Background Technology-enhanced learning is increasingly applied in medical education to support complex cognitive processes, including diagnostic reasoning. Point-of-care ultrasound (POCUS), as a portable and real-time imaging modality, has been widely integrated into clinical training. However, limited research has explored how learners engage with POCUS to construct diagnostic understanding, particularly within cross-cultural educational contexts. This study aimed to investigate international medical students’ learning experiences with POCUS as a technology-enhanced learning tool.Methods A qualitative study was conducted involving 28 third- and fourth-year international medical students who participated in a structured POCUS learning activity. The intervention combined guided instruction with supervised hands-on practice in cardiac and abdominal ultrasound within an emergency medicine training context. Following the activity, participants completed written reflective narratives. Data were analysed using inductive thematic analysis to identify recurring patterns in learners’ experiences and meaning-making processes.Results Four major themes were identified. First, POCUS facilitated diagnostic understanding through real-time visualisation of anatomical structures and physiological processes. Second, integration of ultrasound within problem-based clinical scenarios supported the development of diagnostic reasoning. Third, collaborative learning and instructor scaffolding enhanced engagement and knowledge construction. Fourth, participants recognised the limitations of POCUS and highlighted the importance of reflective practice and continued skill development. These findings demonstrate that learners actively integrate visual, experiential, and contextual information when engaging with POCUS.Conclusion POCUS functions as an effective technology-enhanced learning tool that supports diagnostic reasoning by linking visualisation with contextualised and reflective learning processes. The findings extend current understanding of technology-enhanced medical education by demonstrating how domain-specific technologies facilitate meaning-making and cognitive integration in diverse and cross-cultural learning environments. These insights have implications for the design of ultrasound-based curricula in emergency medicine education.