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The aim of this study was to evaluate the magnetic resonance imaging (MRI) interpretation proficiency of musculoskeletal fellows in training.Between July 2003 and June 2007, 14 musculoskeletal fellows were independently tested with 20 MRI studies of the knee and shoulder at four separate time points during their fellowship years. Trends in true-positive and false-positive interpretation results were evaluated. Fellows who completed their residencies at the fellowship institution (internal fellows) were compared with those from other residencies (external fellows).There was a significant improvement in proficiency between the initial and final (9-month) evaluations (P.0001). At the initial evaluation, there was a mean of 52.8% (41.7 of 79) true-positive results (range, 32-51); at 9 months, there was a mean of 71.0% (56.1 of 79; range, 40-72). The number of false-positive results also declined during this time period from a mean of 8.1 (range, 2-13) at initial evaluation to 4.7 (range, 2-8) at 9 months (P.001). External fellows had more incorrect diagnoses initially but showed greater improvement than internal fellows at 9 months.Fellows continued to improve their MRI interpretation skills throughout the first 9 months of their fellowships. External fellows were slightly less proficient at the start of their fellowships but slightly more proficient at 9 months compared to internal fellows.