries, indicating a high level of enthusiasm among the experts. The expert authority coefficients were 0.940 and 0.970 respectively. The Kendall′s Concordia coefficients were 0.284 and 0.308 respectively (all P<0.001); Finally, an evaluation index system for the clinical ability of eight-year students in traditional Chinese medicine during the residency training stage was established, which includes four first-level indicators: theoretical knowledge of traditional Chinese medicine, knowledge application ability, clinical operation performance, and comprehensive vocational ability, 20 second-level indicators, and 52 evaluation elements. Conclusions The evaluation index system constructed in this study can reflect the clinical ability characteristics of students in the ″5+3″ integrated program of traditional Chinese medicine during the residency training stage. It is scientific and practical, and can provide empirical references for the quality evaluation of students′ clinical abilities during the residency training stage.