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Research indicates that teachers’ conceptions of and approaches to teaching with technology are central for the successful implementation of educational technologies in higher education. This study advances this premise. We present a 10-year longitudinal study examining teachers’ conceptions of and approaches to teaching and learning with technology. Nine teachers on an online Bachelor of Science in Pharmacy and a Master of Pharmacy programme at a Swedish university were studied using a phenomenographic approach. Results showed clear differences between novice and experienced teachers. Although novice teachers initially held more teacher-focused conceptions, they demonstrated greater and more rapid change than experienced colleagues. Experienced teachers tended to exhibit little to no change in conceptions. Supporting conceptual change should, therefore, be a central component of professional development activities if a more effective use of educational technology is to be achieved.