{"id":73577,"date":"2026-10-06T09:13:28","date_gmt":"2026-10-06T01:13:28","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=73577"},"modified":"2026-10-06T09:13:28","modified_gmt":"2026-10-06T01:13:28","slug":"ultrasound-learning-experiences-in-a-japanese-student-led-circle-a-descriptive-study","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/ultrasound-learning-experiences-in-a-japanese-student-led-circle-a-descriptive-study\/","title":{"rendered":"Ultrasound learning experiences in a Japanese student-led circle: A descriptive study"},"content":{"rendered":"<p>Submitted: 11 June 2025 <br \/>\r\nAccepted: 10 June 2026<br \/>\r\nPublished online: 6 October, TAPS 2026, 11(4), 34-43<br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2026-11-4\/OA3772\">https:\/\/doi.org\/10.29060\/TAPS.2026-11-4\/OA3772<\/a><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Shogo Tsuge<sup>1<\/sup>, Kenji Ohba<sup>2<\/sup>, Yasushi Matsuyama<sup>3<\/sup>, Shinnosuke Akeda<sup>1<\/sup>, Sayaka Ogawa<sup>1<\/sup>, Taiki Hosokawa<sup>1<\/sup>, Sanshiro Togo<sup>1<\/sup>, Takeji Saitoh<sup>4<\/sup>, Hiroshi Igarashi<\/span><sup><span lang=\"EN-GB\">2<\/span><\/sup><span lang=\"EN-GB\">\u00a0&amp; Kazuo Umemura<\/span><sup><span lang=\"EN-GB\">2<\/span><\/sup><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Faculty of Medicine, <sup>2<\/sup>Medical Education Centre, Hamamatsu University School of Medicine; <sup>3<\/sup>Medical Education Centre, Jichi Medical University; <sup>4<\/sup>Next Generation Creative Education Centre for Medicine, Hamamatsu University School of Medicine, Japan <\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Introduction: <\/span><\/b><span lang=\"EN-GB\">Peer-assisted learning (PAL) is widely used to support collaborative clinical skill development. In Japan, PAL is often organised through student-led extracurricular groups known as circles or \u201cbukatsud\u014d\u201d. This descriptive study examined the educational characteristics of a student-led ultrasound circle, the Hamamatsu Emergency Room Ultrasound (HERUS), and explored students\u2019 learning experiences.<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Methods:<\/span><\/b><span lang=\"EN-GB\"> We conducted a retrospective survey of sixth-year medical students who completed their clinical clerkships. The duration and extent of HERUS members\u2019 and non-members\u2019 ultrasound learning were compared. Additionally, all 14 HERUS members were surveyed to examine factors associated with learning frequency and faculty recognition. Qualitative open-ended responses about perceived educational benefits were analysed using content analysis.<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Results: <\/span><\/b><span lang=\"EN-GB\">HERUS members gained earlier ultrasound experience in the cardiac, abdominal, and neck regions, and were more likely to have performed cardiac ultrasound on patients during clerkship, than non-members. HERUS members with \u226530 months of participation reported more departments where HERUS was discussed with faculty.\u00a0 Half of the HERUS members practiced ultrasound with peers at least weekly. Content analysis indicated that wearing scrubs helped faculty identify HERUS members and provide them with opportunities for ultrasound practices on real patients. Self-motivating factors were collaborative PAL, perceived competence in ultrasound examinations in clinical settings, and self-paced, repetitive practice.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Conclusion: <\/span><\/b><span lang=\"EN-GB\">HERUS provided a culturally grounded, practical environment for student-led ultrasound learning. Qualitative patterns reflected factors corresponding to relatedness, competence, and autonomy in self-determination theory. These preliminary insights may help refine student-led PAL initiatives.<b><\/b><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Keywords<\/span><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Peer-Assisted Learning, Extracurricular Activities, Student-Led Ultrasound Circle, Japanese Student Circles <\/span><\/i><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">A student-led ultrasound group offers early and frequent hands-on experience beyond the curriculum.<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Longer participation may be associated with increased opportunities for interaction with faculty.<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Culturally rooted activities could help sustain effective peer-assisted learning.<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Custom-designed attires may increase faculty visibility and signal students\u2019 interest in ultrasound.<\/span><\/li>\r\n<\/ul>\r\n<div>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In recent years, peer-assisted learning (PAL) has been increasingly recognised in medical education as an effective collaborative learning approach for knowledge and skills sharing. Numerous studies have demonstrated that PAL enhances learners\u2019 comprehension and fosters autonomy and confidence in educational contexts (Ross &amp; Cameron, 2007). Specifically, in acquiring clinical skills, peer-led instruction creates a psychologically safe environment conducive to repeated practice and immediate feedback. Such features are instrumental in consolidating practical knowledge and improving technical competence, making PAL a valuable strategy across various medical educational settings, including ultrasound training (Bapuji et al., 2024; Hirsch et al., 2025; Weimer et al., 2025).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In Japan, PAL has been uniquely developed within the framework of student-led extracurricular activities, commonly referred to as circles or \u201cbukatsud\u014d\u201d. These activities have long been institutionalised in Japanese primary and secondary education and encompass both athletic and cultural pursuits (Cave, 2004; Onoda &amp; Omi, 2023). Although technically extracurricular, circle activities are often intensive and long-term, emphasising discipline, perseverance, and hierarchical senior\u2013junior student (senpai\u2013k\u014dhai) relationships, thereby playing a central role in students\u2019 socialisation and character development (Sekiguchi &amp; Ikeda, 2025).