1

Read Text A, and then answer Questions 1(a)–1(e) on the question paper.

Text A: National Doctors’ Day

National Doctors’ Day is a day celebrated in many countries around the world, although
the date may vary from nation to nation.

National Doctors’ Day occurs every year. It’s meant to bring attention to the service of
all doctors – living or dead. We should all appreciate their contribution to individual
health and medical progress. But the day may also be a time to reflect on the wellbeing
of doctors themselves. A doctor needs to be well, both mentally and physically, in order
to make others well.

Doctors suffer from ‘burnout’ which typically includes physical or emotional exhaustion,
feeling drained and demotivated in work that once excited them. This may also cause
doctors to feel a lower sense of fulfilment and become more detached from their work.
Of course, this impacts negatively on patients too.

Doctors have some of the most high-intensity, demanding jobs out there – exacerbated
by double shifts, emotional stress, and staying on their feet for hours on end. As hospitals
try to cram as many patients into one day as possible, doctors often face overwhelming
schedules with rarely a chance to breathe, eat, or sleep. Sleep deprivation among
doctors poses risks to both individual health and public safety. More reasonable working
hours could improve care for all.

Doctors are under immense pressure to maintain a strong demeanour, making it harder
for them to reach out for help. ‘The stigma is sometimes difficult to overcome, but finding
time to seek help will help us, help our families, our friends, and our patients,’ writes
Dr. Lea Su about her own struggle with illness during medical school and training.

Perhaps if National Doctors’ Day actually meant a day off for all doctors, or more reward
than a lunch organised by their employers, it really could make a tangible difference?

Read Text A, National Doctors’ Day, in the insert and then answer Questions 1(a)–(e) on this
question paper.

Question 1
(a) What is meant to be the purpose of National Doctors’ Day? [1]

(b) Using your own words, explain what the text means by:

(i) ‘their contribution to individual health’ (lines 2–3): [2]

(ii) ‘to reflect on the wellbeing of doctors’ (lines 3–4): [2]

(c) Re-read paragraph 2, (‘Doctors suffer patients too.’).

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Give two ways in which the physical and emotional effects of burnout might affect doctors’
attitudes to their work. [2]

(d) Re-read paragraphs 3 and 4, (‘Doctors have and training.’).

(i) Identify two ways in which hospitals could make things better for doctors. [2]

(ii) Explain why doctors can find it hard to ask for help. [3]

(e) Re-read paragraph 5, (‘Perhaps if ...difference?’).

Using your own words, explain why some people could think that National Doctors’ Day is not
worthwhile. [3]
 3

Text B: A Dream Job

Dr Craig Spencer works in emergency medicine and is also a physician for Médecins
San Frontières (MSF). This is an international organisation that delivers emergency
aid to people affected by armed conflict, epidemics and natural disasters. He is being
interviewed by a journalist for an article about interesting travel jobs.

Journalist: When someone discovers you work with MSF, what’s the typical
reaction?

Dr Spencer: Usually, ‘When were you last abroad?’ or, ‘Where did you go?’ People
are curious. They associate MSF with challenging, high-intensity conflicts.

So you find yourself getting cornered at parties?

[Laughs] Sometimes! I work with MSF five months a year and in an emergency
department the rest of the time. People are interested in how I’m able to have two
dream jobs – it’s always good though talking about the incredible people we get to work
with.

You mean the locals in the destinations MSF sends you to?

Yeah. People think we’ve got people trained from all over the world meeting up in this
one place to do a mission or tackle some disease. In fact, it’s overwhelmingly people
from that country or region who have some training or are being trained by MSF. How
do you get things from one country to another when there are no flights or there’s
ongoing conflict? We rely on people in the countries we are going to. They’re invariably
awesome – some of the best doctors I’ve ever met.

OK, let’s step back in time. Did you play ‘doctor’ as a kid?

No, actually I wanted to be a sharkologist – until someone told me sharkologists didn’t

exist. [Laughs]

Where did you get the idea to become a doctor?

When I was about 10, I remember seeing that a cardiothoracic surgeon made way more
money than any other profession. I thought, ‘Whoa! I want to do that.’ From then on, I
told everyone I was going to be a cardiothoracic surgeon. That’s largely why I went to
medical school. The job seemed important – everyone has a heart – but I also wanted
to make loads of money.

But you later switched to emergency medicine, right?

Right. Less lucrative, hugely rewarding.

How did you get involved with MSF?

