Cardiovascular ultrasound is an operator-dependent modality that requires careful sequencing of the theoretical and practical training to optimize skills acquisition. This study compares lecture-first (LF) versus practical-first (PF) teaching strategies in undergraduate radiologic sciences students to evaluate the impact of 2 different teaching strategies on students' scores. In a randomized controlled trial, 54 students were allocated to LF (n=25) or PF (n=29) groups. The LF group received didactic lectures followed by hands-on practice, while the PF group reversed this sequence. Outcomes were measured using a multiple-choice question (MCQ) exam for theoretical knowledge and an objective structured clinical examination (OSCE) for practical skills. Evaluation was performed by blinded faculty using standardized rubrics. An exploratory analysis of the impact of supplemental practice sessions was also performed. LF students demonstrated superior overall performance (median score: 0.9 vs. 0.82, P=0.009, effect size: d=0.72) and practical skills (0.95 vs. 0.82, P=0.002, effect size: d=0.85). Theoretical knowledge scores were comparable between groups, with median scores of 0.86 for LF and 0.85 for PF (P=0.9). Students attending extra practice sessions achieved significantly higher scores across all domains (overall: 0.9 vs. 0.83, P=0.004; skills: 0.93 vs. 0.87, P=0.01). Teaching strategy in which a lecture is delivered first, followed by a practical session, was associated with improved scores compared with the design starting with a practical session. Attending additional hands-on sessions can significantly enhance students' knowledge and skills for performing ultrasound examinations. This study suggests that sequencing can influence student academic achievement and indicates that arranging practical sessions after lectures and providing extra practical sessions can enhance learning in the cardiovascular ultrasound curriculum.