Introduction: Trauma is one of the leading causes of death and long-term disability globally. In sub-Saharan Africa, the number of specialist emergency care personnel is inadequate and task shifting is common. We aimed to assess the variation in knowledge on acute trauma care, and self-perceived confidence in performing lifesaving skills amongst final year medical students in Uganda. Methods: We conducted a multi-institutional, cross-sectional survey among final year medical students who had just completed their training from eight medical schools in Uganda. We assessed knowledge using a 25 standardized multiple-choice question test adopted from a previous study, and self-reported confidence in perfuming lifesaving skills, scored on a 5-Point Likert scale. Results: Some 246 (88.5 %) participants responded to the survey and 241 provided complete data. The mean knowledge score was 58.9 % (SD; 12.4) with a mean variation ratio of 0.36 (SD; 0.17). The mean self-perceived confidence score of the participants was 3.8 (SD; 1.0) with relatively high scores in interpretation of radiological investigations (mean 4.2, SD; 0.9) and patient assessment (mean 4.1, SD; 0.9), and lower scores in management of different categories of trauma patients (mean 3.8, SD; 1.0) and performing life-saving procedures (mean 3.5, SD; 0.9). Only three institutions had emergency medicine physicians, with one at each institution, and 146 (60.6 %) of participants received no dedicated trauma training. Conclusion: Final year medical students exiting training in Uganda had variable knowledge in acute trauma care and intermediate self-perceived confidence in performing lifesaving skills. Training programs need to standardize and strengthen acute trauma training and provide specialists and resources essential for trauma training at undergraduate level.