Clarity: Anchoring on a Shared Sense of Purpose

As we reflect on the past year and look ahead to the opportunities before us, one thing stands out with renewed confidence. At a time when the world is marked by significant change and uncertainty, clarity can be one of our greatest strengths.

Clarity of vision, purpose, and communication can be an antidote for uncertainty, It enables us to move forward with optimism, resilience, and momentum. It gives our NBOME Board of Directors, our National Faculty, our staff, as well as all NBOME’s stakeholders, the confidence to embrace new opportunities and move forward with confidence.

True and lasting clarity begins with understanding who you are, and anchoring on a shared sense of purpose—why we do what we do. For the NBOME, our shared purpose is to protect the patients and communities who trust us to develop and deliver high-quality assessments of the competencies that impact their health care.

Our 2025 Annual Report reflects this belief. It has been thoughtfully designed to present our collective accomplishments, insights, and priorities in a clear, engaging, and accessible way. Each section—from Board and National Faculty achievements and assessment program highlights to strategic initiatives and major decisions to financial performance and community impact—demonstrates not only what progress we have made, but how clarity helped us turn goals into measurable outcomes that are meaningful to this purpose – for our patients.

This year’s report highlights several key areas:

• The NBOME Board of Directors and National Faculty leaders and honorees
• Major Enhancements for COMLEX-USA and COMAT as well as other NBOME assessments
• The Core Competency Capstone for DOs (C3DO) assessment of osteopathic clinical skills
• Advancements in Leveraging Technologies, including AI
• Fundamental Osteopathic Medical Competency Domains 2026
• Research Initiatives, Financial Stewardship, and Community Impact
• Collaboration, Partnerships, and Client Assessment Programs

Also throughout 2025, the NBOME gathered input from all of our key stakeholder groups to help build a new strategic plan for 2026-2029, and we will be excited to share this when it is approved by April 2026.

As you explore this report, we hope you share in the clarity and feel the same sense of optimism and confidence that inspires our work every day. With clarity as our foundation, we are well positioned to navigate change, transform disruption into opportunities, and reach even greater heights together. Making a difference for our patients.

Thank you for your continued trust and support throughout 2025 and together, let’s make 2026 our best year yet.

Sincerely,

David Kuo, DO
Board Chair

John R. Gimpel, DO, MEd
President and Chief Executive Officer

Two new members were elected to the NBOME Board in December 2025: Joyce A. Brown, DO, and J. Michael Wieting, DO, MEd. The NBOME also honored board members who had completed their final terms: Mousumi Som, DO, MS, and Donald H. Polk, DO. 

Richard J. LaBaere II, DO, MPH, also completed his service on the NBOME Board, having served as Chair in 2021-2023 and completed his role as immediate past chair in December 2025.

2025 Board Demographics

The John E. Thornburg, DO, PhD, National Faculty Leadership Award

The Thornburg Award is bestowed periodically to National Faculty leadership members who have distinguished themselves by their longstanding contributions to examination development, committee work, or related activities. The NBOME granted Robert J. Theobald Jr., PhD, the John E. Thornburg, DO, PhD, National Faculty Leadership Award at the June Board of Directors meeting.

Theobald began writing test items for the NBOME in the early 1990s and has written numerous test items focused on pharmacology and physiology subjects for COMLEX-USA and the COMAT Foundational Biomedical Sciences (FBS) examination. 

Theobald was part of the original COMAT Foundational Biomedical Sciences Task Force. This work resulted in the establishment of the highly successful COMAT FBS and FBS Targeted examinations. He stood out in his leadership role and went on to serve as the FBS Department Chair, a role he held from 2020-2025.

In addition, he was the COMAT Discipline Lead – Pharmacology from 2017-2019 and has served on numerous other committees and task forces for the NBOME, including the COMLEX-USA Composite Examination Committee, the COMLEX-USA Blueprint Subcommittee, and the Task Force on Numeric Scores.  

