title: Extra-curricular supervised training at an academic hospital: is 200 hours the threshold for medical students to perform well in an emergency room?
abstract: BACKGROUND
  Due to high number of jobs in Emergency Medicine (EM) and the lack of specialist to work in this field, recent graduates work in the emergency room straight after medical school. Additional courses on EM are available through Academic Leagues. This organizations offer lectures and supervised extra-curricular practical activities in their teaching university-affiliated hospital. The objectives of the present study are to assess the influence of hours undertaken in the extra-curricular practical activities on the performance and confidence of students in carrying out the different procedures in the emergency department, and on their own perception of how well they did. Also, to assess the influence the practical activities have on student´s future choice of specialty.
  
  
  METHODS
  A Cross-sectional study conducted by collecting data through a questionnaire. 102 eligible individuals were included and divided into two groups according to the number of extra-curricular hours performed (Group 1- up to 200 hours and Group 2- over 200 hours).
  
  
  RESULTS
  Students in Group 2 (over 200 hours) had a greater number of procedures performed on all variables evaluated, in particular, initial patient care (mean 363.8 vs.136.905 in Group 1 - p = 0.001), Simple Sutures (mean of 96.2 vs 33.980 respectively) ( p = 0.00003). To determine patient follow-up by the student, the number of initial patient care was correlated with number of discharge procedures performed (in Group 1, 49.6% of patients were not followed up and discharged by the same students who first talked to them in the hospital. While in Group 2, this value becomes 29.4 % - values for Group 1 - p = 0.011 and Group 2 - p = 0.117). Regarding the influence of the practical extra-curricular activities, 76.5% of the total reported that it had influenced their choice of future specialty.
  
  
  CONCLUSIONS
  The aptitude, confidence and skill of students are closely linked to the practice time (number of training hours served). Two hundred hours appeared to be a relatively significant time for the student to demonstrate good conduct and ability. Practical extra-curricular activities had the ability to influence the future choice of specialty, either positively or negatively.
authors.affiliation: Federal University of Parana, Curitiba, Brazil.|Hospital do Trabalhador, State Health Department, Parana, Brazil.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Abreu-Reis
authors.affiliation: Federal University of Parana, Curitiba, Brazil.|Hospital do Trabalhador, State Health Department, Parana, Brazil.
authors.forename: Guilherme Czelusniak
authors.initials: GC
authors.lastname: Oliveira
authors.affiliation: University Positivo, Curitiba, Brazil.|Hospital do Trabalhador, State Health Department, Parana, Brazil.
authors.forename: Arthur
authors.initials: A
authors.lastname: Curtarelli de Oliveira
authors.affiliation: University of Birmingham, UK.
authors.forename: Hammad
authors.initials: H
authors.lastname: Sadique
authors.affiliation: Department of Surgery, Federal University of Parana, Curitiba, Brazil.|Hospital do Trabalhador, State Health Department, Parana, Brazil.
authors.forename: Adonis
authors.initials: A
authors.lastname: Nasr
authors.affiliation: Department of Surgery, Federal University of Parana, Curitiba, Brazil.|Hospital do Trabalhador, State Health Department, Parana, Brazil.
authors.forename: Flávio Daniel
authors.initials: FD
authors.lastname: Saavedra Tomasich