Abstract
Ethical issues frequently arise during the practice of clinical medicine and when providing medical education. These issues become particularly challenging when practicing and teaching medicine cross-culturally. In this case study in a family medicine residency program in East Africa, a structured approach to managing ethical challenges effectively was found to assist in overcoming a conflict about potentially removing a seemingly incompetent medical trainee from a residency program. The step-wise approach includes identifying relevant stakeholders; agreeing on actual background facts; understanding the various goals and values involved in the situation; reviewing locally applicable ethical, professional and legal standards; acknowledging limitations in various options to resolve the issues; and analyzing risks and benefits of the various courses of action.