Despite the use of imaging in many medical and surgical practices, no universal mandatory radiology component is required by the Liaison Committee on Medical Education. In contrast, United States medical students are required to complete at least one core subinternship during their final year of medical school in medicine, surgery, pediatrics, or family medicine, regardless of their chosen field of interest. Students are expected to perform just below the level of an intern, performing functions such as assisting in writing notes, placing orders, and arranging for appropriate follow-up. To our knowledge, there are few institutions that offer a comparable clinical experience in radiology. In order to address this, we successfully designed and implemented a hands-on medical student advanced radiology elective, which allowed for experiential learning through independent dictation of radiographic examinations and procedure-based practice. Here, we describe the process of developing such an elective, how to implement it at other institutions, and some insight into troubleshooting any potential pitfalls should they arise. Overall, our novel hands-on elective enables a more student-centered, active learning approach, allowing for more in-depth, accurate evaluation of specialty choice while also equipping faculty and residency programs with the skills to best assess student interest, motivation, knowledge, and communication skills.