Objective To explore the teaching effect of hierarchical progressive online and offline teaching in the standardized training of radiology residents. Method A trial control method was used. A total of 336 residents who received standardized residency training in the Department of Radiology of the Second Hospital of Jilin University from January 2020 to December 2021 participate in the study, among whom 152 residents in 2021 were selected as the experimental group, and 184 residents in 2020 were selected as the control group. They were divided into the professional (radiology) cohort and the non-professional cohort respectively. The residents in the experimental group took the hierarchical progressive online and offline teaching method, and the residents in the control group took the traditional teaching method. The training effect was evaluated by the scores of the residents' practice competence, and the t-test and χ² test were used for comparison between the groups. Results In practice competence, for resident physicians in the professional cohort, the theoretical and clinical film reading ability assessment scores in the experimental group were higher than those in the control group [(91.33 ± 3.48) points vs. (86.27 ± 6.08) points, (96.75 ± 3.21) points vs. (85.59 ± 11.45) points] (all P<0.001); for the non-professional cohort, the theoretical and clinical film reading ability assessment scores in the experimental group were higher than those in the control group [(86.87 ± 7.99) points vs. (67.21 ± 17.47) points, (87.79 ± 8.12) points vs. (76.56 ± 16.16) points](all P<0.001). Conclusions In the standardized training of radiology residents, adopting a hierarchical and progressive online and offline teaching method can help improve the theoretical level and clinical film reading ability of resident physicians, thereby improving teaching efficiency.