Theobald is also a mentor to new basic science National Faculty members, assisting them in writing test questions that marry scientific understanding with clinical application. 

The NBOME Clark Award for Patient Advocacy

This award recognizes individuals who have demonstrated an outstanding commitment to patient safety, patient protection, and quality of care, specifically in their advocacy for osteopathic distinctive assessment for licensure. The NBOME Board honored Donald H. Polk, DO, with the NBOME Clark Award for Patient Advocacy at its December gala.

His longstanding public service on the Tennessee Board of Osteopathic Examination (1996-2016) positioned him for leadership roles at the Federation of State Medical Boards (FSMB) and with the American Association of Osteopathic Examiners (now called the American Society of Osteopathic Medical Regulators). 

Polk has had frequent opportunities to advocate at the national level for the importance of osteopathically distinctive assessment for licensure. In 2014, Polk was elected the Chair of the FSMB Board of Directors, only the third DO to serve in that role in over 100 years since FSMB was founded.

The NBOME honored Peter B. Ajluni, DO, with the Santucci Award at its Board of Directors meeting in June. Ajluni is an orthopedic surgeon and Fellow of the Osteopathic Colleges of Orthopedics and Surgery. He served on the NBOME Board of Directors from 2013-2023 and in pivotal leadership roles, including on the Executive Committee, the Compensation Subcommittee (Chair) and the Nominating (Chair), Finance, and Audit (Chair) committees.

The NBOME awarded Richard J. LaBaere II, DO, MPH with the Santucci Award as its annual Board of Directors Gala in December. LaBaere is the immediate past Chair of the NBOME Board of Directors and was first elected in 2010. He has served as chair of the NBOME’s Special Commission on Osteopathic Medical Licensure Assessment (2020-2022), and previously as a member of the NBOME’s Blue-Ribbon Panel on Enhancing COMLEX-USA (2010-2016). 

His leadership as Board Vice-Chair from 2019-2021 and as Chair from 2021-2023 during the very challenging circumstances brought on by the COVID-19 pandemic emergency proved to be pivotal in the organization’s remarkable agility and responsiveness to its many stakeholders. 

National Faculty

The National Faculty is critical to upholding the NBOME’s mission of protecting the public. These thought leaders have expertise in the practice of osteopathic medicine, a diverse array of specialties and disciplines, osteopathic medical education and assessment, and osteopathic physician licensure and regulation. Balancing their own practice and professional activities, this esteemed group of volunteers commits their time to serving the osteopathic profession and impacting teaching, learning assessment, and quality care around the globe.

Membership Growth

The NBOME welcomed new members of the National Faculty, bringing the total number to 1,033. Of those, several were honored with 2025 Exam Contributor Awards.

NBOME Launches

Fundamental Osteopathic Medical Competency Domains 2026

2025 marked the end of a two-year, highly collaborative process to update the Fundamental Osteopathic Medical Competency Domains 2026: Guidelines for Assessment for Osteopathic Medical Licensure and the Distinctive Practice of Osteopathic Medicine (FOMCD 2026). An evidence-based design led by the NBOME and its more than 1000-member National Faculty, FOMCD 2026 will continue to inform the COMLEX-USA Blueprint and other NBOME assessments.

Osteopathic principles and practices (OPP) are explicitly integrated across all seven competency domains, highlighting the interrelationship of OPP with each domain and attention to the impact that the osteopathically distinctive focus has on the care patients receive from osteopathic physicians. 

FOMCD 2026 introduces several significant enhancements designed to better align the COMLEX-USA examination series with both patient needs and the evolving practice of osteopathic medicine. Quite notably, FOMCD 2026 renames the Competency Domain on Professionalism to “Professionalism and Compassion in the Practice of Osteopathic Medicine,” and better articulated impact of spirituality as relevant to whole-person osteopathic care. 

