Aims: To explore the efficacy of a mandatory intervention programme for at-risk medical students. Method: Students who failed and then repeated first semester were required to participate in a cognitive skills programme, following a syllabus based on principles drawn from both educational experience and multi-disciplinary theory and practice. Performance of programme participants was compared to the performance of students who repeated prior to the mandatory programme. Results: Of the participants (n = 216), 91% passed their repeat semester, compared to 58% (n = 715) for controls (p <0.0001). This significant effect persisted for progression through the school for the subsequent three semesters (p <0.0005). Conclusion: A mandatory programme that draws on a blend of theories and research-proven techniques can make a positive difference to the outcomes for at-risk medical students.