A third of medical students at Birmingham Medical School fail one or more first year exams. Alarm has been raised about the apparent over-representation of ethnic minority students amongst those who fail. In this case study I ask: 1. Is there a connection between students’ ethnicity and performance in end of first year exams? 2. Is the experience of medical students at this medical school conducive to effective learning? 3. What, if anything, could be done to improve students’ learning? I show that there is a link between particular students and exam performance, but the link is with socio-economic background, not ethnicity. Students from a privileged background appear to perform better than students from a disadvantaged background. I argue that this may be due to an environment which is not conducive to effective learning. Using a range of research methods I describe how students are expected to support themselves intellectually to become independent learners while passive educational methods such as lectures and a heavy timetable are favoured and students receive limited formative feedback on their progress. The study ends positively, however, as I identify improvements that could be, and in some instances have been, made to the environment.