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The prestigious Duke Elder Undergraduate Ophthalmology exam in the UK is aimed at medical students who have completed their ophthalmology undergraduate teaching but is open to all medical undergraduates provided they have not graduated at the time of the examination.

The candidate achieving the highest mark is offered a chance to visit St John’s Eye Hospital in Jerusalem, however, the winning candidate can alternatively choose a cash prize of £400. Achieving top 10% in this exam also awards the candidate two points for their portfolio should they apply to Ophthalmic Specialty Training (OST) in the UK. Compare this to the three points one gets for doing FRCOphth Part 1 on the OST portfolio; these are slightly easier points to achieve when you directly compare the amount of preparation required.

The exam is two hours long and consists of 90 multiple choice questions (MCQ’s) that are mostly based on clinical ophthalmology, but other areas covered include ocular physiology, anatomy, and pathology as well as genetics of eye conditions and socio-economic medicine relevant to ophthalmology, for example blind registration or world blindness.

In the clinical questions all the subspecialty areas within ophthalmology are covered, including: cornea and external eye disease, cataract, glaucoma, medical retina, vitreo-retinal surgery, strabismus, paediatric ophthalmology, neuro-ophthalmology, ocular adnexal disease, refractive errors and optics.

In the current climate pertaining to COVID-19, the examination is an online proctored exam whereby candidates can sit the exam in the comfort of their home or workplace without the need to travel to a testing centre or examination venue [1].


1 Plan early

The exam takes place around the same time in March every year and allocating enough time to revise is essential to achieving top 10%. My revision plan consisted of revising an hour each day in the month leading up to the exam and increasing the amount of time to 3 hours a day during exam week.

2 Question banks

The importance of doing as many questions as possible should not be understated. Doing questions has been shown to reduce exam anxiety and highlights gaps in knowledge to aid focused revision. Questions are particularly effective because they provide learners with practice retrieving information from memory, give learners feedback about their misconceptions, focus learners’ attention on the most important learning material, and repeat core concepts, giving learners a second chance to learn, relearn, or reinforce what they previously learned or tried to learn [2].

Start early with questions. During my revision, I covered the ‘Eyedocs’ Duke Elder question bank twice prior to the exam aiming for approximately 100 questions per day. Another useful resource is the renowned Chua ophthalmology website which contains several sample questions targeted to the level of the Duke Elder exam.

Creating a document of one-line ‘key points’ as you go through question banks is essential and provides a good summary sheet especially in the days leading up to the exam. This was invaluable in my preparation.

3 Flashcards

Evidence-based medicine (EBM) has continually shown that testing oneself through methods such as spaced repetition and active recall improve understanding and memory of key information [3]. Flashcards can be made to cover systems / diseases or specific questions. Given current technology, these can be created and accessed on mobile applications such as Anki and can be used alone or as part of a group. There are several web programs that create flashcards based on the content you are learning, some of which allow flashcards to be distributed electronically between fellow students. Quizlet has existing Duke Elder flashcards which can be accessed via the search bar on their website.

The flashcards from were extremely useful in my revision and they saved me a lot of time as they were updated and had relevant information. 

4 The national Duke Elder Preparation Course

This annual day course run by the Royal Society of Medicine is gold dust and an invaluable resource when it comes to studying for the Duke Elder exam. They offer concise lectures on the ophthalmology clinical subspecialties with these lectures delivered by candidates who also scored top nationally in recent years. They also provide a mock exam towards the end of the session which can be used in your preparation in the days coming up to the actual exam. This course is a must-attend!

5 Practising under exam conditions

With anything, the closest one can get to a real-life situation is simulation. From ensuring the smallest things such as table and desk positioning are suitable and comfortable, emptying your bladder prior to sitting the exam and sitting in a quiet room. The advantage of using the Eyedocs question bank is that you can select the number of questions and are also able to set a timer to mimic the exam conditions. Practising under these ‘exam’ conditions early on in your revision will help reduce stress and anxiety on the day.



1. Duke Elder Undergraduate Prize Examination. The Royal College of Ophthalmologists.

2. Dunlosky J, Rawson KA, Marsh EJ, et al. Improving students’ learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychol Sci Public Interes 2013;14(1):4-58.
3. Niroula S, Niroula A. Effective way of studying and learning in medical school. J Nepal Med Assoc 2022;58(231):954-6.

[All links last accessed March 2022].


Declaration of competing interests: None declared.

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Paras Agarwal

Mersey Deanery, UK.

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Oana Vonica

Ophthalmology Department, Kingston Hospital NHS Foundation Trust, London, UK.

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Zaria Ali

Manchester Royal Eye Hospital, Manchester, UK.

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