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Compared with their Western counterparts, Japanese student circles involve significantly more frequent participation, with regular meetings held over weekends and during school holidays. Although officially voluntary, circle activities witness significant participation from students, whereby they develop a strong sense of belonging and achievement through shared challenges and commitments (Cave, 2004; Onoda &amp; Omi, 2023). Unlike mentoring between independent individual learners and teachers in Western contexts, Japan provides a culturally supportive environment for peer mentoring that does not rely on formal authority (Darling et al., 2002). This has led to the emergence of peer-supported learning environments in Japanese education.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Undergraduate medical education primarily occurs at tertiary level, wherein faculty-imposed regulations and hierarchical enforcement tend to be more relaxed. Upon entering university, students are expected to assume greater autonomy and responsibility for their learning, and student-led circles consequently become increasingly important peer-supported learning environments that help students navigate this transition. These circles not only foster autonomous learning and group cohesion but also provide a culturally familiar structure through which students can exercise self-direction within a supportive peer community. These activities often preserve cultural elements inherited from school-based circle activities, such as vertical relationships and shared goals (Sekiguchi &amp; Ikeda, 2025). Beyond recreation, student circles function as informal educational platforms that foster leadership development, peer mentoring, and social integration \u2013 skills highly valued in both academic and professional contexts (Onoda &amp; Omi, 2023). Thus, understanding Japan\u2019s circle culture offers valuable insights into how educational practices shape emotional resilience, collectivism, and long-term commitment, which subsequently influence workplace culture and interpersonal dynamics in adulthood. These cultural factors are closely linked to the enduring informal hierarchical structures \u2013 senpai (seniors), k\u014dhai (juniors), and d\u014dki (same-year peers) \u2013 which significantly shape the development and sustainability of PAL in Japan (Sekiguchi &amp; Ikeda, 2025).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Moreover, in Japan and several other East Asian contexts, undergraduate medical education has traditionally been characterised by teacher-centred instruction, frequent summative assessments, and limited opportunities for learner autonomy (Matsuyama et al., 2019). Rather than contradicting the autonomy observed in student-led circles, this teacher-centred structure may in fact heighten the value of extracurricular peer-driven learning spaces, where students can practice self-initiated learning, experiment with new skills, and support each other outside the constraints of formal curricula. These cultural and structural features have contributed to a growing interest in educational approaches that allow students to take more initiative and responsibility in their learning.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Building on this cultural and institutional context, our institution has supported a student-initiated ultrasound education circle, the Hamamatsu Emergency Room Ultrasound (HERUS), which was established in 2021 (Tsuge et al., 2024). Through a retrospective survey of student participants, this study examines how HERUS functions as a student-led learning environment and explores learning experiences that may relate to concepts discussed in motivation and social learning research.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">A. Overview of HERUS: A Student-Led Ultrasound Education Initiative<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The HERUS Society was established in 2021 by six third-year undergraduate medical students and a certified echocardiologist during a period when clinical training was limited due to the coronavirus disease 2019 pandemic.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">HERUS launched several innovative educational activities. The first was a weekly PAL session, in which peers served as simulated patients to facilitate hands-on practice (Figure 1a). The second involved periodic anatomical training sessions using porcine hearts, which have been recognised as effective instructional tools for learning cardiac anatomy and ultrasound techniques (White et al., 2021) (Figures 1b and 1c). In both sessions, senior students often instructed junior students; however, capable peers or junior students occasionally instructed their classmates or even senior students. In the third educational initiative, members wore custom-designed scrubs featuring probe illustrations during their clinical clerkships (Figure 1d).<\/span><\/p>\r\n<\/div>\r\n<p><img loading=\"lazy\" decoding=\"async\" width=\"1299\" height=\"786\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-1.png\" alt=\"\" class=\"size-full wp-image-73578 aligncenter\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-1.png 1299w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-1-300x182.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-1-1024x620.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-1-768x465.png 768w\" sizes=\"auto, (max-width: 1299px) 100vw, 1299px\" \/><\/p>\r\n<p><span lang=\"EN-GB\">(a) Sonographic image of the long-axis view from a male undergraduate student obtained during a PAL session.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">(b) Porcine heart section, mimicking the long-axis view, obtained during an anatomical training session.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">(c) Edible porcine hearts purchased from a butcher shop.