FOMCD 2026 features an increased focus on social determinants of health and health systems science and on nutrition and diet in patient care and prevention, as well as an elaboration on skills related to clinical skills, digital health, telehealth, and augmented intelligence.Enhancements to the FOMCD 2026 were led by the COMLEX Blueprint Subcommittee and its chair, Wayne R. Carlsen, DO, as well as the COMLEX-USA Composite Committee and its chair, David Kuo, DO. Evidence-based building on FOMCD 2016 included further practice analysis, a comprehensive literature review, and input and expert consensus from across our National Faculty, from osteopathic medical educators and learners at all levels of undergraduate and graduate medical education, experts in osteopathic physician licensure and accreditation, a broad specialty mix of physicians active in diverse clinical practice settings, and public members representing the voice of our patients. 

COMLEX-USA Administrations

COMLEX-USA examinations continue to be administered at Pearson VUE test centers, and test-taker satisfaction remains high.

Candidate Satisfaction with COMLEX-USA

COMLEX-USA Exam Performance

COMSAE is a three-phase self-assessment series used by osteopathic medical students and residents to gain practice with COMLEX-style test questions and format and to gauge their knowledge base in advance of taking each level of the COMLEX-USA examination series. Each COMSAE Phase is presented in a format and structure that aligns with the corresponding Level of COMLEX-USA.

In April, the NBOME introduced COMSAE COM forms on a secure browser for Phases 1 and 2 for COMs who are using these to guide student readiness evaluation. There are three forms for each Phase to use with COM proctoring. In response to requests from COMs who cannot provide proctoring support to remote test takers, there is one form available for each Phase that remains on a nonsecure browser. 

COMSAE Administrations

COMVEX is an assessment of for osteopathic physicians who hold or have held a valid license to re-enter the practice of osteopathic medicine in the United States or where an assessment of an osteopathic physician’s current medical knowledge is otherwise requested by a state medical or osteopathic medical licensing board.

The purpose of COMVEX is to assist state licensing boards by providing an evaluation examination for candidates required or sponsored by a state licensing board to demonstrate current osteopathic medical knowledge and related competencies under standardized conditions.  

This year, the NBOME worked with the state licensing boards in California, Florida, Illinois, Pennsylvania, and West Virginia to provide COMVEX examinations for physicians seeking reentry licensure in their state.

COMAT is a series of nationally standardized subject exams designed to assess osteopathic medical students’ knowledge in core foundational biomedical and osteopathic clinical sciences principles. 

The number of COMAT administrations has increased over previous cycles; Clinical Subject administrations exceeded testing volume in previous years in seven of the eight subjects, and the number of Foundational Biomedical Science Comprehensive (FBS-C) examinations administered increased by nearly 13 percent. 

COMAT Foundational Biomedical Sciences

COMAT New Enhancements

2025 also brought exciting new enhancements to the COMAT program.

• The COMAT Foundational Biomedical Sciences – Comprehensive (FBS-C) Score Report was updated in 2025 to include predictive data for passing COMLEX-USA Level 1 to help schools identify students who may benefit from targeted academic support or intervention.
• The COMAT Expansion Task Force was formed in 2025 to develop criteria and standardize the process for introducing new COMAT subjects, to meet the growing demand among COMs for additional subjects. 
• Through 2025, the NBOME continued offering COMAT-FBS examinations to non-DO graduate students at no cost. This offer will continue through June 30, 2026. Non-DO students include those studying biomedical sciences, podiatric medicine, physician assistant studies, dentistry, or optometry. As of December 31, 2025, 466 COMAT-FBS examinations were administered to non-DO students. 

COMAT-SE

COMAT Self Evaluation (COMAT-SE) is a learning assessment tool for osteopathic medical students to reinforce their medical knowledge and determine any areas needed for additional study in a particular discipline. In 2025, the NBOME launched four new COMAT-SE subjects student forms: Emergency Medicine, Obstetrics and Gynecology, Psychiatry, and Surgery. These join Family Medicine, Osteopathic Principles and Practice, Internal Medicine, and Pediatrics.

