Several scholars contend that learning with computer games and simulations results in students thinking more like professionals. Bearing this goal in mind, we investigated how a group of pharmacy students learnt with an in-house developed computer simulation, SimPharm. Adopting situated cognition as our theoretical lens, we conducted a case study involving 20 undergraduate students to tease out how they made meaning of a clinical case differently in two different contexts: a typical paper-based workshop and one enabled by SimPharm. The data collected included audio recordings of classroom discourse, focus group interviews and class observations. The findings identified differences in four areas: framing of the problem; problem-solving steps and tools used; sources and meaning of feedback; and conceptualisation of the patient. These four areas can serve as axes along which future evaluations of educational simulations can be carried out based on their affordances.