The provision of key text reading lists relies on students to select one they will utilise in undertaking a course. In anatomy and physiology an array of texts exist providing lecturers with the task of deciding the most suitable for inclusion within this list, the final choice for a student to undertake. Little evidence was found to identify the decision-making a student undertook in selecting a text. Based on disparate theoretical concepts an initial development of a conceptual process framework followed to provide a basis from which to identify influences which impacted on the student decision-making process. Using a mixed methods design a survey of students (N=964) undertaking anatomy and physiology courses was conducted whose results, following analysis provided the focus for in depth interviews. These included students (n=15), lecturers (n=3) authors (n=5) and publishers (n=2). Thematic analysis of the transcripts identified four overarching themes these being the Perception of the Textbook, Choice of the Textbook, Mismatch of Perceived Needs and Place of the Textbook. The results suggested two main influences which impacted on the student when choosing a text, those of existing prior knowledge and recommendation. Without prior knowledge, comprehension and cognition of the text was difficult. Recommendation by a lecturer or reading list, a strong influence, saw students selecting a recommended text without considering their own needs leading to an inability to use this. Without knowledge and recommendation students utilised aesthetic preference and heuristics in selecting a text, with many selecting additional texts to assist in using recommended texts. The results led to the development of the conceptual process framework indicating choice was a complex process for the student. Selecting a text is complex and affected by numerous influences. The study highlights a process through which a student traverses as they undertake the selection of their text. The study conclusions have led to the development of the Process Framework for Text Selection providing a novel and coherent linking of established theoretical concepts.