20 years of GPnotebook: from a medical student project to a national resource

WHAT ARE THE ORIGINS OF GPNOTEBOOK?

The original idea for the database began in the canteen of John Radcliffe Hospital in 1990 while James McMorran, a first year Oxford University clinical student, was writing up his medical notes. Instead of writing notes in longhand he wrote his notes in ‘mind maps’ of packets of information linking different concepts and conditions in a two-dimensional representation of clinical knowledge. James discussed with Stewart McMorran (then a medical student at Cambridge University and a talented computer programmer) this way of representing medical knowledge and between them they created the authoring software to produce linking ‘packets’ of information in a database. This first authoring software and database was the origin of what today is GPnotebook. It was, in effect, a ‘Wiki’ over 16 years before the first ‘Wiki’!

Initially James used the authoring software alone to capture his own clinical learning. There was interest from other medical students at Oxford and in the end a team of six authors (mainly Oxford medical students) became the founding (and continuing) principal authors for GPnotebook. Among them was Damian Crowther who, in time, took over the role of technical lead for the site. James takes the role of editorial lead for the website. Damian developed the software for the web version of the database which was released on the worldwide web in 2001 as GPnotebook.

There were many false starts from 1991 until 2001 but the authoring team had continued to update the database as a shared resource for a group of friends. The creation of the GPnotebook website in 2001 changed the database from a shared resource for a group of like-minded medics to a resource used by thousands of doctors from the UK and all over the world each day.

HOW IS GPNOTEBOOK NOW BEING USED?

GPnotebook is regularly used by doctors, particularly GPs in the UK. Access to GPnotebook is free and unrestricted to medical students (via validation of their University email address) and doctors and medical students in developing countries (validation via Facebook). During the 12 months until June 2013, 11.5 million unique users accessed pages on GPnotebook. Of those who logged into personal accounts, 30 621 users were GMC accredited clinicians working in the UK and of these, 18 719 GMC accredited doctors using the site described themselves as GPs.

There were 6.4 million pages accessed by GMC accredited clinicians during this period while they were logged in, of which 4.0 million pages were read by the GMC accredited users who described themselves as UK GPs. Many doctors take advantage of the four free pages per day and so the actual readership by UK GPs is substantially higher. Data concerning users can be derived for all and show we have a mix of two groups of users. One group visits rarely and reads a few open access pages, while the other group are predominantly UK clinicians who visit repeatedly and read more pages.

INFORMATION ACCESSED

GPnotebook is a very ‘broad’ knowledge resource with over 27 000 index terms providing access to more than 2 million words of information. Users may be considered generalists and so analysis of the terms that they enter into the search box may be considered representative of the information needs of the national clinical population.

We have recorded the content of search phrases that have been entered by users of GPnotebook. Table 1 shows the top 10 search phrases, in fact the most common search terms are single words as indicated.

A user may be searching on just the stated term or a combination term that contains the stated term: if we consider this with respect to the term ‘hypertension’ then there are many combination terms containing the term hypertension; for example, systemic hypertension, hypertension and stroke, hypertension and lipids, and pulmonary hypertension. In fact there are 195 different pages in GPnotebook that have hypertension in the title.

If we then consider which pages are subsequently most frequently accessed then the top four are:

• exclusion from school (guidance re: common infections), n = 61 412

• migraine (main page), n = 34 108

• systemic hypertension (main page), n = 35 173

• gout (main page), n = 31 052

The exclusion from school guidance page has been accessed more than 60 000 times by logged in GP users of GPnotebook since the tracker facility became available in 2005.

CONCLUSION

Having started as a project to help a group of medical students cope with the information overload of clinical school, GPnotebook has evolved over the past 20 years to become a national, and international, resource.