The Duke Elder Exam: what it is, and what it is worth

What the Duke Elder exam actually is

The Duke Elder Undergraduate Prize Examination is run by the Royal College of Ophthalmologists and is open to medical students worldwide. It is a prize exam rather than a qualification: nothing depends on passing it, and there is no pass mark to clear.

It is a single paper of 90 multiple-choice questions, sat over two hours, delivered online under live remote invigilation. Candidates in the top 10% receive a special commendation from the President of the College, and sitting it makes you eligible to apply for associate membership.

Source: Duke Elder Undergraduate Prize Examination — The Royal College of Ophthalmologists

Why candidates sit it

It scores on the Ophthalmology ST1 self-assessment, which is the part of the application you can influence years ahead of applying.

Because it is open only to undergraduates, it is also one of the few portfolio items with a hard deadline attached to your career stage rather than to the application cycle. Miss it as a student and it is gone.

How it scores on the ST1 application

Duke Elder is scored in the Prizes and Awards domain of the self-assessment, which names it as its example of a national undergraduate prize through competitive examination. It does not score under Specialty Links and Commitment: that domain's discretionary items exclude sitting the Duke Elder.

What counts is where you place among the entrants, not your raw mark. Each placing is worth these points on your portfolio:

• First place: 3 points
• Top 10%: 2 points
• Top 20%: 1 point

Source: Self-assessment and supporting evidence (NHS England)

What that means in practice

A placing outside the top 20% scores nothing. Moving from the top 20% to the top 10% adds 1 point to your portfolio, and moving from the top 10% to first place adds 1 point. These are points on a portfolio scored out of 50, not marks in the exam.

Sit it if you want to and you are very confident that Ophthalmology is the specialty for you. Preparing is a lot of work: Ophthalmology is barely covered at medical school, and doing well means going beyond the undergraduate curriculum.

Not sitting it is fine. There are plenty of other ways to improve your portfolio, and an Ophthalmology elective or undergraduate project scores while you are still at medical school.

Source: About PrepDukeElder

How to prepare

The exam assesses Ophthalmology knowledge at undergraduate level, and the format rewards breadth over depth: 90 questions in 120 minutes is well under a minute and a half each, so recall matters more than reasoning your way to an answer.