Low rates of academic progression and relative underachievement, attributable to a failure to adjust to the teaching and learning process within institutions of higher education, can impact significantly upon both individuals and institutions. In the Faculty of Medical Sciences at The University of the West Indies (UWI), St. Augustine, despite the favourable profile of students on entry, including a mean admission score of 11.3, completion and failure rates give evidence of low academic progression and relative underachievement. As assessed in the mid-term review of the 1997-2002 strategic plan, a similar situation might exist in the rest of UWI. Although low academic progression and relative underachievement might be attributed to a lack of fit between the students and their chosen programmes, an alternative philosophy would point to the possibility of deficiencies in the quality of the education provision, including the absence of a comprehensive system for student support and guidance. Significantly, the existing quality assessment framework in UWI does not emphasize the development of faculty-specific structures for student support and guidance. This omission remains despite plans, as identified in the latest strategic planning framework, to broaden access and to create a more student-friendly learning environment in UWI. This paper describes the context and rationale behind the design and implementation of an institutional structure intended to manage and coordinate the student support and guidance provision in the Faculty of Medical Sciences. The design of the system follows an educational-failuire offset model. It is argued that an enhanced student support and guidance subsystem is critical to improving the overall quality of the education provision, as well as institutionalizing and crystallizing an ethos of care and concern for students.