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">(d) Custom-designed original scrubs from our student society, HERUS, featuring a probe logo to enhance the visibility of our society&#8217;s activities and encourage faculty engagement, resulting in increased echocardiography learning opportunities with real patients during clinical clerkships and a rise in purchases or donations of ultrasound-related devices<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 1. Integration of peer learning, anatomical simulation, and visual identity to promote undergraduate ultrasound education.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">By March 2024, when the founding members graduated, HERUS had expanded to include more than 80 students. TS, one of the authors of this manuscript, has served as the faculty advisor for the student group since 2022, and KO, the corresponding author, has served as the associate advisor since 2023.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">B. Study Design<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study combines results from quantitative and qualitative data in a manner similar to a convergent parallel design in mixed methods research (Moeller, 2016). A pragmatic paradigm was adopted, prioritising methodological choices that best address the research question (Shannon-Baker, 2016). Pragmatism was appropriate because the study aimed to obtain a comprehensive and practically meaningful understanding of how HERUS participation relates to ultrasound learning opportunities and faculty recognition. From a pragmatic perspective, qualitative and quantitative approaches are viewed as complementary, and their integration enables insights that are both contextually grounded and actionable for educational improvement.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">C. Participants and Data Collection<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">1) Questionnaire Survey of HERUS Members and Non-Members:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">To examine the differences in ultrasound learning opportunities between HERUS members and non-members, a cross-sectional survey was administered to sixth-year medical students who had completed their clinical clerkships. The survey was distributed in July 2023 to all sixth-year students at our institution (N = 116): 14 HERUS members and 102 non-members. Only the responses from participants who provided consent for research use were included in the analysis.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Participants were asked to report the timing of their first ultrasound experience (including practice with peers or simulators) across three anatomical regions: cardiac, abdominal, and neck. Responses were categorised into three periods: (1) Year 1\u20132; (2) Year 3 to the beginning of the clinical clerkship; and (3) from the beginning of the clinical clerkship to graduation. Additionally, the extent of ultrasound experience during clerkship was classified into three categories: (1) performed on patients, (2) performed on peers, and (3) observed only.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">2) Questionnaire Survey of HERUS Members:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">To further identify the factors influencing ultrasound learning opportunities and faculty recognition of HERUS activities, a follow-up survey was conducted among the 14 HERUS members. The questionnaire included the following items (response options in parentheses):<\/span><\/p>\r\n<ol style=\"text-align: justify;\">\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Timing of HERUS enrolment<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Frequency of scrub wear during clerkship (\u2265 once per week, &lt; once per week)<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Frequency of ultrasound practice on non-patient models (e.g., peers, phantoms) during clerkship (\u2265 once per week, &lt; once per week)<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Number of departments in which HERUS was discussed with faculty during the clerkship<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Number of ultrasound scans performed on patients during the clerkship<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Open-ended responses regarding perceived educational benefits of HERUS activities<\/span><\/li>\r\n<\/ol>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\"><br \/>\r\nHERUS membership duration was calculated in months from the time of enrolment to graduation (March of Year 6) and categorised as &lt; 30 months or \u2265 30 months.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">D. Data Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">1) Quantitative Analysis:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Responses from HERUS and non-HERUS students were compared using chi-square (\u03c7\u00b2) tests to examine differences in ultrasound experience across three anatomical regions. For the follow-up survey of HERUS members, independent samples t-tests were performed to evaluate differences in items iv and v according to scrub-wearing frequency, membership duration, and frequency of non-patient practice. All statistical analyses were conducted using GraphPad PRISM v7.0 (GraphPad Software, Inc., San Diego, CA, USA). Statistical significance was defined as two-sided p &lt; 0.05.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">2) Qualitative Analysis:<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Open-ended item (vi) was analysed using qualitative content analysis, following conventional content analysis approaches (Castro et al., 2023). Two investigators (KO and YM) independently categorised all responses, compared their classifications, discussed discrepancies, and reached a consensus. After finalising the categories, other coauthors reviewed the raw data and category structure to confirm consistency. This process constituted investigator triangulation, thereby enhancing the credibility and trustworthiness of the qualitative findings.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Category labels were generated through an iterative abstraction process and were grounded in students\u2019 descriptive accounts. Labels such as \u201cSense of belonging and mutual support,\u201d \u201cSharing tips among students,\u201d or \u201cSelf-paced repetitive practice,\u201d were selected to reflect the meanings conveyed in the raw data rather than to map onto predetermined theoretical constructs. The terminology used was chosen for clarity and interpretability in reporting the descriptive qualitative results.