After medical school, I worked alongside MSF on projects and loved what they were
doing. I support their impartiality and really appreciate their humanitarian principle of
not getting involved in the politics. Eventually I applied to MSF. I’ve done six different
 4

missions with them now.

What are the food and accommodation like on missions?

Different every time. If you’re there for longer, you usually have your own space, running
water and Wi-Fi. There are security guards. People come and cook meals for us – that’s
pretty nice!

On a lighter note, when you take a real vacation, where do you like to go?

My favourite place is this cabin my wife’s grandparents bought on a lake surrounded

by pine trees. I can kayak and relax. But our coolest trip was probably our honeymoon:
we travelled from Sarajevo to Crete. It was unbelievable – amazing beaches with no
tourists. The only thing on any of the sun beds were goats!

Read Text B, A Dream Job, in the insert and answer Question 1(f) on this question
paper. Question 1
(f) According to Text B, what are the attractions and challenges of being an MSF doctor? You
must use continuous writing (not note form) and use your own words as far as possible.
Your summary should not be more than 120 words.
Up to 10 marks are available for the content of your answer and up to 5 marks for the
quality of your writing. [15]
[Total: 30]

1 travel abroad
2 can be in conflict situation
3 time to do other job(s) too / only 5 months a year
4 talking about the job (positive/negative) / people’s curiosity / people’s respect / considered a
dream job
5 work with incredible (local) people / work with local doctors
6 rewarding / satisfying to make a difference
7 helping without having to get involved in the politics of situations / able to remain impartial but
help
8 trying local food / (local) people cooking for them
9 tackling disease
10 logistics
11 accommodation does not always have running water / is not always private / variable
standard
12 security an issue
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Text C: This is going to hurt

After six years of training and a further six years on the wards, Adam Kay resigned from his job
as a doctor. Some years later, he re-reads and decides to publish the diaries he kept in his first
years as a junior doctor.

I don’t remember medicine ever being an active career decision, just the default setting
for my life. My dad was a doctor.

As you might imagine, the training was hard – learning every aspect of the human body,
plus each possible way it can malfunction, is a fairly gargantuan undertaking. But the
buzz of knowing I’d be a doctor one day – such a big deal you get to literally change
your name, like a superhero – propelled me towards my goal. When it was finally time
to step out onto the ward armed with all this exhaustive knowledge and turn theory into
practice, it came as a blow to discover that I’d spent a quarter of my life at medical
school and wasn’t remotely prepared for what came next.

During the day, the job was manageable, if mind-numbing and insanely time-consuming.

You turn up every morning for the ‘ward round’, where your whole team of doctors
troops past each of their patients. You trail behind like a hypnotised duckling, your head
cocked to one side in a caring manner, noting down every pronouncement from your
seniors. Then you spend the rest of your working day (plus generally a further unpaid
four hours) completing dozens, sometimes hundreds, of tasks – filling in forms, making
phone calls. Not really what I’d trained so hard for.

Night shifts were an unrelenting nightmare. At night, you’re given a paging device
affectionately called a bleep, and responsibility for every patient in the hospital. All of
them. The senior doctors will be downstairs reviewing and admitting patients while
you’re up on the wards, sailing the ship alone – a ship that’s enormous, that no one
has really taught you how to sail. You’re bleeped by ward after ward, nurse after nurse,
with emergency after emergency – it never stops, all night long.

Senior colleagues see patients in A&E1 who have a specific problem, like pneumonia
or a broken leg. Your patients are having similar emergencies, but they’re in hospital
already, meaning they already had something significantly wrong with them in the first
place. It’s a ‘build-your-own-burger’ of symptoms layered on conditions layered on
diseases. You’re a one-man, mobile, essentially untrained A&E department, reviewing
an endless stream of worryingly sick patients who, twelve hours earlier, had an entire
team of doctors caring for them. It’s sink or swim – you have to learn to swim because
otherwise a tonne of patients sink with you.

I actually found it exhilarating. Sure it was hard work, the hours were bordering on
inhumane and I saw things that have scarred my retinas to this day, but I was a doctor.
It occurs to me now that the public don’t hear the truth about what it actually means to
be a doctor. So here are the diaries I kept during that time: what it was like working on
the front line, the repercussions in my personal life and how it all became too much for
me. (Sorry for the spoiler, but you watched ‘Titanic’ knowing how that was going to play
out.)
 6

3 August

Day one. I’ve a packed lunch, a new stethoscope, a new shirt and a new email address:
atom.kay@ward.net. It’s good to know that no matter what happens today, nobody
could accuse me of being the most incompetent person in the hospital. And even if I
am, I can blame it on Atom.

