176 Chapter 9 aspects of a case. Such elements do not necessarily emerge in regular case discussions but result from the MCD method, structure, and facilitator-led form. As a result, MCD helps participants to increase their moral reflection skills (Dauwerse, 2013). Most regular case discussions take just as much time, but seldom get beyond the clinical aspect of the case and seldom take into account the values and norms behind the clinical reasoning. In addition, the structure and focus of MCD sessions allows focusing on dialogue rather than on debate and gives participants room to constructively discuss differences of opinion and to reflect on morally complex or problematic cases (Molewijk, van Zadelhof, Lendemeijer, & Widdershoven, 2008b). This contrasts with most regular case discussions, in which participants typically try to convince others of their own opinion in a heated debate. Such a setting tempts participants to repeat the same argument time and time again. A recent Dutch study showed that MCD sessions offer more of the hallmarks of good moral deliberation than regular case discussions, as a greater proportion of the participants’ statements were categorized as examples of moral focus, variety of argumentation, and open interaction (de Snoo-Trimp, Kremer, Jellema, & Molewijk, 2022b). The MCD sessions analysed in this study led to changes for the gender identity clinics at both the treatment plan and general policy levels. The sessions resulted in concrete changes of treatment plans and contributed to several adjustments of the general transgender care policy (Hartman et al., 2019; Hartman et al., 2020). For example, changes were made as to how strictly clinics apply the age criterion for starting puberty suppressing treatment. Dutch gender identity clinics strictly maintained a minimum age of 12 years for eligibility to start this treatment. Partly due to the outcomes of several MCD sessions focusing on cases of young children and puberty suppressing treatment, the clinics now apply the minimum age criterion more flexibly. This result is in line with other studies which show that MCD promotes the development, improvement, and implementation of guidelines and policies (Molewijk et al., 2008b). It should be noted that describing other changes in clinical policy resulting from the MCD sessions analysed in this study is beyond the scope of the current study. Nevertheless, for more information about the integration of CES into the daily work processes at a Dutch gender identity clinic see Hartman and colleagues (2019; 2020). The individual interviews and focus groups in this study led to concrete recommendations on improving the use and implementation of MCD. The recommendations were: to ensure the lessons learned from MCD sessions are followed up; to boost the sense of ownership and responsibility regarding actions to be taken; and to ensure the lessons learned are reflected in guidelines and policies. To put these recommendations into action, in our local situation a steering group was created with members from the management team of the Centre of Expertise for Gender Dysphoria at the Amsterdam University Medical Centres, location VUmc in Amsterdam. Two of the researchers discussed the recommendations