Human models, real patients, and simulators are useful teaching modalities for ultrasound training and competency-based assessments. Each can increase trainee confidence and skill and has unique advantages and disadvantages related to versatility, cost, resource limitations, and faculty availability. There is a lack of strong evidence to support a single preferred modality, and instead a combination of all three is often used for ultrasound training. In this chapter, some strategies are presented to implement and improve the practical application of these teaching modalities. Further research is needed to assess the effectiveness of the latest technologies available and to evaluate for possible selection or gender bias in the recruitment process of human models. There is a pressing need for explicit guidelines to address the specific roles for each of these teaching modalities, especially in competency-based models for ultrasonography training.