By the end of year, there were a total of 5,540 COMAT-SE examinations purchased. Overall feedback of COMAT-SE among students has been positive, noting that the forms are “good preparation material for COMAT” and that “The CATALYST platform (which hosts COMAT-SE and WelCOM examinations) was easy to navigate.”

In spring 2025, the NBOME completed Phase 2 of the Core Competency Capstone for DOs (C3DO), including the final meeting of the C3DO Task Force and compilation of a report to inform the Board of Directors’ decision regarding next steps in clinical skills competency assessment for osteopathic medical licensure. 

Spring 2025 also saw the beginning of Phase 3, with an increase to 10 COMs across 12 campuses; enhancements to case development and to training and administrative protocols; introduction of a provisional standard, provided by the Task Force, to assist participating COMs in interpreting their student performance results; and rollout of automated data and video transfer systems for COMs that use the three most popular exam software platforms—an enhancement that on its own greatly increased the C3DO’s feasibility. 

At its June 2025 meeting, the NBOME Board of Directors decided next steps in clinical skills competency for osteopathic medical licensure. Starting with the graduating class of 2029, the NBOME will make new options available for assessment and verification of osteopathic clinical skills competencies as part of the eligibility requirements for COMLEX-USA Level 3. These will both require the demonstration that a candidate possesses fundamental osteopathic clinical skills competencies at the level expected for entering graduate medical education. The NBOME Board anticipates that the C3DO assessment will be the standard for Level 3 eligibility in the future.

In October, another four COMs, six campuses were accepted to join the C3DO in Phase 4 and the NBOME instituted a rolling application for COMs, allowing them to apply now for their choice of starting year, starting 2027 and beyond, assisting them—and the NBOME—with future planning. 

Almost 2,000 students from 10 schools across 12 campuses participated in Phase 3 of C3DO, and over 4,000 students have taken C3DO in total.

DO Student Feedback

COM Feedback

The NBOME established the NBOME Research Committee in 2025, which will play a pivotal role in advancing NBOME’s mission by driving innovation in assessment, upholding high standards for scientific rigor and ethical conduct, and fostering collaboration. 

The Committee encourages both internal and external researchers to pursue innovative projects in assessment, ensures alignment with the Board of Directors’ strategic priorities, and will oversee a restricted grant program—funded at approximately $100,000 annually—that prioritizes research on osteopathically distinctive assessments. Through these efforts, the Committee hopes to strengthen research quality in this area and cultivate meaningful partnerships within NBOME and with external collaborators.

Throughout 2025, researchers conducted presentations at more than 10 national and international conferences and meetings, including the International Association of Medical Regulatory Authorities, American Association of Colleges of Osteopathic Medicine Educating Leaders, American Educational Research Association/National Council on Measurement in Education meeting, and the National Residency Match Program Transition to Residency Conference, among others.

These presentations ranged in topic and scope and included clinical skills assessment, artificial intelligence and use in assessment, scoring, equating and scaling, test assembly, score reporting, and predictive validity studies. These presentations allow researchers to showcase ongoing projects, share operational updates and strategies, and receive feedback from attendees as manuscripts are prepared for submission and publication.

NBOME researchers published a total of six journal articles and white papers. Most notably, a paper published in the Journal of Surgical Education found strong correlations between performance on COMLEX-USA examinations and performance on the American Board of Surgery (ABS) In-Training Examination and the ABS Qualifying Examination for board certification.

Learn more about “The Use of COMLEX-USA Performance When Considering DO Applicants to General Surgery Residency Programs,” published in the Journal of Surgical Education with  Kristen Conrad-Schnetz, DO, vice chair of education, Digestive Disease Institute, at the Cleveland Clinic

Read the paper

The NBOME continues to carefully steward resources directed to its mission and to benefit our many stakeholders. Growth in candidate numbers across the NBOME’s largest assessment programs and careful expense management yielded good financial performance from operations for 2025. The operating gains were further supported by a conservatively invested equity and bond market portfolio.

