This article examines the transmission of Tibetan medical knowledge in the Himalayan region of Ladakh (India), taking three educational settings as ethnographic ports of entry. Each of these corresponds to a different operating mode in the standardisation of medical knowledge and learning processes, holding profound implications for the way this therapeutic tradition is known, valued, applied and passed on to the next generation. Being at the same time a cause and a consequence of intra-regional variability in Tibetan medicine, the three institutional forms coexist in constant interaction with one another. The authors render this visible by examining the 'taskscapes' that characterize each learning context, that is to say, the specific and interlocking sets of practices and tasks in which a practitioner must be skilled in order to be considered competent. The authors build upon this notion by studying two fields of transmission and practice, relating to medicine production and medical ethics. These domains of enquiry provide a rich grounding from which to examine the transition from enskilment to education, as well as the overlaps between them, and to map out the connections linking different educational forms to social and medical legitimacy in contemporary India.