Academic journals represent shared spaces wherein the significance of thematic areas, methodologies and paradigms are debated and shaped through collective engagement. By studying journals in their historical and cultural contexts, the academic community can gain insight into the ways in which authors and audiences propose, develop, harness, revise and discard research subjects, methodologies and practices.Thirty top-cited articles published in Medical Education between 1986 and 2014 were analysed in a two-step process. First, a descriptive classification of articles allowed us to quantify the frequency of content areas over the time span studied. Secondly, a discourse analysis was conducted to identify the continuities, disruptions and tensions within the three most prominent content areas.The top-cited articles in Medical Education focused on three major areas of interest: problem-based learning, simulation and assessment. In each of these areas of interest, we noted a tension between the desire to produce and apply standardised tools, and the recognition that the contexts of medical education are highly variable and influenced by political and financial considerations. The general preoccupation with achieving efficiency may paradoxically jeopardise the ability of medical schools to address the contextual needs of students, teachers and patients.Understanding the topics of interest for a journal's scholarly audience and how these topics are discursively positioned, provides important information for researchers in deciding how they wish to engage with the field, as well as for educators as they assess the relevance of educational products for their local contexts.