Background <p>Ultrasound has become a core clinical skill, but overcrowded curricula and limited faculty availability pose major barriers for ultrasound education. Independent image acquisition assignments potentially address these barriers but offer uncertain benefits in pre-clerkship curricula. We examined the impact of “homework” image requirements on first-year medical students.</p> Materials and Methods <p>All 104 first-year (intervention) medical students were required to upload homework clips using handheld probes. The prior year’s students provided a historic control with an otherwise identical curriculum and probe access. Using an explanatory mixed methods approach, we analyzed probe use, image uploads, surveys, and focus groups paired with inductive thematic analysis to characterize the assignments’ impact.</p> Results <p>Negative binomial regression indicated that intervention students completed approximately three-fold greater scan sessions and uploaded 34 times the number of images than control students. Intervention students uploaded more non-required images than controls (439 vs. 33, <i>p</i> &lt; 0.001). Two hundred six students completed the survey (97.2%). While ultrasound-related confidence and perceived utility were similar, most intervention arm students characterized “homework” assignments as valuable or somewhat valuable (93.9%). Thematic analysis found that homework: enhanced intrinsic motivation; required additional educational supports; established a positive online learning environment through asynchronous feedback; created potential psychological discomfort; and competed with other courses for student attention.</p> Conclusions <p>Image acquisition assignments were a valuable preclinical learning tool that did not require additional curriculum space. The assignments motivated learning and independent probe use beyond what was formally required. Value was mediated by personal, interpersonal, and structural features that could inform the design of similar initiatives elsewhere.</p>