Health Science students at the University of KwaZulu-Natal perform better in their professional modules compared with their physiology modules. The pass rates of physiology service modules have steadily declined over the years. While a system is in place to identify "at-risk" students, it is only activated after the first semester. As a result, it is only from the second semester of their first year studies onward that at-risk students can be formally assisted. The challenge is thus to devise an appropriate strategy to identify struggling students earlier in the semester. Using questionnaires, students were asked about attendance, financing of their studies, and relevance of physiology. After the first class test, failing students were invited to complete a second questionnaire. In addition, demographic data were also collected and analyzed. Correlation analyses were undertaken of performance indicators based on the demographical data collected. The 2011 class comprised mainly sport science students (57%). The pass rate of sport science students was lower than the pass rates of other students (42% vs. 70%, P < 0.001). Most students were positive about physiology and recognized its relevance. Key issues identified were problems understanding concepts and terminology, poor study environment and skills, and lack of matriculation biology. The results of the first class test and final module marks correlated well. It is clear from this study that student performance in the first class test is a valuable tool to identify struggling students and that appropriate testing should be held as early as possible.