The discourse of any institutional field is composed of a variety of different genres. In medical discourse, three prevalent genres are the research article, the doctor—patient interview and the textbook. This article describes how the textual, interpersonal and ideational metafunctions of each genre operate in relation to their institutional context of situation. As a medical text is delocated and relocated from one institutional context to another, transformations take place with regard to: the ideational options of tense, transitivity and process, the interpersonal options of modality and speaker's comment, and its rhetorical organization. These transformations constitute the codes of the pedagogic device. These operate as a symbol system having two ideological effects. First, certain medical texts are privileged over others as `doxic' texts; and second, subjects are variably positioned in the professional field depending on their command of the codes of the genres relating to different institutional sites.
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