Martine Kruijtbosch

144 Chap t e r 4 METHODS Study design This is a descriptive explorative study of community pharmacists’ moral reflectivity in two MCD sessions. 27,28 The two dilemma cases are instrumental in investigating the potential effect of the deliberation on the ability to reason based on the pharmacy profession’s core values. Case presenters, participants, facilitators Ten early career community pharmacists, who had written a moral dilemma narrative during the postgraduate community pharmacist specialisation program they had recently completed, were approached to present their dilemma case during an MCD session. The first three pharmacists who responded positively to the invitation became case presenters (CPs). All CPs were contacted beforehand to prepare them to present their cases in the MCD sessions. A minimum of five participants per session, excluding the CP, is recommended to perform an MCD session. 8,11 These participants were recruited through the CPs’ networks and the electronic newsletter of the Utrecht Pharmacy Practice network for Education and Research. 29 Two facilitators (MK and EvL), both members of the research team, facilitated the MCD sessions. Moral case deliberation During an MCD session, participants learn to systematically unravel a dilemma case by joint reflection and critical investigation of each other’s (moral) viewpoints regarding the case. 14,30-32 From their gained shared understanding and moral insights, participants may reach a consensus about what the morally good action for resolving the dilemma case would be, but this is not required. In case no consensus is reached, the conclusion may lead to new questions about what the different viewpoints and ideas may mean for dealing with similar situations in daily practice. 14,33 Participants’ decision-making and social performance in moral dilemmas in practice may improve as well. 16,34 In this study, the dilemma method 11,14,20 was used as the conversation method to structure the deliberation. This well-known method formulates the ethical issue as a dilemma, presented as at least two mutually exclusive options. 11,14,20 The facilitator MK was trained to use the dilemmamethod. 35 The dilemmamethod consists of 10methodical steps, eachwith a clear aim, as shown in Box 1. The 10 steps are subdivided into three phases 36 : (1) the image-formation phase (steps 2-6), (2) the judgment-formation phase (step 7) and (3) the decision-making