I find it amusing that you quickly dismissed conclusions from a previous study in this thread due to its limitations, yet make no mention of the paragraph filled with them in your own article. Could it be that your bias on the issue prevents you from being as critical when you agree with the idea? Or perhaps you have so little experience with academic literature that you were unaware that inclusion of such limitations is standard for discussion sections of this nature.
I criticized the conclusions of the Saha and Shipman for a number of reasons - the quote I included in my post alluded to the inadequacies and if you had read the entire 42 pages of the article (as I did), you would understand that the authors' double talk about their study's limitations were far removed from standard disclaimers.
1. their study was a selective ( as opposed to comprehensive) review of studies - eg. they arbitrarily refused to include studies before 1985 for subjective reasons that demonstrated their personal biases "we limited our review to studies published in or after 1985, since the social significance and meaning of race in particular has changed, and continues to change, over time. Studies published before 1985 often included data from a period when minority representation in the health professions was substantially lower and when racial attitudes were closer to those of the pre- Civil Rights era than they are today. "
2. Saha and Shipman even acknowledged ( as a footnote "of sorts" at the bottom of page 6) that there was inbuilt institutional bias that influenced their focus:
"* Our review was commissioned by BHPr, whose diversity programs target individuals from URM groups and socioeconomically disadvantaged backgrounds. As such, we conceptualize diversity from this perspective. It should be noted that other underserved populations are also underrepresented in the health care workforce (e.g. rural populations), and investigation into the role of enhanced diversity in these areas is also warranted. "
Just so you know, commissioned means paid for lock stock and barrel. One of BHPr's goals is to increase the numbers of URM's in health professions and to convince Congress of the need to increase funding of these programs. Coincidently in 2004 - 2 years before Saha and Shipman published their study - BHPr came under significant criticism for not doing enough in that regard.
http://www.nationalahec.org/MembersOnly/documents/Advocacy/ResponseToOMBAssessment.pdf
3. Saha and Shipman not only excluded studies done prior to 1985, but they also used questionable home-baked strategies so they could get answers they wanted. When they claim they may have missed some studies, that was a laughable understatement. They didn't test their hypotheses objectively. They looked at ways to prove their theories by excluding things and including others. Last paragraph of page 7 is revealing:
"Evidence Search. We developed strategies to search the existing literature addressing each of the four lines of evidence discussed above: service patterns, concordance, trust in health care, and professional advocacy. We searched the MEDLINE, HealthSTAR, and CINAHL databases using search terms available in each database. For the concordance hypothesis, we also searched the PsycINFO database, because we knew that many of the studies related to patient-practitioner concordance were conducted in the context of mental health counseling and published in journals not included in the other three databases. We supplemented these database searches in four ways. First, we conducted a “gray” literature search, for studies that may not have been published as journal articles but rather as monographs or book chapters. Second, we manually searched the reference lists of included studies and relevant review articles. Third, we searched selected Web sites for relevant references. Finally, we presented our initial results to several audiences including experts in health professions diversity and solicited their input on relevant evidence not yet included in our review.
4. The Appendix was a compilation of studies many of which used telephone surveys, patient self reporting, 1 study included didn't even have a description of the design or methods. It was embarressing to see what was included as "evidence."
What Meghani and Brooks et al did in contrast was an objective comprehensive survey of published research in 3 traditional databases over a lengthy time (1980-2008). They didn't exclude materials on whim. They didn't taint their focus by "consulting with experts in health professions diversity and soliciting their input on relevant evidence not yet included in their review." They didn't include potentially biased unscientific info from reading lists or websites ( "gray" material).
The studies Meghani and Brooks used were based on data from 56,276 patients and 1756 providers. Their data analysis followed established protocol (unlike Saha and Shipman):"The quality of the articles was evaluated using a structured data extraction form generated based on the Agency for Healthcare Research and Quality guidelines to rate the strength of scientific evidence (
AHRQ 2002). Studies were evaluated in five domains: (1) appropriateness of study question and design; (2) study sample; (3) comparability of subjects; (4) measurement of outcomes; and (5) appropriateness of study conclusions."
Meghani's and Brooks' disclaimers and suggestions for future studies were standard fare.
I hope this helps you evaluate studies more critically in the future.