5 August
Whatever we lack in free time, we make up for in stories about patients. Today over
lunch we’re trading stories about nonsense ‘symptoms’ that people have presented
with – from itchy teeth to sudden improvements in hearing.

9 August
Bleeped awake at 3 a.m. from my first half-hour’s shuteye in three shifts to prescribe
a sleeping pill for a patient, whose sleep is evidently much more important than mine.
My powers are greater than I realised – I arrive on the ward to find the patient is asleep.

1A&E: ‘accident and emergency’ refers to the acute, emergency department in a hospital.
 7

Read Text C, This is going to hurt, in the insert and then answer Questions 2(a)–(d) on this
question paper.

Question 2

(a) Identify a word or phrase from the text which suggests the same idea as the words
underlined:

(i) Adam did not recall making an informed, planned choice to become a doctor. [1]

(ii) When he was training, the idea that he would become a doctor gave Adam the motivation to
achieve what he set out to do. [1]

(iii) Once he had completed his training at medical school, Adam was looking forward to
applying what he had learned. [1]

(iv) Adam found working as a doctor during the daytime extremely boring. [1]

(b) Using your own words, explain what the writer means by the words underlined:

Night shifts were an unrelenting nightmare. At night, you’re given a paging device affectionately
called a bleep, and responsibility for every patient in the hospital. All of them.

(i)
unrelenting [1]

(ii) affectionately [1]

(iii) responsibility [1]

(c) Use one example from the text below to explain how the writer suggests how difficult it is for
Adam to deal with his patients.

Use your own words in your explanation.

It’s a ‘build-your-own-burger’ of symptoms layered on conditions layered on diseases. You’re a

one-man, mobile, essentially untrained A&E department, reviewing an endless stream of
worryingly sick patients who, twelve hours earlier, had an entire team of doctors caring for them.
It’s sink or swim – you have to learn to swim because otherwise a tonne of patients sink with
you. [3]

(d) Re-read paragraphs 2 and 4.

 8

• Paragraph 2 begins ‘As you might ’ and is about Adam’s progress through training.

• Paragraph 4 begins ‘You turn up ’ and describes the daytime work as a junior doctor in the
hospital.

Explain how the writer uses language to convey meaning and to create effect in these
paragraphs. Choose three examples of words or phrases from each paragraph to support your
answer. Your choices should include the use of imagery.

Write about 200 to 300 words.

Up to 15 marks are available for the content of your answer. [15] [Total: 25]

Adam’s progress through training in paragraph 2, beginning ‘As you might imagine ... ’

As you might imagine, the training was hard – learning every aspect of the human body,
plus each possible way it can malfunction, is a fairly gargantuan undertaking. But the
buzz of knowing I’d be a doctor one day – such a big deal you get to literally change
your name, like a superhero – propelled me towards my goal. When it was finally time
to step out onto the ward armed with all this exhaustive knowledge and turn theory into
practice, it came as a blow to discover that I’d spent a quarter of my life at medical
school and wasn’t remotely prepared for what came next.

The writer presents Adam’s training through the contrast between the romanticised view of the
challenges and the harsh reality. Training is presented as ‘gargantuan’ and therefore an
enormous, challenging and time consuming period. Nonetheless, Adam is presented as being
‘propelled’ towards his goal of being a doctor, suggesting it is his fate as an irresistible and out
of control force drives him on. He also feels the ‘buzz’ of knowing he will have the title of doctor
at the end of the training, which suggests excitement and enthusiasm, and emphasises the hard
work entailed through the bee imagery, which connotes hard work. When he achieves the title,
he will feel ‘like a superhero’, which dramatically emphasises the prestige, honour and
extraordinary power associated with being a doctor. After his training was completed, he was
‘armed with all this exhaustive knowledge’ which presents a hospital as a battlefield and the
doctors as soldiers battling a war on disease. He felt protected with the huge amounts of
information at first, however once he began his career as a doctor it felt like a ‘blow’ when he
realised the training hadn’t actually prepared him for the reality of life as a doctor. This
realisation not only emphasises how his romantic illusion of medicine has shattered but also his
disappointment that he had wasted all that time training.

Overview: romanticised view of challenging adventure, fighting adversity, contrasted with reality

propelled me: (towards my goal): driven on as if by an irresistible force, rocketed, out of control
gargantuan: gigantic; enormous; colossal, giant
buzz: excitement, reminiscent of a busy insect / worker bee / machine
like a superhero: comic book characters with extraordinary powers, known by alias to protect
their identity
armed with (all this exhaustive knowledge): has learned huge amounts of information, though as
protection / a weapon in dealing with the challenges of the job this turns out to be ineffective,
military image of fighting losing battle
blow: hit hard, sudden realisation, takes breath away, shatters illusions
 9

• day to day work as a junior doctor in the hospital in paragraph 4, beginning ‘You turn up ...’

