Toward a sustainable model for novice ultrasound training: mixed-methods analysis of student portfolios and objective outcomes in Korean Medicine.

BACKGROUND: Ultrasound is an essential educational tool for anatomy, physiology, diagnosis, and procedure in medical education. Various educational cases have been reported to date, yet novice experiences in non-traditional, resource-constrained contexts remain underexplored. This study explores Korean Medicine (KM) students' perceptions of introductory ultrasound education, learning experiences, and the process of learning transfer.

METHODS: We analysed students' learning portfolios from an introductory musculoskeletal ultrasound training program for KM students. Quantitative data included self-assessment of goal achievement, pre- and post-training self-efficacy, self-directed learning indicators, and objective structured clinical examination (OSCE) scores. Qualitative data comprised reflective narratives that were analysed using framework analysis and subsequently interpreted alongside quantitative data.

RESULTS: Qualitative analysis identified four themes: "perceptions of the learning environment," "challenges and insights during training," "assessment and further learning," and "application and transfer." Correlation and multiple regression analyses showed that self-assessment, self-efficacy change, and self-video activity were not significantly associated with OSCE performance. Students valued instructor's supportive guidance and portable ultrasound practicality in the learning environment. Ultrasound skill acquisition enhanced equipment operation, probe proficiency, anatomical recognition, and diagnostic competency, leading students to reappraise ultrasound as "a real-time anatomical visualization and safe acupuncture guidance tool." Students' self-efficacy increased significantly after training (p < .001), primarily due to perceived improvements in performance speed and accuracy and greater confidence in procedural performance. Students' plans for further learning varied, from short-term practice to future certification acquisition. In terms of 'application and transfer,' they identified clinical barriers including insurance ineligibility, high equipment costs, and the limitations of portable devices.

CONCLUSIONS: Musculoskeletal ultrasound training integrated into the KM curriculum may enhance students' self-efficacy and support the integration of anatomical knowledge with clinical application. Although no significant quantitative predictors of OSCE performance were identified, the findings suggest important pedagogical implications regarding novice students' cognitive load, self-assessment difficulties, and the potential role of structured feedback and longitudinal educational support in ultrasound learning. Future KM ultrasound education may benefit from more longitudinal and educationally integrated approaches that support the development and sustained application of ultrasound competency in resource-sensitive educational contexts.