Mihai Bica

Introduction

The Royal College of Ophthalmologists annually organizes the Duke-Elder Undergraduate Prize examination, which is open for entry to all undergraduate medical students. It serves as an initial step for medical students to gain a better understanding of the field of ophthalmology. Furthermore, it contributes to enhancing one’s portfolio, increasing the likelihood of securing a competitive ophthalmology training number, which, in recent years, has seen a fierce competition ratio of 10:1.

Why Should You Consider Sitting the Duke-Elder Examination?

1. Entry to Ophthalmology Specialty Training: The Royal College currently awards 2 points for ranking in the top 10% of entrants and 0.5 points for being in the top 60%. These points are invaluable when applying for an ophthalmology training number, as even a fraction of a point can significantly impact your chances.
2. Career Exploration: If you are uncertain about pursuing a career in ophthalmology, the Duke-Elder examination provides an opportunity to delve into additional reading and assess your interest in the theoretical aspects of this field. Ophthalmology is often underrepresented in medical school curricula, leaving students with limited exposure, making it challenging to determine genuine interest.

Personal Experience

As a fifth-year medical student, I first took the Duke-Elder examination in 2017, achieving a top 10% ranking in the first attempt. The following year, with increased diligence and preparation, I secured the first place, resulting in an opportunity to visit St. John’s Eye Hospital in Jerusalem. Since then, I have shared my experiences and insights by delivering lectures at various medical schools throughout the UK. This article aims to provide guidance for those aspiring to succeed in this challenging examination.

Preparation Challenges

One of the major challenges posed by the Duke-Elder examination is the substantial additional study requirement beyond regular medical school examinations. The provided curriculum, though comprehensive, is quite extensive, and students often find it overwhelming.

Official Reading List

The official candidate information pack offers a recommended reading list, including notable texts like “The Eye: Basic Sciences and Practice” by Forrester et al., “MCQ Companion to the Eye” by Galloway et al., “Clinical Optics” by Elkington et al., and others. Reading all these texts would provide enough preparation to sit through the entire FRCOphth examinations, exceeding the requirements of an exam designed for medical students, and thus can be an overwhelming and excessive endeavor.

How to get top 10%

For those aiming for a top 10% position, I recommend “Lecture Notes: Ophthalmology” by Bruce James. This book strikes a balance between basic science and common clinical conditions encountered in the examination. It offers clear explanations, relevant diagrams, and addresses the ophthalmic manifestations of systemic conditions emphasized in the examination. This book is suitable for those new to ophthalmology or those striving for a top 10% ranking.

How to win the Duke Elder

To secure a top spot, more comprehensive preparation is essential, as the examination covers a broad curriculum. Preparation strategies may vary among individuals due to the diversity of topics. The examination can be viewed as a test of one’s dedication to ophthalmology. Therefore, extensive reading, active involvement in clinics, organizing student-selected components and electives can provide valuable exposure that aids in answering examination questions.

For my second sitting, when I won the competition, I employed the following methods:

1. Comprehensive Reading: I used “Training in Ophthalmology” by Matthew Gardiner, specific chapters of “Basic Sciences in Ophthalmology” by Louise Bye (e.g. anatomy), and tackled some questions from FRCOphth Part I (400 SBAs and CRQs) by Nikki Hall. I compiled my own notes and reinforced memory through active repetition.
2. Question Banks: Utilizing question banks, such as Eyedocs- which has 1000 questions (and explanations) is very relevant. I went through them multiple times. You should probably aim to be first in their online leaderboard.  The Chua website (mrcophth.com) also offers Duke-Elder questions.
3. Preparation Courses: Many medical schools and societies offer preparation courses, and I attended a few. These courses highlight common themes in questions and insights that are beneficial. Consider organizing local teaching sessions within your medical school or ophthalmology society, featuring registrars and consultants as lecturers.
4. Gaining Experience: By the time of my second attempt, I had organized my student-selected component and elective in ophthalmology, which significantly enhanced my exposure to relevant areas for the examination.

Ending remarks

In conclusion, the Duke-Elder Undergraduate Examination is challenging but attainable. A top 10% position can be achieved with relatively moderate preparation, while securing the first place demands more commitment and extensive engagement with ophthalmology as a potential career. With diligent preparation and a stroke of luck, obtaining the top spot is within reach.