1-2 students per month
Elective starting January 2025. 
Offered monthly, except December.

Location: Ambulatory Medicine Clinics of the Pine Ridge Unit of the Indian Health Service, Oglala Lakota Nation 

Purpose 
- This elective offers the senior physician-in-training (M4) an experience of cross-cultural, rural ambulatory primary care medicine in the Oglala Lakota Nation by fostering the following:

- The development of clinical skills through the experience of working under direct clinical supervision in a rural outpatient primary care setting where patients from across the age and development spectrum seek care from family medicine and pediatric medicine physicians for acute and chronic illnesses.

- A more textured understanding of the interpenetration of the Lakota experience (Lakota culture, history, language, and spirituality) and primary care ambulatory medicine (and public health) via the healthcare model of the Indian Health Service. 

- A more nuanced cross-cultural understanding of Oglala Lakota patients, many of whom commonly face substantial social barriers to accessing adequate health care, including limited access to public and private transportation, lack of indoor plumbing, notable food insecurity, and a chronic shortage of affordable housing stock.

- Professional growth through the mentorship of seasoned clinician-educators who will guide the M4 in evaluating, treating, and managing patients with complex clinical histories in a community with chronically limited healthcare resources.

Description

The M4 will use the following cultural and historical resources for contextual preparation prior to beginning her, his, or their clinical experience in the Oglala Lakota Nation:

- View the Chloe Zhao film entitled Songs My Brothers Taught Me.
https://www.youtube.com/results?search_query=songs+my+brothers+taught+me+full+movie

- View the documentary entitled Women of the White Buffalo.
https://www.youtube.com/watch?v=pWmWHX4xedk

- View the YouTube videotape series entitled “Children of the Plains.”
https://www.youtube.com/watch?v=IJapHc7B8Xs&list=PLi3KmHPCKhkoH3biYdNNUj7fa4WuovzZ9

- Read three essential chapters (“Red Cloud’s War,” “Dance of the Ghosts,” and “Wounded Knee”) from the classic historical text Bury My Heart at Wounded Knee [Brown, Dee. (1970) Bury My Heart at Wounded Knee. New York: Henry Holt and Company.]

The four-week elective experience comprises the following broad features:

- On arrival the M4 will report to the on-site supervisor and the on-site coordinator to begin the orientation process at the Pine Ridge Service Unit. 

- Elwyn Garaza, M.D. (Elwyn.Garaza@ihs.gov [719.588.1983]), Director of Ambulatory Clinics, the Pine Ridge Service Unit of the Indian Health Service, will serve as the on-site supervisor for this elective, and Tricia Uhlir, R.N., A.N.P. (Tricia.Uhlir@ihs.gov [605.455.8203]), Deputy Director of Outpatient Services and Supervisory Nurse Practitioner, Kyle Health Center of the Indian Health Service, will serve as the elective coordinator. They will collaborate with Ms. Dwan Kendrick, R.N., B.S.N., Deputy CEO of the Outlying Clinics (dwan.kendrick@ihs.gov [605.252.1632]).

- The application process begins after the CCGH Program Manager communicates directly with the on-site elective coordinator, Tricia Uhlir, R.N., A.N.P. (Tricia.Uhlir@ihs.gov), Deputy Director of Outpatient Services and Supervisory Nurse Practitioner, Kyle Health Center of the Indian Health Service (please see Application Process at the end of this document).

- The elective schedule runs from 0800 to 1730 Monday through Friday at the Kyle Health Center, the Wanblee Health Center, and the Pine Ridge Hospital Outpatient Clinic.

- The outpatient clinic at the Kyle Health Center is the primary venue; and the outpatient clinics at the Wanblee Health Center and the Pine Ridge Hospital are the secondary venues. The M4 will rotate through each of the three outpatient clinics—without any overnight call responsibilities—and will also participate in the work of the community health nurses and the nurse practitioners in the women’s health clinic.

- A family medicine physician or a pediatrician will serve as the direct clinical preceptor for the M4 in each of the three outpatient clinics.

- The M4 will keep a patient log and a personal journal that archives her, his, or their experiences—medical and psychosocial. The patient log and the journal reflections will inform a 500-word reflective essay, which is due at the conclusion of the elective experience.

- The M4 should consider visiting the following culturally, historically, and spiritually significant sites: the Wounded Knee Memorial, Chief Red Cloud’s grave, the Black Hills, the Badlands National Park, Wind Cave National Park, and Bear Butte State Park. Each is within a reasonable driving distance from the location where the physician-in-training will work and reside during the elective period.

- The M4 will complete a final evaluation of the elective to assist the LUC SSOM faculty supervisor in further strengthening the elective experience. 

 Eligibility

Though the application process for this elective will unfold during the third year (M3 year), interested physicians-in-training should consider that to participate in this elective one must have passed STEP 1; completed all required M3 clerkships; and maintained satisfactory academic standing.

Housing and Transportation

-The Kyle Health Center, Kyle, South Dakota, the primary site for this elective, is 875 miles from Chicago—a drive of approximately 12 hours.

-Lakota Cabins (7966 Lakota Prairie Drive [physical address]; Post Office Box 518 [mailing address], Kyle South Dakota 57752; lakotacabins@gmail.com; 605.455.2555 [business]; 605.209.8375 [cell]), will provide housing for the M4. Travel time from the Lakota Cabins to the Kyle Health Center is 5 minutes (30 minutes to the Wanblee Health Center; 45 minutes to Pine Ridge Hospital).  

-Lakota Cabins offers single rooms with a microwave oven or a cabin with a full kitchen for meal preparation. 

-A grocery store is available in Kyle, South Dakota. Additional larger grocery stores are available in Martin, South Dakota, and in Gordon, Nebraska, about 35 minutes south of Kyle. A laundromat is available in Gordon, Nebraska (101 North Elm Street).

-M4s will require a vehicle to travel to the different clinical and cultural sites—and should plan to use their own.

Expenses

Expenses for the elective include the following:

▪Travel from Chicago to the Oglala Lakota Nation costs approximately $5.00 for tolls and $65.00 for food and fuel (each way).

▪Travel costs during the elective period are largely fuel-related and amount to $75.00 for the elective period (although this will vary depending on a vehicle’s efficiency).

With respect to evaluating learner performance, the following applies:

- The elective uses the pass/fail system. 

- All M4s will receive their final grade from the LUC SSOM supervisor of the elective.

- The supervisor of the elective will generate a final grade by reviewing the patient log; assessing the required 500-word reflective essay; and by consulting the on-site supervisor’s clinical evaluation. 

- The supervisor of the elective will review the entire elective proposal and on-site experience at the conclusion of the academic year and amend the elective description and experience as needed.