Purpose: Relevant processes and outcomes of utilizing milestones framework in the training of non-physician therapists are seldom reported. This study aimed to construct learning milestones for radiation therapists (RTTs) through a stringent multi-modal consensus-based approach and explored its impacts. Methods: The nominal group technique (NGT), modified Delphi Method (MDM), and focus group method were integrated into the consensus development. After finalizing the consensus, qualitative and quantitative questionnaires were distributed to the participants to explore the impacts of the process. Medical educator's feedback was assessed with a Likert 5-point scale, which focused on: (1) Self-assessed comprehension of the 5 core competencies of RTTs; (2) Effectiveness of the consensus methods; and (3) Benefits of milestones framework on clinical education and promotion of professional identity. Results: Twenty-nine expert educators from medical institutions across Taiwan participated in the consensus development. Through the process, 13 sub-competencies and 115 milestones were developed. The self-assessed comprehension of core competencies significantly increased after the consensus development. All three consensus methods were deemed effective (the average scores for NGT, MDM, and focus group were 4.79, 4.66, and 4.62, respectively). The development process was considered beneficial to the clinical education of RTTs (4.79), the willingness to adopt the learning milestones (4.66), and the promotion of professional identity (4.66). Conclusions: The stringent multi-modal consensus development approach was feasible in establishing learning milestones for RTTs. Moreover, medical educator training was facilitated through the process. Comprehension of the five core competencies and professional identity were promoted by participating in the process.