The study investigates medical students' ways of approaching a medical task. Fourteen medical students in their clinical years responded to a written patient case on chest pain. Variations in the students' responses to the task were analysed from a contextual and linguistic perspective. Students approached the task in two distinctly different ways. Either they treated the task as a problem situated within a purely academic context--listing concepts relevant to the symptom, applying the steps in the diagnostic process only once--or dealt with the task as a problem contextualised within a hypothetical clinical situation--testing alternative meanings of the symptom, elaborating on implications for the patient. It is not students' conceptualisations of medical theory that explain these outcomes but rather how students construct contexts in which these conceptualisations are embedded. The results highlight the importance of being sensitive to what students make of a given task, how their interpretations relate to what was intended by the teacher, the desired outcome of the curriculum, and the influences exercised upon students by the various educational settings confronting them in their studies.