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Integrating these qualitative categories with quantitative indicators allowed the examination of not only whether HERUS involvement was associated with enhanced learning opportunities, but also how students experienced these opportunities and why they perceived them as beneficial.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">E. Use of Generative Artificial Intelligence<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">During the preparation of this work, the authors used ChatGPT-5.1(OpenAI; San Francisco, CA) to improve the language and readability of the text. After using ChatGPT-5.1, the authors have reviewed and edited the content as needed and take full responsibility for the content of the publication.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">A. Comparison Between HERUS Members and Non-Members<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Of the 116 sixth-year medical students invited to participate in the survey (14 HERUS members and 102 non-members), 99 responded (13 HERUS members and 86 non-members), yielding an overall response rate of 85.3%. HERUS members reported a significantly earlier ultrasound experience than non-members across all three anatomical regions (cardiac, abdominal, and neck) (Figure 2a). Most HERUS members gained hands-on ultrasound experience before beginning their clinical clerkship.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Regarding ultrasound experience during clerkship, HERUS members were significantly more likely to have performed cardiac ultrasound on patients compared to non-members (Figure 2b). A similar trend was observed for abdominal ultrasound; however, the difference was not statistically significant. While a small number of non-members only observed ultrasound procedures during graduation, none of the HERUS members reported such limited exposure.<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" width=\"1299\" height=\"1345\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-2.jpg\" alt=\"\" class=\"size-full wp-image-73579 aligncenter\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-2.jpg 1299w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-2-290x300.jpg 290w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-2-989x1024.jpg 989w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-2-768x795.jpg 768w\" sizes=\"auto, (max-width: 1299px) 100vw, 1299px\" \/><\/p>\r\n<p><span lang=\"EN-GB\">(a) Timing of first ultrasound experience (cardiac, abdominal, and neck ultrasound) among HERUS members (n = 13) and non-members (n = 86). Y1\u20132: performed during Years 1\u20132; Y3\u2013PreCC: performed during Year 3 to pre\u2013clinical clerkship; PostCC: performed after the beginning of clinical clerkship through graduation. p-values were calculated using the chi-square test.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">(b) Extent of ultrasound experience during clinical clerkship. \u201cPatient\u201d denotes practice on patients, \u201cPeer\u201d represents practice with peers, and \u201cObservation\u201d denotes observation only.<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 2. Differences in ultrasound experience between HERUS members and non-members. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">B. Findings from HERUS Member Survey<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">All 14 HERUS members completed the survey. One student could not recall the number of departments mentioned by HERUS during faculty conversations, leaving only 13 responses.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Students who wore HERUS scrubs at least once a week reported recognition of HERUS by faculty members in more departments, although this difference was not statistically significant (Figure 3a). Conversely, students with \u2265 30 months of HERUS membership reported significantly more departments discussing HERUS during clerkship than those with &lt; 30 months (Figure 3b).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Seven students (50%) reported practicing ultrasound on non-patient models at least once a week (Figure 3c, f). However, no significant association was found between the practice frequency and the number of departments in which HERUS was discussed (Figure 3c).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">No statistically significant associations were found between the number of patients who underwent ultrasound and any of the following factors: scrub wear frequency, HERUS membership duration, or non-patient practice frequency (Figure 3d\u2013f).<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" width=\"1112\" height=\"1632\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-3.jpg\" alt=\"\" class=\"size-full wp-image-73580 aligncenter\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-3.jpg 1112w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-3-204x300.jpg 204w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-3-698x1024.jpg 698w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-3-768x1127.jpg 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2026\/09\/oa3772-figure-3-1047x1536.jpg 1047w\" sizes=\"auto, (max-width: 1112px) 100vw, 1112px\" \/><\/p>\r\n<p><span lang=\"EN-GB\">(a\u2013c) Associations of scrub-wearing frequency, HERUS membership duration, and frequency of non-patient practice with faculty recognition of HERUS.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">(d\u2013f) Associations of the same three factors with ultrasound experience involving real patients during clinical clerkship.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><span lang=\"EN-GB\">Figure 3. Influence of student engagement and visibility on faculty recognition and ultrasound experience during clinical clerkship.