This week, preparing a January course, I viewed 5000 test items: stems and responses. I adjusted the points so that all 56 quizzes added up to 100 points.
When possible, I made everything gender-neutral. I tried to remove all culture and gender bias. I updated the language to reflect current philosophy, example: "the nurse collaborated with the physician", instead of "reported to". The girls are no longer shy. The 16-year old male drug addict is now a teen who used a recreational substance. Patients are people. Nurses don't "check", "notice", or "mention"; they "assess" and "instruct". Yes, 5000. Took me over 30 hours, which I did in about 4 days.
Now on to the next exciting task for Spring 2019: updating quizzes in a different class.
And some fun: instructional videos.