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Public Mindful Language Guide Now Available

October 4, 2023

In April 2023, the NBOME announced the development of a new Mindful Language Guide. The guide is meant to assist National Faculty members in considering diversity, equity, and inclusion (DEI) into NBOME assessments when writing or editing test questions.

View it here.

Since then, we have received unprecedented interest in a public version, which we are happy to share here. By sharing this document publicly, the NBOME aims to showcase its efforts to create test questions that are inclusive and free of bias, and to offer guidance to those who wish to do the same.

Diversity, equity, and inclusion is a core value of the NBOME, and is integrated throughout the COMLEX-USA Master Blueprint and COMAT learner-centered objectives. In addition to creating the Mindful Language Guide, the NBOME has committed to ensuring bias-free language in item content by taking the following steps:


  1. Conducting test question sensitivity reviews with National Faculty members
  2. Ensuring the use of person-first language and bias-free content in exam questions via training for item writers and reviewers
  3. Reviewing test questions to eliminate testing race-based medicine protocols
  4. Promoting diversity of skin tones in multimedia exhibits
  5. Reviewing candidate comments related to bias to ensure scoring validity of test questions
  6. Consulting with subject matter experts for an extensive review of external resources for best practices


This is an ongoing initiative. As language evolves, our guidance on its usage will also evolve.

Feedback from COMLEX-USA and COMAT test-takers on each question has been of particular help when creating this guide. Therefore, we encourage test-takers to continue submitting comments if they perceive an item to be biased for further investigation.

Feedback on this handout is welcome at editors@nbome.org.

About the NBOME:
The NBOME is an independent, non-governmental, nonprofit assessment organization committed to protecting the public by providing the means to assess competencies for osteopathic medicine and related health care professions. NBOME’s COMLEX-USA examination series is a requirement for graduation from colleges of osteopathic medicine and provides the pathway to licensure for osteopathic physicians in the United States and numerous international jurisdictions.

Renee Cree, MA
Director for Communications