Adam Hatoum
Introduction
The Duke Elder Examination is an annual prize examination run by the Royal College of Ophthalmologists, targeted to undergraduate medical students with a special interest in Ophthalmology. It is a prestigious award, one of only two Ophthalmology awards which can only be achieved as an undergraduate: The Duke Elder exam, and The Patrick Trever-Roper Undergraduate Travel Award.
It is a great opportunity for medical students to add valuable points to their portfolio, while simultaneously expanding their knowledge in an area not well covered in most undergraduate curriculums. The prizes for the exam are set out in the table below.
| Ranking | Prize |
|---|---|
| Top Candidate | £400 or Visit to St John’s Eye Hospital, Jerusalem |
| Top 20 candidates | Signed letter of commendation from the President of the Royal College of Ophthalmologists |
| Top 10% candidates | 2 points on ST1 portfolio |
| Top 60% candidates | 1 point on ST1 portfolio |
Given the competitive nature of ST1 Ophthalmology applications, it is a great idea to try and achieve as many points as possible as a medical student.
The exam draws hundreds of applicants each year but don’t be alarmed, setting aside the time to revise properly for it can give you an advantage over those who don’t take it as seriously, increasing your chances of achieving highly.
Revision Strategy
I would recommend setting aside at least a few months to revise for the exam. It’s important to keep in mind that you will still have all your other undergraduate commitments alongside this exam, so planning ahead means you will be able to tackle topics at a steady pace, as well as allowing you to practice spaced-repetition to solidify any learning.
For my general revision strategy, I used textbooks as a starting point to make notes on the topics outlined by the Royal College for the exam. These are 1) Cornea and external eye disease, 2) Cataract, 3) Glaucoma, 4) Medical retina and vitreo-retinal surgery, 5) Strabismus and paediatric ophthalmology, 6) Neuro-ophthalmology, 7) Ocular adnexal and orbital disease, 8)Refractive errors and optics.
The Royal College has an exhaustive list of textbooks it recommends (listed below). In my experience in revising for the exam, I found some of these books a bit too intense for beginner reading, however others served as good references for topics I did not understand from reading elsewhere. It will be up to you to decide which you find most helpful.
I personally used Lecture notes in Ophthalmology, which is an easy front-to-back read, and I found a great starting point for all, describing a wide range of conditions. It is also full of images and diagrams, making the information easily digestible and suitable for visual learners too. When it comes to learning things in more detail, I would recommend Kanski’s Clinical Ophthalmology: A Systematic Approach.
EyeWiki, a free online encyclopaedia written by qualified Ophthalmologists, was also crucial to my revision. It serves as a quick, easy-access resource where you can look up conditions you haven’t heard of that you may pick up in questions/textbooks/teaching. It breaks down ophthalmological pathologies into the important details e.g. Etiology, Diagnosis, Management, and Complications.
Textbooks
RCOphth recommended reading outlined in the Duke Elder information pack:
- The Eye: Basic Sciences and Practice. Forrester JV, Dick AD, McMenamin P, Roberts F. WB Saunders, Elsevier. 2007 ISBN-10: 070202841X ISBN-13: 978- 0702028410
- MCQ companion to the Eye. Basic Sciences in Practice. Galloway PH, Forrester JV, Dick AD, Lee WR. WB Saunders 2001. ISBN-10: 0702025666 | ISBN-13: 978-0702025662
- Clinical Optics. Elkington AR, Frank HJ and Greaney MJ. John Wiley & Sons, Blackwell Science, 1999. . ISBN: 0632049898/9780632049899
- Clinical Anatomy of the Eye. Snell RS, Lemp MA. Blackwell Scientific Publications 1998. ISBN: 063204344X
- Clinical Ophthalmology: A Systematic Approach. JJ Kanski, B Bowling. Butterworth-Heinemann, Elsevier, 2011. ISBN-10: 0702040932 ISBN-13: 978- 0702040931.
- Clinical Ophthalmology: A Self-Assessment Companion. JJ Kanski, Agnes Kubicka Trzaska. Elsevier, 2007. ISBN-10: 0750675381, ISBN-13: 978- 0750675383
- EMQs And MCQs For The FRCOphth Part 2 [Paperback] Patrick Chiam. Lulu Marketplace, 2011. ISBN 9781447806615
Practice Questions
The next important resource for your revision is online question banks. There are a number of these available to you, however they do come at a cost. The best resource I found was from EyeDocs, who have a dedicated Duke Elder exam question bank, with a 6 month subscription accessible for £60. There are 1000 questions available, so more than enough to get through. They also have a selection of free questions which you can try before you buy!
Recently, a number of MCQ text-books have also been published which again are a useful resource to practise. The best one I found which helped me was ‘180 MCQs for the Duke Elder Exam’.
I would recommend doing the bulk of your revision before tackling questions. Furthermore, I made sure to save enough questions to allow myself to replicate a mock run-through of the exam under exam conditions. This will help to build up your stamina in answering plenty of challenging questions in the time frame allowed.
Courses
Finally, we come to courses, which may have been the single most helpful resource in my revision for the exam. There are a number of courses which you can attend, most notable to ‘Duke Elder Preparation Course’ run by Moorfields Eye Hospital. This course consists of several talks, divided broadly into the topic outlined by the Royal College in the information pack.
The talks in this course are given by former students who have scored highly in the exam, so as well as teaching the content, they can share their insight into how they performed well. Each talk is supervised by a consultant Ophthalmologist so the quality of the talks is truly excellent. It should be noted that this course is paid, however in my opinion I feel it really was worth the money.
Nevertheless, there are a number of free teaching sessions you can access too. One good thing that COVID brought us was the rise of online teaching sessions. During my time at University, we created a Duke Elder preparation course, very similar to that run by Moorfields, which was free for all and taught over Zoom. It was attended by hundreds of students from medical schools all over the UK. I would highly encourage you to join the facebook groups of University Ophthalmology societies, as they will often host teaching sessions which are also run by previous high-performing students in the Duke Elder.
Exam Strategy
The exam is structured as a single 2-hour paper, with 90 Single Best Answer-style questions. There is no negative marking, so ensure you attempt every single question. If you’ve never sat the exam before, it is important to know that it is not like your traditional pass/fail examinations that you will sit at medical school. The exams you sit at medical school are designed to have a range of questions of varying difficulty: some that every competent medical student should know the answer to, and other more difficult questions that only those who have done a higher level of reading will know.
The Duke Elder, on the other hand, is a prize examination. This means it is not designed to test your competency, but rather to award those who have gone above and beyond. As such, the questions can be quite daunting and difficult to approach.
The approach which worked for me was using a process of elimination. Through the course of your revision, you will cover a lot, but given that the range of questions is so broad, you will likely not cover it all. So in each question, try to use the knowledge you do have to eliminate answers you KNOW cannot be correct.
You will end up guessing a lot of the questions, but this way you may be able to narrow your options to give yourself a 50% of being correct, rather than 25%, and this will make a huge difference in your overall score.
Final Words
The exam is very difficult, but given that you have taken the time to read this article, you are likely committed to doing well. With the right preparation, there is no reason you cannot perform highly and get into that top 10%!
The deadline for applications this year is Monday 12th December. More information on this year’s exam can be found on the RCOphth website.
Good luck!