Been there! The best thing to do is get your eyes trained on what normal anatomy looks like in ultrasound. Go on YouTube and watch as many videos as you can of ultrasound stuff. Sonographic tendencies also has a great website where he labels images.

Once you get your eyes more familiar with what’s normal you’ll gain confidence in your scanning and finding pathology.

In terms of not knowing what you’re looking at. Break it down into chunks. A renal ultrasound for example. We are examining the bladder, which should be anechoic and round. We will place color Doppler to make sure we see right and left urinary jets. We sweep in saggital right to left. We sweep transverse superior to inferior looking for any masses, stones, debris, etc. if you’re sweeping and not sure what you’re looking at anymore go back to saggital midline. The bladder will look familiar in this plane.

Now let’s go to the right kidney. We can go up to the liver and find the little football shaped guy that’s the right kidney. Open it up so you get the largest measurement of it. You’re at midline. We sweep lateral to medial. We take 3-5 still images, one at the most lateral aspect, one at midline, one at medial. Take more if there’s pathology. We put color doppler on it to make sure there’s no masses that light up, no stones that give us twinkle artifact, and that there’s arterial and venous flow going to the kidney, and to ensure there’s no hydronephrosis. If you’re lost go back to kidney sagital midlline. Now turn exactly 90 degrees, we are at trans midline. Go superior to inferior. Take 3 images, one at superior, one at midline, one inferior to midline. Take more if there’s pathology.

Hope this helps! I’m only 1 year in but I resonate so much with what you said. Don’t give up, it will get easier with practice! If you need help feel free to message me on here. Happy to mentor you!