Educating medical students is resource intensive, including substantial human, financial, and capital investment. When students experience academic difficulty, there are ramifications for faculty and staff, as well as personal stress and anxiety experienced by the struggling student. This article offers some lessons learned in the process of developing a medical school curriculum-wide system to support struggling students. This model for a comprehensive academic support program describes a formal structure for intervention beginning at new student orientation with the hope of preventing course failure and the complications of remediation. Some eight years ago, our medical school (400 students) embarked on this targeted consolidation and integration effort for academic support services. As implemented, Learning Specialists from the Office of Academic Resources & Support (OARS) meet with and coach students from all classes (MSI-MSIV) for medical school transition, learning and study skills training, both theoretical and clinical exam remediation, licensing exam preparation (US), curriculum schedule monitoring, personal issues, and research project coaching. Learning Specialists work closely with the Student Affairs and Assessment offices and initiatives, and participate in Curriculum and Block (course) Directors meetings. Despite a 25% increase in student matriculants six years ago, many with challenging personal and academic situations, we maintain an average 85% four to five-year graduation rate, which includes personal, academic, and enrichment activities. As a unit of Undergraduate Medical Education (UME), the academic support program has evolved and continues as a meaningful voice for student performance intervention.