<\/span><\/p>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 100%;\">\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 33.2451%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Category<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 21.5168%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Subcategory<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 43.1217%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Representative Student Excerpts<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" style=\"width: 33.2451%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Collaborative PAL in the HERUS<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 21.5168%;\">\r\n<p align=\"center\"><i><span lang=\"EN-GB\">Sense of belonging and mutual support<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 43.1217%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">\u201cTeaching other students also enhanced the learning of those who served as instructors.\u201d<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 21.5168%;\">\r\n<p align=\"center\"><i><span lang=\"EN-GB\">Sharing tips among students through teaching and learning<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 43.1217%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">\u201cWe could share ultrasound techniques and knowledge we had individually learned, which helped us acquire skills more broadly than practicing alone.\u201d<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" style=\"width: 33.2451%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Perceived competence when given the opportunity to perform ultrasound examinations in real clinical settings<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 21.5168%;\">\r\n<p align=\"center\"><i><span lang=\"EN-GB\">Expanded opportunities through HERUS identity<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 43.1217%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">\u201cWearing the HERUS scrubs, I was invited several times\u2014 \u2018Do you want to try the ultrasound?\u2019\u201d<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 21.5168%;\">\r\n<p align=\"center\"><i><span lang=\"EN-GB\">Confidence gained from repeated experience in real clinical settings<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 43.1217%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">\u201cI received many more chances to perform procedures, especially during the emergency term.\u201d \/ \u201cWhen offered a chance to perform ultrasound, I could confidently take it.\u201d<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" style=\"width: 33.2451%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Students\u2019 self-paced repetitive practice toward self-motivation in real settings<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 21.5168%;\">\r\n<p align=\"center\"><i><span lang=\"EN-GB\">Self-paced repetitive practice<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 43.1217%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">\u201cWe had weekly ultrasound study sessions.\u201d \/ \u201cDaily ultrasound practice.\u201d<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 21.5168%;\">\r\n<p align=\"center\"><i><span lang=\"EN-GB\">Motivation gained from repeated practice in preparation for real settings<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 43.1217%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">\u201cBy practicing several times, I learned the basics and felt more confident.\u201d \/ \u201cSince I had learned the basic movements, I could easily try taking an ultrasound during ward rotations.\u201d<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p><span lang=\"EN-GB\">Abbreviations: HERUS, Hamamatsu Emergency Room Ultrasound; PAL, peer-assisted learning.<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 1. Categories Derived from Students\u2019 Reflections on the HERUS Ultrasound Initiative.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Qualitative analysis of the open-ended responses identified three descriptive categories that illustrated how students perceived educational benefits from participating in HERUS (Table 1).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">First, Collaborative PAL in the HERUS were noted, including mutual support and the sharing of tips and techniques among peers. These interactions were described as enhancing approachability and reinforcing understanding.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Second, students reported increased perceived competence in real clinical settings, including confidence when invited to perform an ultrasound and expanded opportunities linked to visible HERUS affiliation. Authentic participation contributed to a sense of growth.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Third, students described self-paced repetitive practice as an important component of their learning, noting that regular independent or group practice sessions helped them acquire foundational skills and initiate scans more readily during clerkship.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Together, these categories highlight how HERUS provided students with practical opportunities that supported their skill development, confidence, and engagement in clinical learning environments.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This descriptive study examined the educational characteristics of a student-led ultrasound initiative and explored how participants experienced ultrasound learning opportunities. Rather than interpreting the findings using predetermined theoretical frameworks, we focused on documenting the actual tasks undertaken by the students, the emergent learning opportunities, and the development of these experiences within their clinical environment. Additionally, we conducted a data-driven qualitative content analysis to describe students\u2019 reflections in their own terms, which represented multiple ways in which HERUS members perceived educational benefits (Table 1). The quantitative findings showed that, compared to non-members, HERUS participants gained significantly earlier experiences with ultrasound scans across multiple anatomical regions, such as the cardiac, abdominal, and neck regions (Figure 2). Cardiac ultrasound is inherently challenging because of the dynamic nature of the heart, and its educational effectiveness is limited by the low fidelity of phantom models and high cost of dedicated simulators (Weimer et al., 2023). Within such constraints, HERUS members could enhance their skills through repeated PAL sessions, where students alternately played the roles of examiner and examinee. These sessions enabled real-time peer feedback and visible skill progression, which aligns with the qualitative findings indicating the students\u2019 growing sense of competence (Table 1).