A more feasible alternative for countries like Brazil has been the formation of extra-curricular groups linked to both academic and non-academic hospitals where students are taught by qualified teachers, and thus complement their learning in specific areas such as EM [1–4]. In Brazil, these groups are known as “”Academic leagues.”" Academic Leagues offer lectures and supervised extra-curricular practical activities in their teaching university-affiliated hospital and form part of an overall parallel curriculum. The name Academic Leagues come

from medical students creating these activities in order to acquire theoretic and practical experience [1, 2]. This parallel Z IETD FMK curriculum has become essential for medical students in Brazil due to the gaps in Medical School core teaching and the amount of learning and training medical students need to be competent clinicians. Tavares et al. showed that 82.5% of medical students of CUDC-907 manufacturer a Brazilian University actively take part in the “Parallel curriculum”, spending on average 8.2 hours per week [2]. Furthermore, a similar study in the Brazilian state of Alagoas demonstrated that by the third year of medical school, 98.4% of the students are involved in some form of extracurricular activity [3] and for 12.5% of them, these activities lasted for more than 12 hours per week [3]. Extra-curricular

activities in non-teaching hospitals without University affiliation may influence career choices as well. A study of medical students involved PRN1371 clinical trial in extra-curricular activities in Critical Care Medicine in the city of Salvador, Brazil, concluded that the students’ in a career in Critical Care rose from 32% to 65% the establishment of an Academic League in this field [1]. Extra-curricular activities also boost good social work practice [3], providing valuable experience in dealing with death, suffering and feelings of powerlessness [4]. Some authors dispute the importance of the Academic Leagues in the training of medical students. Despite their potential benefits, these authors warn of the possible risk of Pregnenolone premature specialization and too much

practical work without being accompanied by theoretical knowledge, which can skew medical training [5]. The Hospital do Trabalhador in the city of Curitiba, Brazil, is a well-established Level I Trauma Center. It has the only emergency department in the city that utilizes an “”open door system” (where the citizen can seek assistance directly) without referral by other hospitals or physicians. The Emergency Room of the Hospital do Trabalhador admitted 63,057 patients in 2010 and performed approximately 1,500 surgeries per month [6]. This public hospital is covered exclusively by the Brazilian Unified Health System (SUS). The hospital offers residency programs in general surgery and orthopedics/trauma. The hospital currently has 140 medical students in a supervised extra-curricular program.