Weak students often continue with little guidance and feedback, and often have ongoing difficulties. Early support may stop students experiencing a cycle of failure. Key to supporting struggling students is to identify reasons for poor performance. We explored the reasons for poor performance in a cohort of fifth year students who failed their final clinical examinations. Qualitative methods ( interviews and a focus group) identified several themes. Many of the students had experienced personal problems or issues. They regarded themselves as competent students although they had significantly greater problems with earlier exams than the year mean, and significantly lower scores in formative assessments during the year leading up to these exams than their peers. Factors relating to the exam itself were seen as relevant to failure. More specific support and feedback throughout the MBcHB was seen as desirable. They tended to take little personal responsibility for their performance and were reluctant to seek help. We conclude that while the onus is on Faculty to identify and support failing students, the results indicate that students would benefit from support in developing self-reflection skills in such a way to support life-long learning.