Introduction A perennial difficultly for remediation programmes in medical school is early identification of struggling learners so that resources and assistance can be applied as quickly as is practical. Our study investigated if early academic performance has predictive validity above and beyond pre-matriculation variables.

Methods Using three cohorts of medical students, we used logistic regression modelling and negative binomial regression modelling to assess the strength of the relationships between measures of early academic performance and outcomes—later referral to the academic review and performance committee and total module score.

Results We found performance on National Board of Medical Examiners (NBME) exams at approximately 5 months into the pre-clerkship curriculum was predictive of any referral as well as the total number of referrals to an academic review and performance committee during medical school (MS)1, MS2, MS3 and/or MS4 years.

Discussion NBME exams early in the curriculum may be an additional tool for early identification of struggling learners.