Duke Elder Examination – All you need to know

If you ask any ophthalmology trainee about how to improve your ST1 ophthalmology application at medical school, they will point you towards the Duke Elder exam. It is very well known in the UK ophthalmology community.

What will we cover?


The exam is a 2 hour, 90 question MCQ that any UK undergraduate can sign up for, even if you have not yet done your ophthalmology placements at medical school. What is most helpful is that you can sit the exam as many times as you like, providing you have not finished medical school. The deadline to sign up is usually early December each year, so, unfortunately, this year’s deadline has passed. The exam this year is Wednesday 9th March 2022.


There is a lot of information out there about the exam, and I will try not to duplicate things beyond what has been said in the following pieces:


  1. The RCOphth website has a helpful web page with some general information, as well as an information pack – you should read this thoroughly!
  2. A past winner has detailed his experience and advice here. There are lots of other blogs you can Google here and here

There are a few hundred applicants a year and those in the top 60% will be considered to pass. The candidate who wins overall can either choose a chance to visit St John’s Eye Hospital in Jerusalem or choose a cash prize of £400. It is extremely prestigious to win this award, and you see many big names in the field who place it front and centre on their CV! Ranking in the top 60% gets you 1 point on your ST1 application, and you get an additional point if you come in the top 10% of applicants. Nobody will know if you fail, and you can only submit one certificate in your application, so passing once before finals is as helpful as passing three times! 


The important thing to emphasise is that this is a challenging exam – to get into the top 20 candidates in 2021 you only needed a score of 59%. The level of ophthalmology knowledge that you need to pass far exceeds any undergraduate curriculum, and you need to know this if you are going to take this exam seriously. It may feel overwhelming at first when you already have a lot of knowledge to remember and exams to revise for throughout medical school. However, this should not put you off. Firstly, if you are going to pursue ophthalmology as a career, the information you learn for this exam will be more relevant to your future life as an ophthalmologist than your other medical school curriculum. Just ask a senior eye trainee to interpret an ECG and you’ll know what I mean. Secondly, as you have multiple attempts at the same exam, you can build on previous years, with a view to doing your best in final year. If you’re not in your final year, I would strongly encourage multiple attempts as there is a lot of content to cover, and it is hard to pass at the first attempt. Having said that, I know of many who did and scored very well. I was lucky to sit and pass it three times before graduating, coming 13th overall in my final year.  

How do you pass?

Sadly there are no shortcuts to doing well; you just need to put the hours in. If you are tactical about things, then you will realise that your sitting in final year will take place after your Situational Judgment Test (SJT) and foundation training applications have been submitted. Therefore the extra incentive to improve your decile score is less than in previous years. If you are lucky enough to be in contention for medical school honours, then you should press ahead as you get an extra point in your ST1 application for this, however for the rest of us, it may do your future career a benefit by committing more time to passing the Duke Elder and achieving your point(s) here.

How might you revise for this?

The two ways I revised for this involved question banks and revision weekends. In my experience, Eyedocs has the most comprehensive question bank available, with feedback and performance matching relative to your peers. The exam questions are harder than this, so don’t get stressed if you come across diseases you have never heard of in the real thing! The other question bank I found helpful was on http://www.mrcophth.com/Duke-elderexamination/dukeelderexamination.html, but there certainly are a few out there with a simple Google search. There are also some good online websites – start with Tim Root’s Ophthobook, which is free and pretty entertaining.


Revision weekends provided by any medical school were very helpful – attend as many as you can. You are exposed to a broader curriculum, and if the same topics are discussed at more than one course, it is probably high yield! I went to ones at Birmingham, KCL and UCL in my time.


The best textbook to look at is Kanski’s clinical ophthalmology. However, I think this should carry a supplementary role to the above methods. Other textbooks may be geared towards FRCOphth part 1 exam (such as Snell’s clinical anatomy) and may limit the breadth you can cover before the exam. 


Otherwise, trust yourself in your revision! You have worked very hard to get into medical school, and the techniques that have got you through so far (revision notes, flashcards, study buddies etc.) will work well here.

What parts should I revise?

The curriculum is probably too big to cover fully, and they can ask you anything. It includes questions on any of the below topics:

  • Cornea and external eye
  • Medical retina and vitreo-retinal surgery
  • Cataract
  • Glaucoma
  • Optics and refraction
  • Paediatric ophthalmology and strabismus
  • Neuro-ophthalmology
  • Adnexal and orbital disease

 The pieces of advice I can give are:

  1. Anatomy is the topic of the highest yield – as well as being the foundation with which you learn everything else (and for when you are a surgeon!).
  2. Clinical questions focused on history, examination and diagnostics as opposed to management plans. They appreciate your clinical experience is not comprehensive, so they seemed to weigh things heavily towards getting the correct diagnosis.
  3. There are other questions that always seem to come up such as epidemiology (commonest causes of blindness overall/in working age/in developed world/developing world) so look at the curriculum carefully!

Final Words

Overall, it is a tough exam, but if you are keen on ophthalmology, it will be beneficial in your further career ambitions, and it’s an excellent point on your CV to show you are dedicated to the field. I hope you agree that the content is much more interesting than asthma management or anything to do with bowels! Good luck!

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