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Purpose: Trauma leagues (TLs) are extracurricular programs that offer medical students supervised exposure to trauma and acute care surgery, mentorship, and participation in other academic activities. TLs are fully approved medical schools, and currently, over 100 TLs exist in Brazil. We hypothesized that the performance/competence of medical students who participated in TLs was superior compared to non-participants. This study evaluated and compared the cognitive performance and technical skills of the two groups. Methods: This retrospective cohort study evaluated the performance of TL medical students to non-TL alumni from 2005 to 2017, using the students' academic performance coefficient, Clinical Competence Assessment, and Progress Test results. SigmaPlot 12.0 software was used to perform statistical analyses, including Mann–Whitney comparison tests and the Kruskal–Wallis test to confirm the data. Results: Of the 1366 medical students who graduated from a Brazilian university, 966 were included, with 17.9% having participated in TL. Compared to non-TL participants, TL students demonstrated better cognitive performance according to the performance coefficient (p = 0.017) and Progress Test result (p < 0.001), and higher achievement in the Clinical Competence Assessment (p < 0.001). Conclusion: The academic performance of TL students was superior to that of non-TL students at the University of Campinas (Unicamp), suggesting a positive impact of TL in the preparation of future doctors. The study findings suggest that participation in TL at Unicamp was beneficial in preparing better doctors and should be considered by medical schools worldwide. Evidence level: II (Retrospective cohort). [ABSTRACT FROM AUTHOR]