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In the quantitative analysis, half of the members practiced ultrasound on non-patient models (e.g., peers or phantoms) at least once per week during clerkship, with some performing additional scans on patients (Figure 3). These quantitative patterns align with the qualitative descriptions (Table 1), indicating that students engaged in repeated, self-directed practice and sought opportunities to apply their skills in clinical settings.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Despite this variability, practice frequency was not associated with faculty recognition (Figure 3c), suggesting that interpersonal factors such as membership duration or clinical context may have a greater influence than practice frequency alone. Longer membership duration (\u2265 30 months) was associated with discussions on HERUS across a greater number of departments (Figure 3b). This suggests that sustained participation not only provides continuity of practice but may also increase students\u2019 visibility to the faculty. If longer membership and broader discussions on HERUS across departments translated into more opportunities to perform ultrasound examinations in real clinical settings, this could provide a meaningful explanation for the qualitative category in which students described a perceived sense of competence when given such opportunities (Table 1).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Although the scrub-wearing frequency was not statistically associated with faculty recognition or the number of scans performed (Figure 3a, d), one student reported that wearing HERUS scrubs prompted the faculty to invite them to undergo ultrasound examinations (Table 1). Prior research has suggested that medical students\u2019 attire can serve as a social signal of professionalism and engagement (Ahmed et al., 2020). Visible affiliation may therefore function as a practical cue that signals students\u2019 interest in and readiness to participate in ultrasound-related tasks.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Overall, integrating the quantitative and qualitative findings suggests that the categories derived from the qualitative content analysis (Table 1)\u2014(a) collaborative PAL within HERUS, (b) perceived competence when given opportunities to perform ultrasound examinations in real clinical settings, and (c) self-directed repetitive practice\u2014help explain how earlier and more frequent learning opportunities observed in the quantitative results (Figure 2) were experienced and interpreted by the students.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Self-determination theory (SDT) posits that human motivation and sustained engagement are supported by the fulfilment of three basic psychological needs (Deci &amp; Ryan, 1985): autonomy (experience of self-directed action), competence (sense of effectiveness in one\u2019s activities), and relatedness (feeling of connection with others). In this study, the three categories identified through the qualitative content analysis (Table 1) aligned conceptually with the elements commonly discussed in SDT. Educational relationships in PAL resemble relatedness; perceived competence, when given opportunities to perform ultrasound examinations in real clinical settings, corresponds to competence; and self-directed repetitive practice reflects aspects of autonomy. These connections do not constitute a theoretical claim; however, they suggest that student-led ultrasound activities may naturally foster learning conditions that parallel SDT\u2019s three basic psychological needs, even though SDT did not guide data collection or analysis in this study.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Although these conceptual parallels remain exploratory and were not empirically evaluated, building on these descriptive observations, future program development could intentionally structure PAL learning activities to further support relatedness, competence, and autonomy. Despite the growing body of literature demonstrating the effectiveness and wide application of peer teaching in ultrasound education, training approaches remain heterogeneous, and no unified framework has yet been established (Winter et al., 2024). In this context, student-led ultrasound circles may offer a potential avenue for gradually refining PAL practices. By modestly incorporating elements that could enhance relatedness, competence, and autonomy, such initiatives may contribute to the development of more coherent and sustainable approaches to undergraduate ultrasound education, although further investigation will be needed to clarify their broader impact.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study had several limitations. First, the sample size of the HERUS members was small, which might have limited the statistical power of the analyses. Second, the students who chose to join HERUS may have had a higher baseline level of motivation, introducing a potential selection bias. Third, faculty recognition of HERUS activities was based on student self-reports and may not reflect objective evaluations. Fourth, although qualitative comments were interpreted in relation to concepts discussed in motivational research, the study was not designed to measure psychological constructs such as autonomy, competence, or relatedness, and no validated scales were used. Therefore, these qualitative patterns should be understood as being descriptive rather than as evidence of underlying theoretical mechanisms. Finally, because this was a retrospective, self-reported survey, recall bias and variability across clerkship environments may have influenced responses. To build on these preliminary observations, future studies should incorporate larger samples, validated motivation measures, and prospective designs that can more rigorously evaluate how structured PAL environments influence learner development.