You turn up every morning for the ‘ward round’, where your whole team of doctors
troops past each of their patients. You trail behind like a hypnotised duckling, your head
cocked to one side in a caring manner, noting down every pronouncement from your
seniors. Then you spend the rest of your working day (plus generally a further unpaid
four hours) completing dozens, sometimes hundreds, of tasks – filling in forms, making
phone calls. Not really what I’d trained so hard for.

The writer ridicules the futility of ward rounds as part of the day to day work of a junior doctor.
The team of doctors ‘troops past’, which presents a sense of formality and drama like the
ceremonial parade of soldiers, but also suggests a sense of superficiality and performing the
task for the sake of appearances. He ‘trail[s] behind’ which highlights his feelings of
insignificance and lack of enthusiasm and usefulness, similar to a ‘hypnotised duckling’, which
evokes an image of a vulnerable, naive, and innocent creature overwhelmed in a new
environment, where they are being controlled by unknown forces. He describes his body
language of having his ‘head cocked to one side in a caring manner’ to feign interest and
empathy by appearing to listen with concern. He also presents how he had to note down ‘every
pronouncement’ which again shows how he feigned paying attention by writing down
everything. He mocks reverence of the senior doctors as ‘pronouncement’ suggests a formal
declaration or statement from a higher being. Finally, he presents having to complete ‘dozens,
sometimes hundreds’ of tasks in unpaid hours. The increase of figures suggest the workload
intensifying as time went on and his feelings of being more and more overwhelmed and unable
to complete the sheer number of tasks.

Overview: ridicules futility of the exercise

troops past: move past in a group (slowly), no sense of urgency, as if on an outing or trip and
taking in the scenery, ridiculous and out of place like circus performers / ceremonial parade of
soldiers
trail behind: drawn along after them, as if being towed, lack of impetus, little enthusiasm, just
taken along, feeling useless
like a hypnotised duckling: vulnerable creature, naïve, innocent, ungainly, disorientated, being
controlled
head cocked to one side in a caring manner: tilted on an angle as if listening with concern,
superficial, feigning interest only
noting down every pronouncement: appearing to pay attention to all that is said by writing notes;
mock reverence, as if formal declaration, words from a higher authority
dozens, sometimes hundreds: numbers are imprecise and multiplying, exaggeration but sense
of being so over-whelmed it seems like there is an impossible number to complete

Table A, Reading: Analysing how writers achieve effects

Use the following table to give a mark out of 15 for Reading.

Level Marks Description

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5 13–15 • Wide-ranging discussion of judiciously selected language with some high

quality comments that add meaning and associations to words/phrases in both
parts of the text, and demonstrate the writer’s reasons for using them.
• Tackles imagery with some precision and imagination.
• There is clear evidence that the candidate understands how language works.

4 10–12 • Explanations are given of carefully selected words and phrases.

• Explanations of meanings within the context of the text are secure and effects
are identified in both parts of the text.
• Images are recognised as such and the response goes some way to
explaining them.
• There is some evidence that the candidate understands how language works.

3 7–9 • A satisfactory attempt is made to select appropriate words and phrases.

• The response mostly gives meanings of words and any attempt to suggest
and explain effects is basic or very general.
• One half of the text may be better addressed than the other.

2 4–6 • The response provides a mixture of appropriate choices and words that
communicate less well.
• The response may correctly identify linguistic devices but not explain why they
are used.
• Explanations may be few, general, slight or only partially effective.
• They may repeat the language of the original or do not refer to specific words.

1 1–3 • The choice of words is sparse or rarely relevant.

• Any comments are inappropriate and the response is very thin.

0 0 • The response does not relate to the question.

• Inappropriate words and phrases are chosen or none are selected.

Re-read Text C, This is going to hurt, in the insert and then answer Question 3 on this
question paper.

Question 3

Imagine you are Adam. After reading your diaries, you write a letter to your parents reflecting
 11

on your time in medicine and your decision to quit:

In your letter you should explain:

• why you went to medical school and what medical training was like
• the challenges involved in working on the wards as a junior doctor and how you felt about the
job at the time
• why you felt you had to give up and your feelings as you look back now.

Write the words of the letter.

