Duke Elder: The Complete Guide

Duke Elder samples the whole of ophthalmology at undergraduate level, weighted toward clinical ophthalmology but also covering optics, basic sciences, pathology, genetics and public health. It is open to medical students worldwide and is often used to strengthen an application to ophthalmology specialty training. Because it rewards broad recall and clear reasoning rather than clinical experience, it is very learnable with structured, syllabus-mapped question practice.

Question format

A single paper of 90 single best answer multiple-choice questions, each with one correct option from four. There is no clinical or practical component.

Duration

Two hours.

Delivery

Sat online under live remote proctoring, from home or another quiet location, with an ID check and camera monitoring. There is no test centre.

Marking

Number-right marking with no negative marking: one mark for a correct answer and nothing deducted for a wrong one.

These topic areas are grouped for revision and reflect the whole-of-ophthalmology scope the Duke Elder exam samples at undergraduate level.

Scoring

It is not pass or fail. Every candidate is ranked, and receives their percentage score and their position in bands of 10 percent.

Prizes

The highest-scoring candidate is offered a visit to St John Eye Hospital in Jerusalem, or a £400 cash prize instead, and there is no second prize. Candidates in the top 10 percent receive a special commendation from the President of the RCOphth.

Who can sit it

Medical students worldwide who have not yet graduated. It is aimed at students who have completed their ophthalmology teaching, but any medical undergraduate may enter, and you may sit it more than once if you have not previously won.

Applying

You apply through your medical school's Duke Elder organiser, not individually. For 2026, names had to reach the organiser by 4 May and the fee was due by 3 July.

Sitting

In 2026 the exam is on Wednesday 9 September, with results on 2 October. It is held once a year; confirm future dates on the RCOphth examinations calendar.

Fee

£65 for 2026. Check the current fee with your medical school before applying.

Start early and revise by topic, not at random. Begin with a diagnostic to find your weakest areas, cover the whole syllabus systematically, then drill exam-style questions and consolidate the topics you score lowest on. Little-and-often beats occasional marathons, and active recall beats re-reading. Because Duke Elder is a ranked exam, the aim is to know the common topics cold and to convert the harder ones into marks.

Follow the full Duke Elder study plan.

Pair a concise clinical ophthalmology text with focused optics and basic-science revision, and make active question practice the backbone of your preparation. Practising recall under timed conditions is what lifts your score. AuroPrep is the practice component: syllabus-mapped SBAs with referenced explanations and a grounded AI tutor.

Make active recall the backbone with a Duke Elder question bank.

• Starting too late. Duke Elder rewards steady, spread-out practice, so begin well before the sitting.
• Neglecting optics and basic sciences because they feel dry. They are predictable marks once you drill them.
• Reading passively instead of testing yourself. Active recall with questions is far more efficient.
• Ignoring public health and statistics. They appear on the paper and are quick to learn.
• Reviewing only the correct answer. Work out why each distractor was wrong so the reasoning sticks.

Reading gets you only so far. The fastest way to lift your Duke Elder mark is to practise Duke Elder SBAs with explanations under exam conditions, then review every mistake until the principle sticks.