Original Publication
Open Access

American Indian Health in South Dakota—A Health Systems Case

Published: August 20, 2014 | 10.15766/mep_2374-8265.9869

Included in this publication:

  • Instructor Overview.doc
  • Teaching Note.doc
  • Case Study.docx
  • Group Activity.doc

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: This resource teaches health professionals about health systems by exploring one with unique, pressing challenges. The primary goal is for learners to develop the analytic skills to understand the health system, thereby allowing them to propose suggestions for reform. The case also offers a window into health for Native populations and underserved rural populations, neither of which are often included in health care curricula. This resource is intended for use by any group of health professionals. The material was originally designed to be used with first-year medical residents. Methods: The resource includes a 3-hour business school-style case study teaching principles in health systems and health systems strengthening through the example of two struggling Indian Health Service sites in South Dakota. The session is designed for 15-20 learners but could be taught with a smaller or larger group. Included in the resource are an instructor’s guide, a teaching note, a group problem-solving activity, and the case study itself. Central issues include health disparities, social determinants of health, rural health, Native health, and health systems reform. The resource features a number of innovations, including a journalistic style, a health systems problem without an obvious solution, and a grounding of the case in a learner perspective. Results: The case has been taught twice annually to internal medicine interns. Learner reviews were positive. The group session was well liked and its length extended in the second year. Discussion: The case’s difficulty should be considered before teaching. It challenges learners by requiring both analysis and some novel thinking. The case study document might be used alone in various settings. It is possible that simpler teaching methods (e.g., didactics) might be more successful for beginner learners.

Educational Objectives

By the end of this case, learners will be able to:

  1. Explain to a peer how history, culture, and socioeconomics can affect health.
  2. Describe how a small, complex health system is organized and funded.
  3. Offer one or more reasonable suggestions for strengthening a health system.

Author Information

  • Matthew Tobey, MD: Massachusetts General Hospital
  • Chana Sacks: Massachusetts General Hospital
  • Daniel Foster: Rosebud Service Unit
  • Dennis Norman: Massachusetts General Hospital
  • Susan Karol: Indian Health Service
  • Patrick Lee: Massachusetts General Hospital

None to report.

None to report.


Tobey M, Sacks C, Foster D, Norman D, Karol S, Lee P. American indian health in South Dakota—a health systems case. MedEdPORTAL. 2014;10:9869. https://doi.org/10.15766/mep_2374-8265.9869