175 Dealing with moral challenges in treatment for transgender children and adolescents: evaluating the role of moral case deliberation 9 “The amount of cooperation [between different disciplines] in transgender care is uncommon in the medical world. A doctor normally makes his or her own diagnosis and then starts treatment. Even when a patient is referred by someone else, the doctor will always take their own look. […] I do not think there is any other field of care in which the clinician takes care of the diagnostics and the physician then carries out the medical treatment. This requires trust in each other’s expertise.” - Individual interview with a clinician DISCUSSION This project described Dutch transgender clinicians’ assessment of MCD sessions effectiveness in their clinical work with adolescents. A representative group of 34 team members from two teams in different cities participated in this mixed methods evaluation study, enabling us to acquire a broad, but nuanced understanding of their experiences with six MCD sessions. Our results showed that the clinicians considered MCD a useful method that has helped them deal with care situations where they were uncertain which step was morally right or where they could not agree on a what was the best possible care. In the individual interviews and focus groups, team members indicated that the need for thorough reflection on work challenges is particularly critical now because the current focus on efficiency has cut into contemplation time. The team members indicated a need to devote time, structure (in the shape of a facilitator and a conversation method), and dialogue (instead of a polemical debate) to a thorough reflection on difficult cases. Yet, not all team members valued the various aspects of MCD in the same way. They disagreed on how much time should be spent on an MCD session and how MCD sessions should be structured. Their criticisms of the MCD process focused on: the length of time dedicated to discussing individual cases, the need for more practical and concrete results after MCD sessions and the lack of follow-up and integration of MCD into regular work process. These results are in line with other studies on MCD, which show that the follow-up, organization, and implementation of CES can be challenging in clinical practice (Finder & Bliton, 2011; Hartman, Inguaggiato, Widdershoven, Wensing-Kruger, & Molewijk, 2020; Hartman et al., 2019; Hem et al., 2015; Weidema, van Dartel, & Molewijk, 2016). Team members were critical about whether or not the MCD’s dialogue, including the specific conversation method used, was a determining factor leading to the perceived results. They wondered whether these same results could be achieved simply by taking the time to deliberate on a case. The data obtained in this study do not allow us to draw any conclusions about whether time or MCD as such was a more determinant factor. Nevertheless, we can say that MCD probably adds value in highlighting the moral