The Duke Elder is an optional exam open to all undergraduate medical students in the UK. It is recommended for students who are interested in ophthalmology. Scoring in the top 10% of candidates gives you 2 points for your specialty application in ophthalmology, and scoring in the top 60% gives you 1 point. With rising competition ratios every year, taking this exam and scoring well is crucial to your ophthalmology specialty application. In this article, I will share the resources I used and how I prepared to get top 10% in the Duke Elder exam.
The Duke Elder exam is on 17 September 2025 this year.
Closing date for entry is 6 June 2025.
See official Royal College of Ophthalmologists website for more information: https://www.rcophth.ac.uk/examinations/examinations-calendar/
The Duke Elder exam is taken online whilst being proctored. Before you sit the exam, you have to sign up through your university. Make sure you know the registration deadlines, since you have to sign up directly with your medical school. Some medical schools where many students take the Duke Elder exam each year may remind you to register. However, this may not be the case for all medical schools, so you may have to enquire with the admin team directly if you wish to sign up.
I have made an entire video on how to prepare for the Duke Elder, see below:
The exam consists of 90 single best answer (SBA) questions that are to be completed in two hours. There are a wide variety of questions covered in this exam. Some are “core ophthalmology” knowledge, i.e. core content expected of all undergraduate medical students. This includes the diagnosis and management of very common conditions such as giant cell arteritis, orbital cellulitis, cataract, glaucoma, and strabismus. They may also test concepts related to basic clinical optics such as astigmatism, concave/convex lenses, and ocular manifestations of systemic diseases.
They also ask many similar questions on the anatomy of the eye. Question themes that come up in the exam frequently include the bones that make up the walls of the orbit, the muscles involved in eye movements, and the nerves in the orbit. They also like to test knowledge relating to Vision 2020, tropical eye diseases, epidemiology of ophthalmic conditions and about blindness registration in the UK. These are easy marks to score because they are such predictable questions and are easy to revise for.
However, there are also a number of more challenging questions. For example, when I sat the exam, I had questions on how the cataract surgery equipment worked. As you probably know, this is not covered in the medical school curriculum, so such questions are designed to distinguish candidates who have done additional reading from those who haven’t. These questions were more technical. For example, they may ask questions requiring understanding of how lasers operate, or how certain aspects of the slit lamp works.
One thing you should be aware of is that the Duke Elder also tests some core medical science topics that are not ‘ophthalmology content’ per se. For example, when I sat the Duke Elder, I had questions on anaphylaxis, DNA synthesis, protein synthesis, and even COVID-19. These questions are more difficult to predict or revise for. It is probably not a very high yield exercise to revise your preclinical science knowledge in its entirety just for this exam, and so, unless you are aiming for the top five positions, I recommend focusing on revising the core ophthalmology topics and hoping that you know the answers to the basic science questions.
Below are the revision courses I attended and my personal review of each:
Cambridge University Ophthalmology Society Duke Elder Series from Facebook
Free; Highly recommended
This course was a series of eight webinars hosted weekly by students who have experience taking the Duke Elder exam. The good thing about this course was that it was spaced out over eight weeks, giving you time to go over the topics in each tutorial after it is covered. The tutorials were very fast-paced and covered the core concepts in each of the topics tested in the Duke Elder. Since this course was delivered by students, they were able to give tips focused on revising answering the questions for this specific exam. Best of all, the course was free!