As point-of-care ultrasound (POCUS) invades medical specialties, more students covet earlier ultrasound training programs in medical school. Determining the optimal placement and format in the curriculum remains a challenge. This study uses student perceptions and confidence in interpreting and acquiring images to evaluate the effectiveness of an ultrasound curriculum, and assesses their performance on ultrasound content. A unique ultrasound curriculum was incorporated into first year clinical anatomy at Tufts University School of Medicine (TUSM). Students completed surveys evaluating changes in ultrasound confidence and perceptions. Mean ratings on pre- and post- surveys were compared using Mann-Whitney U tests. Performance on ultrasound examination questions were evaluated. Two independent evaluators coded narrative responses and NVivo software was used to identify common themes. Two hundred eleven students completed the ultrasound curriculum. Students reported higher post-curriculum mean confidence ratings on ultrasound comprehension, operation, image acquisition, artifact recognition, and normal image interpretation (P < 0.0001). Ultrasound reinforced anatomy concepts and clinical correlates (9.56, ± 0.97 SD; 9.60, ± 1.05). Students disagreed with items stating learning ultrasound is too difficult (1.2, ± 2.2) and that it interferes with learning anatomy (0.68, ± 1.7). Students scored above passing on practical ultrasound knowledge questions, supporting survey data and the relation to learning spatial relationships. Qualitative analysis identified seven major themes and additional subthemes. Limited integration of ultrasound breaks barriers in students’ perceptions and confidence in performing POCUS. The TUSM ultrasound curriculum is a natural marriage of anatomy and POCUS applications, serving as a template for medical schools.