THE DUKE ELDER
The Duke Elder Exam is an undergraduate exam in ophthalmology for medical students. Below, I cover what resources you need to score in the top 10% of candidates and recommend good courses, question banks, textbooks and other resources. In addition to this, I provide recommendations on how to best tailor your revision in order to do well in the exam.
by Abhiyan Bhandari
Top 10% Duke Elder Exam 2021
Who is this exam for?
The Duke Elder is an optional exam that can be taken as an undergraduate medical student. It is open to all medical students who have not yet graduated from medical school and is recommended for students who are interested in ophthalmology. Scoring in the top 60% of candidates scores you 1 point for your ophthalmology speciality application, and scoring in the top 10% of candidates scores you 2 points. Since ophthalmology forms part of the undergraduate medical school curriculum, some students may also choose to sit this exam as additional practice for their medical school exams, even if they do not want to apply for an ophthalmology training post in the future.
About the exam
The Duke Elder exam is usually held in the first few weeks of March, and it is taken online whilst being proctored. Before you sit the exam, you have to sign up through your university. The deadline to sign up is usually sometime in mid-December. Medical schools with many students taking the Duke Elder exam do sometimes take the initiative to remind their students of this deadline. 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.
What kinds of questions come up in the exam?
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!
Moorfields Duke Elder Preparatory Course
£25; Highly recommended
This course was very well organised. They provided notes, recordings, and a copy of their slides at the end so that you could go through the content in your time. This course is delivered by ophthalmology registrars who also sat the Duke Elder before, and the content for every lecture is reviewed by senior ophthalmologists to ensure that the information is accurate and up to date. Again, they provided many practical tips on where to focus your revision. If you could only pick one course to attend, I would say to go for this one.
North West Duke Elder Revision Course
£20 for the course (+£15 for an optional 100-page booklet)
This course was run by ophthalmology trainees and consultants from Manchester. The course covers very high-yield concepts tested in the Duke Elder. However, if you’ve already attended the above courses, you will find that a lot of the information overlaps with the content covered here. It is always good to go over the information again, but if you are attending the above two courses, this will not be completely necessary. I did not even end up going through the full booklet in my revision as most of the information had been covered elsewhere.
This is the perfect book to give you a solid foundation of ophthalmology for you to build your knowledge from. If you read this book from cover to cover, you will do very well in the Duke Elder and have a general understanding of the main topics in ophthalmology.
This is free and available online. The tutor does a fantastic job explaining difficult concepts easily. He also has videos of clinical skills in ophthalmology. If you are entirely new to ophthalmology, I'd suggest going through this OphthoBook first to build a solid foundation of knowledge that you can build on later.
This is a hefty book and I recommend it if you are aiming for the top 10 positions in the Duke Elder. I only used it as a reference tool when the other books did not cover the information I was looking for, or to learn a bit more about a specific niche condition. If you are planning to go through this whole book properly, give yourself a few months, as this will take a reasonable amount of time.
This is a basic anatomy book that only had a few relevant pages in Chapter 2, but these few pages covered the anatomy of the eye and orbit really well. For learning the anatomy of the eye and orbit, I also recommend Teachmeanatomy. Make sure you are familiar with the bones that make up the walls of the orbit, the nerves that go through various foramen, and the trigeminal nerve and its branches.
This question bank has basic questions from the undergraduate medical school curriculum. It is not very specific for Duke Elder, but you should definitely already know all of the content covered here because these types of questions are definitely tested on the Duke Elder.
Eyedocs Duke Elder Question Bank
This was an expensive question bank (it costed £60), so I shared this subscription with a colleague, so we could split the cost. This is probably the most relevant and high-yield question bank for the Duke Elder. The questions are hard, so it may take you a long time to get through them, but they are around the same level of difficulty as the Duke Elder exam.
If you are learning new content, which you will be when studying for the Duke Elder, make sure you review this information regularly to ensure you remember this information. Personally, I made new Anki cards and reviewed those cards regularly.
Make sure you know niche conditions like Behçet's syndrome, Vogt-Koyanagi-Harada disease, Sturge-Weber syndrome, sympathetic ophthalmia, and Coats disease, to name a few.
For neuro-ophthalmology watch Dr Andrew Lee on YouTube. He has 599 videos (and counting) on neuro-ophthalmology. Obviously, you don't need to watch all of them, but if there is a topic you are finding difficult to understand, just search that topic on his channel and he will most likely have an excellent video explaining it!
Watch Dr Najeeb's eye lectures to learn the fundamentals of eye anatomy. This will take up a lot of your time because he repeats a lot of content and his lectures are long, so only do this if you are really struggling with eye anatomy and if you are planning your revision many months in advance.
If there is anything you need to learn more about quickly, use EyeWiki as a reference tool. They contain good images and cover basically everything in ophthalmology.
All the best!
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Page last updated: November 2021
Abhiyan Bhandari is a final year medical student studying in London. He scored in the top 10% of candidates who sat the Duke Elder examination and runs ophthalmology and Duke Elder revision sessions aimed at medical students. He also runs a YouTube channel aimed at medical students, covering topics ranging from study tips, productivity and vlogs of his journey through medical school.