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This preliminary descriptive study highlights that the educational value of HERUS lies in its ability to provide frequent practice opportunities, promote peer collaboration, enhance visibility to faculty, and encourage active participation during undergraduate education. These features suggest that HERUS can serve as a practical and sustainable complement to formal ultrasound education. Content analysis of the open-ended questions in the questionnaire showed that students experienced benefits in terms of peer relationships, perceived competence in authentic clinical settings, and self-directed practice. Taken together, these elements align with relatedness, competence, and autonomy as described in self-determination theory. Future program development may build on these observations to further strengthen these elements and explore their potential effects on learners\u2019 motivation and skill development.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Shogo Tsuge reviewed the literature, designed the study, collected and analysed the data, and drafted the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Kenji Ohba reviewed the literature, designed the study, collected and analysed the data, and drafted the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Yasushi Matsuyama reviewed the literature, designed the study, analysed the data, and provided critical feedback on the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Shinnosuke Akeda contributed to the study design and facilitated data collection.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Sayaka Ogawa contributed to the study design and facilitated data collection.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Taiki Hosokawa contributed to the study design and facilitated data collection.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Sanshiro Togo contributed to the study design and facilitated data collection.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Takeji Saitoh contributed to the study design and facilitated data collection.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Hiroshi Igarashi contributed to the study design and facilitated data collection.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Kazuo Umemura designed the study and provided critical feedback on the manuscript.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Approval to conduct this study was obtained from the Ethics Committee of Hamamatsu University School of Medicine (approval number: 24-095), and informed consent was obtained from all participants.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The data that support the findings of this study, including the qualitative data written in Japanese, are available from the authors upon reasonable request.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The authors wish to express their sincere gratitude to all those who contributed to this study, including the participants. In particular, they would like to thank Dr. Naoto Toda and Dr. Noriaki Shimamoto, who, together with the four author-members (Shogo Tsuge, Shinnosuke Akeda, Taiki Hosokawa, and Sanshiro Togo) were part of the &#8220;Original Six&#8221; founding members of HERUS. The authors also thank Dr. Hiromitsu Kataoka and Prof. Yuko Suzuki for their invaluable guidance during the early development of the group.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The authors declare that they have no commercial or financial relationships that could be construed as a potential conflict of interest.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Ahmed, A., Israr, S., Chapple, K. M., Wang, W., Jamjoom, A., &amp; Mahmud, A. (2020). Patient perception of medical student professionalism: Does attire matter? <em>Journal of Surgical Education, 77<\/em>(6), 1345\u20131349. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1016\/j.jsurg.2020.04.016\">https:\/\/doi.org\/10.1016\/j.jsurg.2020.04.016<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Bapuji, R., Eagles, D., Ferreira, N., Hecht, N., Zhang, Y., Woo, M. Y., Cheung, W. J., Ly, V., &amp; Pageau, P. (2024). Comparison of peer-assisted learning with expert-led learning in medical school ultrasound education: A systematic review and meta-analysis. <i>Canadian Journal of Emergency Medicine, 26<\/i>(3), 188<\/span><span lang=\"EN-GB\">\u2013<\/span><span lang=\"EN-GB\">197. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1007\/s43678-024-00663-x\">https:\/\/doi.org\/10.1007\/s43678-024-00663-x<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Castro, L., Gessler, T., &amp; Maj\u00f3-V\u00e1zquez, S. (2023). Content analysis in mixed method approaches. In F. Oehmer-Pedrazzi, S. H. Kessler, E. Humprecht, K. Sommer, &amp; L. Castro (Eds.), <i>Standardized content analysis in communication research<\/i> (pp. 37\u201358). Springer VS. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1007\/978-3-658-36179-2_4\">https:\/\/doi.org\/10.1007\/978-3-658-36179-2_4<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Cave, P. (2004). \u201cBukatsud\u00f4\u201d: The educational role of Japanese school clubs. <i>Journal of Japanese Studies, 30<\/i>(2), 383\u2013415. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1353\/jjs.2004.0041\">https:\/\/doi.org\/10.1353\/jjs.2004.0041<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Darling, N., Hamilton, S. F., Toyokawa, T., &amp; Matsuda, S. (2002). Naturally occurring mentoring in Japan and the United States: Social roles and correlates. <i>American Journal of Community Psychology, 30<\/i>(2), 245\u2013270.<\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1023\/A:1014684928461\">https:\/\/doi.org\/10.1023\/A:1014684928461<\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Deci, E. L., &amp; Ryan, R. M. (1985). Conceptualizations of intrinsic motivation and self-determination. In <i>Intrinsic motivation and self-determination in human behaviour<\/i> (pp. 11\u201340). Springer. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1007\/978-1-4899-2271-7_2\">https:\/\/doi.org\/10.1007\/978-1-4899-2271-7_2<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Hirsch, C., Audet, E., Dawood, E., Beardmore, F., Hussain, N., Wong, W. C., Barry, R. J., &amp; Buckley, S. (2025). Participation in a pre-registration student interprofessional education (IPE) society: Influence on subsequent professional practice. <i>Frontiers in Medicine, 11<\/i>, Article 1497799. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.3389\/fmed.2024.1497799\">https:\/\/doi.org\/10.3389\/fmed.2024.1497799<\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Matsuyama, Y., Nakaya, M., Okazaki, H., Lebowitz, A. J., Leppink, J., &amp; van der Vleuten, C. (2019). Does changing from a teacher-centred to a learner-centred context promote self-regulated learning? A qualitative study in a Japanese undergraduate setting. <i>BMC Medical Education, 19<\/i>, Article 152.<\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-019-1550-x\">https:\/\/doi.org\/10.1186\/s12909-019-1550-x<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Moeller, A. J. (2016). The confluence of language assessment and mixed methods. In A. J. Moeller, J. W. Creswell, &amp; N. Saville (Eds.), <i>Second language assessment and mixed methods research<\/i> (pp. 3\u201316). Cambridge University Press.<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Onoda, R., &amp; Omi, Y. (2023). The value of extracurricular activities to Japanese junior high school students: Focusing on the expression of a school&#8217;s attractiveness in writing. <i>Frontiers in Education, 8<\/i>, Article 1284618. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.3389\/feduc.2023.1284618\">https:\/\/doi.org\/10.3389\/feduc.2023.1284618<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Ross, M. T., &amp; Cameron, H. S. (2007). Peer assisted learning: A planning and implementation framework: AMEE Guide No. 30. <i>Medical Teacher, 29<\/i>(6), 527\u2013545. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1080\/01421590701665886\">https:\/\/doi.org\/10.1080\/01421590701665886<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Sekiguchi, T., &amp; Ikeda, M. (2025). The informal structure of <i>senpai<\/i> (seniors), <i>kohai<\/i> (juniors), and <i>doki<\/i> (peers) in Japanese organizations. <i>Encyclopedia, 5<\/i>(2), Article 49. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.3390\/encyclopedia5020049\">https:\/\/doi.org\/10.3390\/encyclopedia5020049<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Shannon-Baker, P. (2016). Making paradigms meaningful in mixed methods research. <i>Journal of Mixed Methods Research, 10<\/i>(4), 319\u2013334. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1177\/1558689815575861\" target=\"_new\">https:\/\/doi.org\/10.1177\/1558689815575861<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Tsuge, S., Hosokawa, T., Togo, S., Toda, N., Ohba, K., &amp; Kataoka, H. (2024, August 24\u201328). <i>Student-centred unique learning activities in undergraduate ultrasound education<\/i> [Conference presentation abstract]. AMEE 2024 Annual Conference, Basel, Switzerland. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.21955\/mep.1115494.1\">https:\/\/doi.org\/10.21955\/mep.1115494.1<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Weimer, J., Rolef, P., M\u00fcller, L., &amp; L\u00f6ffler, S. (2023). FoCUS cardiac ultrasound training for undergraduates based on current national guidelines: A prospective, controlled, single-centre study on transferability. <i>BMC Medical Education, 23<\/i>, Article 80. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-023-04062-1\">https:\/\/doi.org\/10.1186\/s12909-023-04062-1<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Weimer, J., Yilmaz, D., Ille, C., Weinmann-Menke, J., M\u00fcller, L., B\u00fcchner, H., Buggenhagen, H., St\u00e4uber, M., Neubauer, R., Winter, L., Weimer, A., Dirks, K., K\u00fcnzel, J., Rink, M., Dionysopoulou, A., Lorenz, L., Kloeckner, R., Recker, F., &amp; Schiestl, L. (2025). Quality assessment of a training program for undergraduate sonography peer tutors: Paving the future way for peer-assisted learning in medical ultrasound education. <i>Frontiers in Medicine<\/i>, <i>12<\/i>, Article 1492596.<\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.3389\/fmed.2025.1492596\"> https:\/\/doi.org\/10.3389\/fmed.2025.1492596<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">White, A., Singh, G., Moon, M. C., &amp; Frohlich, J. (2021). Current status of simulation use in Canadian cardiac surgery training programs. <i>Canadian Journal of Cardiology, 37<\/i>(10), 1639\u20131643. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1016\/j.cjca.2021.04.020\">https:\/\/doi.org\/10.1016\/j.cjca.2021.04.020<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Winter, L., Neubauer, R., Weimer, J., Dietrich, C. F., Wittek, A., Schiestl, L., Marinova, M., Sch\u00e4fer, V. S., Strizek, B., &amp; Recker, F. (2024). Peer teachers as ultrasound instructors? A systematic literature review of peer teaching concepts in undergraduate ultrasound education. <i>BMC Medical Education, 24<\/i>(1), Article 1369. <\/span><span lang=\"EN-GB\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-024-06345-7\" target=\"_new\">https:\/\/doi.org\/10.1186\/s12909-024-06345-7<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p>*Kenji Ohba<br \/>\r\nMedical Education Center,<br \/>\r\nHamamatsu University School of Medicine,<br \/>\r\n1-20-1 Handayama, Chuo-ku,<br \/>\r\nHamamatsu, Shizuoka 431-3192, Japan<br \/>\r\nEmail: ohbak@hama-med.ac.jp<\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":5,"template":"","issues_category":[12],"archive_category":[],"issue_type":[24],"volume_category":[],"class_list":["post-73577","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-current-issue"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ultrasound learning experiences in a Japanese student-led circle: A descriptive study - 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