Since most of the time you are on your first rotation during the first year, don't think about speed. Try to learn important basics, comprehensive imaging anatomy and bread and butter pathologies. Speed will come over time, even after you are done with your fellowship in the first year in pp.
Call is when you have to try to build up a balance between speed, quality and gain confidence.
I think a very bad trend these days is to have 24 hour in house attending. It kills the opportunity to be on call on your own and develop the above-mentioned skills.
I totally agree with you about learning the basics/bread and butter path. Frankly, I wish I felt like I could perseverate on some studies longer and do some spot reading however, my program seems to stress speed ... even for first years. That's why I was curious. And... no in-house attending for me
speed is often a function of confidence. it's difficult to be confident as an R1, which probably explains why i see too many of them putz their way through the plain films because they worry about missing things on cross-sectional studies. don't worry about missing something or being wrong - that's what i'm there for. i think it's the practice and experience of forcing yourself to say something intelligent and putting it out there for the world to see (even in the form of preliminary report) that helps build speed. i totally agree with shark on the call point; in-house attending coverage can really hurt in developing this ability.
As a frame of reference, where I was they expected fellows on call to read something on the order of four cross-sectionals an hour, or 10-15 plain films.
That was way faster than the average pace most junior residents read at, but I think it is way slower than what you would probably be expected to do in the working world.
I think four is a reasonable number to work towards - that means you get 15 minutes to read, dictate, proofread, and sign a CT. Obviously, some studies you can do way faster than that (cough negativedvt cough) and others may take much longer.
Another way to look at it is how many studies can you read in a day. A number for private practice I have seen come up frequently is 100 (mix of all kinds of exams).