The first year university Health and Social Care course examined here introduces students from diverse backgrounds into the academic discourse of health and social care in the UK (see Northedge 2003). The course providers were concerned about students’ written engagement in these discourses, and invited academic literacy specialists to work with them. Using Systemic Functional Linguistics-based genre analysis (Martin and Rose 2007, 2008), the genres of assignment tasks were mapped. This confirmed that there was a correlation between the grades awarded to students, the organization of their assignment texts, and how they moved between abstract HSC concepts and case study details. Ways of enhancing assignment design, guidance and feedback were suggested. However, interviews with students revealed variations in students’ ways of using language and of thinking that influenced how they interpreted and applied assignment design, guidance and feedback. It is proposed that responding to such ‘semantic variation’ among students can further enhance students’ access to the academic discourses of HSC.