How to pass the Duke Elder exam
The Duke Elder Undergraduate Prize examination is a prestigious but challenging examination sponsored by the Royal College of Ophthalmology, aimed at undergraduate medical student with an interest in Ophthalmology as a career path. This article will provide a brief introduction to the structure and content of the exam, discuss whether you should take this exam, and some personal tips for preparing for it.
Structure of the examination
The exam consists of 90 multiple choice questions with a time limit of 2 hours. Candidates will be monitored by a live exam proctor via their computer webcam.
Eligibility
All medical undergraduates (both UK and international) are eligible, provided that have not graduated at the time of the examination. All medical students will need to apply through their medical school.
Important dates (2025 sitting)
Application deadline: 6 June 2025
Examination date: 17 September 2025
Release of results: 17 October 2025
Should I sit the Duke Elder?
In short, yes.
If you are planning to apply for Ophthalmology Specialty Training, this is a fantastic opportunity to show your commitment to the specialty as a medical student. It is also a great way start building points for your portfolio - scoring in the top 10% will score 2 points towards your portfolio, while placing in the top 60% alone will score 0.5 points (https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-25/evidence-folder-lib).
For those who are unsure if ophthalmology is the right specialty for you, preparing for the Duke Elder will help you gain a more comprehensive and in-depth understanding into both the basic science and clinical aspects of the specialty, allowing you to make a more informed decision. On a more practical note, studying for this exam would cover most, if not all, of your undergraduate ophthalmology syllabus for finals!
The cost of the exam is £50, but many medical school offer subsidisations so it is worth checking with them if this is a consideration for you.
How should I prepare for the Duke Elder?
The Duke Elder is notoriously difficult because of the breadth and depth of topics that it covers, and it may seem overwhelming to approach in the beginning. I have broken this down into a step-by-step guide which will hopefully make this more manageable.
1, Start with the basics
There is a considerable amount of factual, trivia-style basic science questions in the exam. Having detailed knowledge of the anatomy of the eye is key – from the order of the five layers of the cornea, to the diameter of the nasolacrimal duct. Pharmacology also features substantially, so it would be helpful to brush up on the mechanism of action of common drugs used in ophthalmology.
Resources that I found helpful:
Ophthalmology: Lecture Notes – a concise textbook that was easy to read and included a reasonable amount of detail, this formed the main bulk of my revision.
Kanski’s Clinical Ophthalmology – the gold standard textbook in ophthalmology covering common and rare conditions in great detail. I personally used it for referencing certain topics but did not read it back-to-front.
2. Common Ophthalmological conditions
After establishing an understanding of the fundamentals, I would suggest moving on to look at the common conditions affecting the eye. If you use question banks such as PassMedicine and QuesMed for your medical school examinations, these are a very good starting point. From there, I would do further reading and make additional notes using resources such as the textbooks I have mentioned above.
3. ‘Niche’ topics
At this point, you would have covered the basic ‘high-yield’ topics to achieve a good score in the Duke Elder. If you are aiming to score in the top deciles, there are a few specialist topics that I would advise looking into. These are not especially difficult per se, but do require a bit of time to prepare. Some Duke-Elder favourites include embryology, optics, and tropical diseases.
Resources that I found helpful:
Dr David Hunter’s lecture on Optics and Refraction – this is a 6-hour video available on Youtube. I would not recommend watching this in one go, but in chunks across a few days or even weeks. Optics is, in my opinion, the most difficult topic in the Duke Elder, but Dr Hunter explains them in a very clear and easy-to-understand manner.
World Health Organization (WHO) website – this is a wonderful resource to provide an overview into the epidemiology of tropical diseases, with very helpful infographics and factsheets.
4. Recognizing images
Picture questions have become increasingly popular on the Duke Elder exam in recent years. This can range from explaining the function of a component of the slit lamp, to identifying a surgical instrument, to interpreting an Optical Coherence Tomography (OCT) image. Similar to analysing a chest x-ray or an ECG, preparing for these types of questions comes down to exposing yourself to lots of images and studying by pattern-recognition.
Resources I found helpful: EyeWiki, EyeGuru and American Academy of Ophthalmology.
When should I sit the Duke Elder?
You can sit the Duke Elder exam any time before you graduate from medical school. I sat it in my 5th year (out of 6) – this was the ideal time for me personally as I had completed my clinical rotation in ophthalmology which gave me a good basis to build my revision upon, without the imminent pressure of medical school finals.
However, this is entirely up to you. For example, some people may decide to take it during their intercalated BSc year as this would give them more time to study.
Final tips for preparation
1. Courses and question banks
There are lots of courses and question banks out there to prepare for this exam. I attended the Duke Elder preparatory course organised by Moorfields Education which provided a brilliant overview into the topics covered in the exam and helped shape my study plan. In terms of question banks, I used EyeDocs which was a great tool to test my understanding and point out gaps in my knowledge.
2. Have a study group
Find friends who are also interested in the exam and prepare together. For example, you could each prepare a topic to teach one another. From a financial perspective, you could share the cost of textbooks and question banks which would make it more manageable.
3. Start early
Although there is a substantial amount to cover for this exam, it is very doable especially if you start early. I would recommend starting with 15 minutes a day a few months in advance, and slowly building up as you approach this exam date to avoid last-minute stress!
TL;DR summary
Overview:
Prestigious exam for medical students interested in ophthalmology.
90 multiple-choice questions (2 hours), proctored online.
Open to all medical undergraduates globally, provided they haven’t graduated.
Key Dates (2025):
Application deadline: 6 June 2025.
Examination date: 17 September 2025.
Results released: 17 October 2025.
Benefits of Taking the Exam:
Demonstrates commitment to ophthalmology.
Portfolio points:
Top 10% = 2 points.
Top 60% = 0.5 points.
Helps confirm interest in the specialty and strengthens knowledge for finals
Preparation Steps:
Start with the basics: Master eye anatomy and pharmacology. Resources: Ophthalmology: Lecture Notes and Kanski’s Clinical Ophthalmology.
Common Conditions: Use question banks like PassMedicine/QuesMed; supplement with textbooks.
Niche Topics: Focus on embryology, optics, and tropical diseases for high scores. Resources: Dr. David Hunter’s optics video, WHO website.
Image Recognition: Study slit lamp components, OCT images, and surgical instruments. Resources: EyeWiki, EyeGuru, and AAO.
When to Take the Exam:
Anytime before graduation.
Ideal timing: After completing an ophthalmology clinical rotation.
Tips for Success:
Attend courses (e.g., Moorfields Education) and use question banks (e.g., EyeDocs).
Study in groups to share resources and teach each other.
Start early: Begin with 15 minutes daily, increasing closer to the exam date.
Cost: £50; check for medical school subsidies.
