How to prepare for the Duke Elder exam

Each of the 90 questions has one best answer from four. A correct answer scores one mark and a wrong one scores nothing, so a blank can only cost you: answer every question, and skip the slow ones to come back to at the end. There is no calculator, only one sheet of white paper and a pencil for working. You sit it online under a live proctor, from home or your workplace, and a week before the exam you are emailed a link to check your computer, camera and microphone: run it the day it arrives. Log on at the start time, because a candidate who is late has their exam cancelled.

Most of the questions are clinical, and the College says they cover every subspecialty, naming eight: cornea and external eye disease; cataract; glaucoma; medical retina and vitreoretinal surgery; strabismus and paediatric ophthalmology; neuro-ophthalmology; ocular adnexal and orbital disease; and refractive errors and optics. Work through them in turn, revising by presentation (the red eye, sudden visual loss, gradual visual loss) rather than by disease, and drill questions on each subspecialty while it is fresh.

The rest of the paper ranges wider than most undergraduate teaching: ocular anatomy, physiology and pharmacology, basic science, statistics, pathology, embryology, the genetics of eye conditions, optics including ray diagrams, and socio-economic topics such as blind registration and world blindness. In a ranked exam, every topic you skip is marks for everyone else. Draw ray diagrams rather than memorising answers: a pencil is all you will have on the day.

Start with the three example questions in the College's candidate information pack, to see how its questions are written. Neither the pack nor the College's Duke Elder page offers past papers, so the rest of your practice is exam-style questions: work them by topic while you cover the syllabus, then switch to timed, mixed blocks of 90 questions in two hours in the final weeks. Review every question you get wrong, including why each wrong option was wrong.