Study Tips for the Duke-Elder Undergraduate Prize Exam

The Duke-Elder Undergraduate Prize Exam is an optional competitive exam run by the Royal College of Ophthalmologists, designed for undergraduate medical students who have an interest in Ophthalmology. It is amongst the most prestigious undergraduate prizes in the United Kingdom and attracts hundreds of applicants per year. However, most students will have little or no clinical experience in Ophthalmology making the exam both daunting and overwhelming. This article aims to assist candidates with some guidance on how to prepare for this exam. 

The Duke-Elder Exam is challenging; however, there are several incentives to do well. All candidates receive their score and decile ranking. Candidates within the top 10% receive a certificate, and the top 20 also receive a special commendation from the Royal College of Ophthalmologists. Furthermore, as per the ST1 Ophthalmology National Recruitment in 2022, applicants in the top 10% score 2 points or those in the top 60% score 1 point. Considering the fierce competition ratios for Ophthalmology training, getting points early on is desirable. 


The curriculum for the Duke elder exam is broad and extensive and therefore requires a significant time commitment. I would recommend between three to six months to revise for this exam to do well, but less revision may still allow you to still score well. Start by reading Lecture Notes Ophthalmology and/or The Duke Elder Exam of Ophthalmology: A Comprehensive Guide for Success. Lecture Notes Ophthalmology covers all the core concepts, is easy to follow as a novice and has lots of images, making it a treat for visual learners. The Duke-Elder Exam of Ophthalmology: A Comprehensive Guide for Success is denser than the Lecture Notes Ophthalmology and covers more content but can also be a bit overwhelming for a beginner. Braver souls can also read Kanski’s Clinical Ophthalmology: A Systematic Approach; however, I used it to cover topics I didn’t understand properly. I would not recommend starting with Kanski, as it is much too detailed and designed for the FRCOphth exit exam. 

Certain topics that may not be up to date in these books include global eye health. For this, I would review the eye care, vision care, vision impairment and blindness section in the World Health Organisation (WHO) website and the VISION 2020 website.

Question Banks

I would encourage candidates to get their hands on as many questions as possible to put their knowledge into practice. I have recommended some resources below.

  • The website is dated but has a section with free past questions, mainly in a true-false format that helps test knowledge.  
  • Eyedocs has an excellent online question bank of over a thousand questions. 
  • 180 MCQs for the Duke-Elder Examination is a great resource, which replicates the difficulty of the exam. 


Furthermore, although I’m not a fan of paying for courses, attending one for this exam is a good idea, given that many candidates have never been lectured on a lot of the content before. Topics such as optics and refraction can be difficult to learn from textbooks alone, and a course may simplify difficult concepts. I would highly recommend the Duke Elder Course run by Moorfields Eye Hospital. Lectures are given by students and junior doctors that have recently done this exam. To ensure the quality of these lectures, every lecture is supervised by an Ophthalmology trainee/consultant, and the course utilises interactive questions that keep it interesting for all participants. 


To summarise, the Duke Elder exam is challenging but can be very rewarding. If you’re struggling with time, read Lecture Notes Ophthalmology, do as many questions on Eyedocs as possible, and attend the Moorfields Course. However, I would encourage candidates to jump into the deep end and at least give it a go or even try again if you didn’t do so well the first time. The basic knowledge you learn will help in medical finals, and the more detailed content is relevant to those who want to pursue a career in Ophthalmology and will help you prepare for your first training post.

Information about the exam

Books for the exam

  • Lecture Notes Ophthalmology
  • The Duke Elder Exam of Ophthalmology: A Comprehensive Guide for Success
  • Additional Reading – Kanski’s Clinical Ophthalmology: A Systematic Approach

Question banks and books for the exam

Courses for the exam 

Written by Dr Vinay Badhwar (ST1 Ophthalmology) & reviewed by Mr Zain Juma (ST6 Ophthalmology)

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