Investing in Enhancements

The NBOME continued to invest in enhanced technologies with the goal of meeting our strategic priority of enhancing the test-taking experience for stakeholders. The investment into Phase 3 of the C3DO pilot in 2025 provided encouraging data in the pursuit of a COM-based national assessment of osteopathic clinical skills.

The NBOME has made considerable investments in the C3DO program, including grants to the participating institutions in Phase 3. Learn more about these COMs and Phase 3 in the “Test What Matters” section of this report.

Investing in the Profession

In 2025, the NBOME served as the diamond sponsor for the American Association of Colleges of Osteopathic Medicine Educating Leaders Annual Conference and as a sponsor of the Federation of State Medical Boards Annual Meeting, supporting continuous learning across the osteopathic medical and related healthcare professions. 

The NBOME also sponsored the A.T. Still Fit for Life Fun Run 2025, which supports the Advocates for the American Osteopathic Association, a non-profit aimed at championing osteopathic students, residents, physicians, and the osteopathic profession at large. The NBOME also contributed hundreds of hours toward faculty development programs, including item writing and editing and case development. Many of these coincided with onsite COM visits.

Investing in DO Students and Residents

The NBOME partnered with the Department of Veterans Affairs to ensure all levels of COMLEX-USA were approved for reimbursement under education and training benefits for veterans, such as the GI Bill. 

In addition, the NBOME continued its support of osteopathic medical students and resident scholarships through donations and support of the American Osteopathic Foundation. The NBOME Candidate Assistance Fund aided numerous COMLEX-USA candidates who experienced extraordinary financial hardships relating to taking their exams. The most common example was added expenses for weather-related COMLEX-USA cancellations.

Supporting State Licensure Assessment with COMLEX-USA and COMVEX Nationally Standardized Assessment

The NBOME continues to save state governments and taxpayers millions of dollars annually through its nationally trusted standardized licensure assessment program for the practice of osteopathic medicine. Without such an exam, considerable state funds would be required to replicate efforts for valid, reliable, defensible, and fair assessments of physician licensure. Through NBOME assessments such as COMLEX-USA and COMVEX, patients are assured that their osteopathic physician has met a national standard of competency to practice osteopathic medicine.

NBOME Learning Center

The NBOME Learning Center serves as a training hub for NBOME staff, National Faculty, medical professionals, and participating C3DO schools and colleges of osteopathic medicine. It hosts 40 training modules focusing on continuing medical education and osteopathic continuous certification offerings such as C3DO training courses, the item writing series of educational programs, and human resources and governance training for NBOME Board members and staff. A newly energized NBOME Learning Center is scheduled to go live in spring 2026.

Advancing Technology and Artificial Intelligence

Over the past year, NBOME has made significant strides in advancing its information technology (IT) and technology initiatives to strengthen operational reliability, security, and innovation.

A major focus was on the creation of the Artificial Intelligence Task Force (AITF) in December 2024, which convened throughout 2025 to establish AI policy guidelines, recommend best practices, and assess the responsible use of generative AI in assessment and education. The AITF addressed critical issues such as mitigating risks from misinformation and bias, outlining ethical and legal implications for AI, and advising on the integration of natural language processing in psychometrics and test development.

Infrastructure modernization was another key priority. The transition of NBOME’s on-premises Portal system to Amazon Web Services was completed in January 2026. This was the final phase of a comprehensive three-year cloud strategy. In addition to the cloud migration strategy, major internal infrastructure and cybersecurity improvements were implemented in 2025.

Technology is an increasingly important and mission-critical aspect of any organization’s operational and strategic plans. With the 2026 startup of a new project to build a replacement for the Portal, growing demands from the COMs and medical industry constituents for more automated access to NBOME student data, and continued development of C3DO into a production-scale product, these foundational improvements set the stage for linking technology goals to broader strategic planning, ensuring the organization remains a leader in serving the osteopathic profession and safeguarding public interests.

