We sought to assess how the use of an audience response system (ARS) in medical student radiology instruction affects the self-confidence, ability to gauge mastery, and insights for future preparation in students when they participate as audience members and when they give peer teaching presentations. Twenty-seven medical students discussed radiology case files in groups and used an ARS to present their assigned cases to peers. Students' views of interactive audience response versus traditional pedagogy were surveyed using a 5-point Likert scale (1, strongly agree; 2, agree; 3, neither agree nor disagree; 4, disagree; 5, strongly disagree). Students reported that instruction with interactive ARS lectures gave them more confidence to verbally answer questions in subsequent lectures when compared to instruction with standard didactic lectures, where a presenter asks questions and a single student responds (2.35 versus 3.14, p < .024). Students found it easier to gauge their level of mastery of material by answering ARS questions than by hearing classmates' verbal responses to questions posed in lecture (1.77 versus 2.68, p < .002). When giving peer teaching presentations, students reported that the ARS lecture format helped them to gauge their audience's level of understanding (1.55, 95% CI [1.27-1.82], p < .001). Radiology instruction utilizing an ARS can help build students' confidence, knowledge of self-mastery, and insights for future studying. Similarly, student presenters using an ARS improve their confidence, better gauge their audience, and develop helpful insights for future teaching presentations.