Ultrasound is becoming increasingly used in many medical specialties. However, the quality of the ultrasound examination is highly operator dependent and sufficient training of clinicians is challenging. Virtual Reality ultrasound simulation enables training under controlled conditions and it allows trainees to make mistakes before practicing on patients. However, this type of training is expensive due to costs of simulators and clinician supervisors to provide instructions and feedback while the trainees are practicing. Training in pairs, also known as dyad training, may provide a learning advantage to trainees due to shared memory and increased confidence. Moreover, dyad training allows training twice the number of trainees on simulators, which has implications to the cost-effectiveness of VR simulation.