Wellness for NBOME Staff and Leadership

Wellness for the Community

The NBOME strengthened its social impact through charitable community engagement programs, including school supply drives and holiday gift drives. In addition, the NBOME hosted a successful Lee National Denim Day, raising funds for breast cancer awareness.

Wellness for Candidates and the Profession

Activities in 2025 included:

• “How do you celebrate small wins?”  social media campaign
• Spreading awareness of Suicide Prevention Month and World Suicide Prevention Day 
• Contributions to American Osteopathic Foundation scholarships  
• Supporting the Advocates for the American Osteopathic Association

Education and Advocacy

In 2025, the NBOME advanced its advocacy and educational mission through a series of impactful initiatives that reinforced its commitment to the osteopathic profession and the recognition of COMLEX-USA. Eleven specialties now publicly affirm the equivalence of COMLEX-USA and USMLE in holistic review, representing 91 percent of specialties for DO senior matches in 2025. NBOME collaborated with the Association for Academic Pathology to release a consensus statement discouraging residency and fellowship programs from requiring USMLE scores from DO applicants.

Notably, significant progress was made within surgery specialties; NBOME published research demonstrating strong correlations between COMLEX-USA performance and outcomes on surgery in-service and board examinations. This evidence has bolstered confidence in COMLEX-USA among surgery program directors.

Further, the Association of Program Directors in Surgery issued guidance encouraging program directors to accept COMLEX-USA scores and maintain transparency in applicant selection policies. In November, NBOME secured a formal statement of support from the American Osteopathic Academy of Orthopedics, affirming the equivalence of COMLEX-USA and USMLE for orthopedic residency and fellowship selection. Colorectal Surgery joined numerous other specialties in noting COMLEX-USA acceptance in their fellowship program applicant guidance.

Throughout the year, the NBOME engaged 355 residency and fellowship programs, with 120 programs formally confirming exam parity in their licensing requirements. The organization attended several conferences focused on graduate medical education to inform stakeholders about COMLEX-USA and collaborated with five national organizations involved in the transition to residency, advancing data sharing and policy initiatives that directly impact DO applicants.

In addition, the NBOME engages with stakeholders from state licensing boards, osteopathic medical schools, students and residents, graduate medical education leaders, and practicing physicians through its Liaison Committee. Convening annually, this group serves to share updates and information, and to better understand the needs and perceptions of these members for COMLEX-USA and related programs.

2025 Liaison Committee invitees represented the following organizations:

• American Association of Colleges of Osteopathic Medicine 
• Assembly of Osteopathic Graduate Medical Educators 
• Council of Osteopathic Student Government Presidents
• American Society of Osteopathic Medical Regulators 
• Accreditation Council for Graduate Medical Education
• American Medical Association
• American Osteopathic Association (AOA)
• AOA Bureau of Emerging Leaders
• Commission on Osteopathic College Accreditation
• Student Osteopathic Medical Association
• Council of Medical Specialty Societies – Organization of Program Director Associations
• Federation of State Medical Boards
• National Resident Matching Program

Collectively, these initiatives demonstrate NBOME’s leadership in providing education about its programs, advocating for the osteopathic medical profession, and promoting the equitable recognition for DO applicants and with their COMLEX-USA qualifications in the residency selection process. Through research, strategic partnerships, and outreach, NBOME continues to support the professional development and opportunities for osteopathic medical students and graduates.

Osteopathic Medical Students

The NBOME regularly works with student groups such as the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association to answer questions and gather important feedback on NBOME assessment tools and resources. NBOME leadership is invited to present to these groups multiple times throughout the year. Representatives from these groups serve on the NBOME Liaison Committee as well as on the Student Experience Panel.

Client Organizations

The NBOME partners with numerous osteopathic medical and related healthcare organizations to develop, administer, and manage assessments that ensure the competency of osteopathic physicians and other healthcare professionals.

NBOME provides a myriad services for our assessment partners in examination development, administration and psychometrics. Some activities include conducting standard settings, facilitating item and form development, and virtual examination administration, among others.