Base your letter on what you have read in Text C, but be careful to use your own words.
Address each of the three bullet.

Write about 250 to 350 words.

Up to 15 marks are available for the content of your answer and up to 10 marks for the
quality of your writing. [25]

[Total: 25]

Dear Mum and Dad

How are you? I hope you are both well. I recently found the diaries I wrote during my medicine
training...which brought back a lot of memories and feelings.

I don’t ever remember actively making the decision to be a doctor. I suppose it was a natural
career choice as dad was a doctor, and perhaps I wanted to make him proud. A part of it was to
 12

be given the power to save people, like a superhero. Training was time consuming and involved
a lot of theory; I remember many late nights memorising every aspect of the human body. It was
challenging but I managed to do it. The thought of finally completing the training and getting out
onto a ward kept me going. But as the training was largely theoretical, deep down I still felt
unprepared for real life situations in a hospital, like I was an imposter, so I became somewhat
frustrated that I had wasted a quarter of my life.

When I read back on my experiences as a newly qualified junior doctor, I am filled with
conflicted emotions. I remembered the tedious ward rounds every morning, and the patronising
attitudes of senior doctors. It also brought back the frustration of the administrative side of the
job - endless filling in of forms and making phone calls. I knew it was necessary but I couldn’t
help feeling that I didn’t train so hard to do paperwork. At night, however, the tables were turned
as I went from feeling under-challenged to over-challenged. Each time my pager bleeped, I
remember feeling a sense of dread as it was another reminder that I had sole responsibility for
all patients. I felt utterly unsupported. The hours were painfully long and the work unrelenting as
I was called to ward after ward. Patient cases were obviously complex so I always had to be
alert as mistakes would have cost likes. Despite this, I do remember feeling exhilarated as I was
no longer playing the role of a doctor but actually a doctor. At the end of each shift, I did feel a
sense of achievement.

Looking back, I do not regret leaving medicine. I almost have to laugh at how naive and
innocent I was when I first started at the hospital - I really thought being a doctor was a
rewarding career but I soon found that there was no hope for a work-life balance. It certainly
played a role in my break up with Karen. It also felt like I lived and breathed the hospital every
minute of the day - my mind couldn’t get a break away from medicine. Even during our breaks,
we would sit in the canteen sharing stories about patients. It was funny at first but then it just
became repetitive. I couldn’t tell you anything about my colleagues, who were the closest thing I
had to friends at the time. Also, there were just unreasonable expectations, like being bleeped
at 3am from my first nap after working three shifts. I honestly don’t think I had a good night’s
sleep throughout the whole time training and working as a doctor. It got to a point when I felt I
was going to have a breakdown.

Things have changed so much since those days. Anyways, I will visit soon. See you then.

Best,

Adam

____________________________________________________________________________

A1: why you went to medical school and what medical training was like
• father was a doctor (det. not an active career decision) [dev. following in father’s footsteps /
wanted to make him proud]
• involved learning every aspect of human body (det. how body can go wrong) [dev. challenging
but managed to do it]
• training took a long time (det. a quarter of his life, 6 years of training) [dev. excited to finish
medical school and get out onto the ward]
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• training (largely) theoretical / did not prepare them (det. put knowledge into practice) [dev. felt
had wasted his time]
• wanted to save people (det. like a superhero) [dev. romantic view, liked the image]

A2: The challenges working on the wards as a junior doctor involved and how you felt about the
job at the time
• boring ward round(s) (det. every morning) [dev. patronised by senior doctors]
• administrative tasks (det. filling in forms, making phone calls) [dev. frustrating]
• nightmarish night shifts (det. pager, sole responsibility) [dev. felt unsupported]
• extremely long hours (det. all night, extra unpaid hours) [dev. physically demanding]
• complex conditions (det. very sick patients) [dev. easy to get it wrong]
• exhilarated (det. was a doctor) [dev. felt sense of achievement]

A3: Why you felt you had to give up and your feelings as you look back now
• public do not hear the truth (det. public unaware what job entails) [dev. might not have started
if he knew the reality / wants people to know]
• affected relationship(s) (det. impact on personal life) [dev. break up due to work/life conflict]
• mental toll (det. all became too much) [dev. breakdown due to stress]
• naivety / innocence / early optimism (det. new shirt, packed lunch) [dev. like first day at school,
sadness now]
• camaraderie / humour (det. stories about patients, atom.kay ) [dev. lost sense of humour as
time went on]
• unreasonable expectations (det. being woken from sleep, allowed insufficient sleep) [dev.
unsafe, did not get easier]