Objective To explore the application effects of the structured reporting (SR) in the internship teaching of undergraduate students in medical imaging. Methods A controlled experimental approach was adopted. Using a random number table method, 64 undergraduate students majoring in medical imaging who interned in the Department of Radiology at Xijing Hospital, Air Force Medical University, from July 2023 to January 2024 were divided into a study group and a control group, with 32 individuals in each group. The study group was taught using the SR template, while the control group was taught using the traditional free-text reporting (FTR) template. The teaching effectiveness of the two groups was evaluated using both objective assessments and survey questionnaires. Statistical analysis were performed using t-tests, Mann-Whitney U tests. Results After the internship, the study group had higher practical imaging skills and total scores than the control group after the internship [(87.75±3.35) vs. (84.38±4.24) for practical imaging skills, (88.55±2.54) vs. (86.31±2.45) for total scores, both P<0.05], while there was no significant difference in theoretical knowledge scores between the two groups [(89.34±2.85) vs. (88.25±3.07), P=0.144]. The time taken by the study group to write image reports was shorter than that of the control group [(10.8±1.54) minutes vs. (11.9±2.01) minutes], but the difference was not statistically significant (P=0.178). The study group rated the convenience of the report template, the consolidation of imaging theoretical knowledge, the cultivation of imaging diagnostic thinking, the improvement of imaging diagnostic confidence, and the establishment of clinical diagnostic reasoning higher than the control group did [4.0 (2.0) vs. 4.0 (1.0), 4.0 (1.0) vs. 3.0 (1.0), 5.0 (1.0) vs. 4.0 (1.0), 4.5 (1.0) vs. 4.0 (1.0), 5.0 (1.0) vs. 4.0 (1.0), all P<0.05]. Conclusions The SR template is convenient to use in medical imaging internship teaching. It can improve the speed and confidence of imaging diagnosis, especially enhancing practical imaging skills, cultivating imaging diagnostic thinking, and establishing clinical diagnostic reasoning. This helps achieve capability and quality objectives, and has a promising application prospect.