Figure 9: Level of knowledge of students of PV cells in Moroccan public hospitals

Figure 10 : Hospitals with a PV cell.

Discussion

This study aims to assess the contribution of the reverse class to PV teaching. This is the first study to be carried out in our country among pharmacy students from Moroccan public universities. The results obtained showed that the majority of the students who participated in this survey were satisfied with the new method implemented and they declared that these online courses can replace the lectures. Several articles report data on student satisfaction based primarily on the teacher's perception, or even on informal data collection [3-9]; [17-21].

Some studies have directly measured student satisfaction through mandatory surveys with reference to their experience of the reverse class [1;22-28]. All of this research documented a higher student satisfaction rate than the previous session following the implementation of the reverse class.

Furthermore, in higher education, absenteeism is an important indicator of the satisfaction and motivation of students in general [29].

Moore and al., (2008), [30] who documented the motivation of undergraduate university students, found that, for less motivated students, access to online course notes made it easier to miss a class. If the presence in the classroom is influenced by virtual access to the different educational resources, we cannot fail to see in it a certain plea against the inverted class. Moore et al. (2008), [30] have also pointed out that several reasons, such as illnesses, prevent highly motivated students from going to class. The inverted class would allow, according to Schiller (2013), [20] for those who must be absent from a course, to nevertheless have access to its content while on the move or when they deem it appropriate. In our case the students said that the reverse class can solve the problem of absenteeism and they estimated an increase in class attendance after its implementation.

The vast majority of participants do not experience a pace of learning in reverse class as when they attended a lecture. As emphasized by Davies et al. (2013), [3] in an inverted class approach, the pace, the feedback on the content and the breaks are not dictated by the group,but by the individual, during the out-of-class portion.

This method allowed to our students to better adapt their learning pace, and gave them learning autonomy. Sales (2013) [19] also asserts that students integrate learning better when they are going at their own pace, rather than when they have to comply with that imposed by formal teaching. In this sense, several authors believe that the inverted class can prove to be an approach likely to help teacherstobetterrespectthelearningpaceofstudents[20,22;31,33].Wemaywonderiftheimplementation of the reverse class was perceived by the students as increasing their workload. Indeed, when asked about their reverse class experiences in terms of workload and preparation time, one of the comments made by students repeatedly, is that they perceive this load as more important than in a lecture [4,1,26,34]. In our case, three quarters of the students say that this new method has increased their workloads. In return, students reported a decrease in study time before exams [1,27,34]. Still according to Enfield (2013) [4] and Mason et al. (2013), [34] students engaged in an inverted classroom approach developed the skills needed more quickly in order to become more independentintheirlearning.The results of our study raised high student satisfaction with the clarity of the shared video sequences and with the activities accompanying these videos. When it's about preparing students for the theoretical content of a lesson, the use of video presentations seems preferable to the single use of readings. Of course, if we want to optimize learning, it is important that these preparatory videos are of good quality. Sales (2013) [19] mentioned that making short, interesting and engaging videos is of paramount importance to the success of the reverse class.
The pharmacovigilance discipline has evolved considerably since the 1972 WHO technical report and remains a dynamic clinical and scientific discipline. It has been essential to address the growing challenges of drugs (including vaccines), which have the potential for inevitable and sometimes unpredictable harm. However, the risk of harm is reduced when the drugs are used by an informed healthcare professional and by patients who understand and share responsibility for the use of the drugs. When an adverse reaction and/or toxicity appears, it is essential to analyze it and communicate it effectively to a knowledgeable audience in order to interpret the information. This is the role of pharmacovigilance. Much has already been achieved, but more is needed to integrate the discipline into clinical practice and public policy [35].

To meet PV skills in clinical practice, a culture change is necessary in health facilities where PV is not yet common practice. The number of pharmaceutical products is increasing, as is the number of patients with access to these treatments worldwide. The central role of PV is fundamental for future health professionals; by developing PV skills in universities, we can take the first step in this path of practices change [36]. Beyond awareness of adverse effects in individual patients, PV also focuses on improving public health in terms of safety and the safe use of drugs. Students should understand that there is limited information on ADRs in the pre-market phase and that healthcare professionals have a responsibility to share their clinical experienceinthereallifewithregulatoryauthorities.. Spontaneous notification of adverse drug reactions by health professionals is the cornerstone of any pharmacovigilance system, it allows monitoring of all new and old drugs. This surveillance is carried out on a large scale since 70 countries currently have national pharmacovigilance centers. This spontaneous notification system continues to be an effective method of signal detection [37]. Reporting an adverse reaction to PV centers or other relevant organizations is a skill that can be easily developed during clinical placements for student pharmacists and physicians [38,39].

Several studies have shown that pharmacy students do not have sufficient knowledge of pharmacovigilance practices and the importance of reporting adverse reactions. The national survey of pharmacovigilance activities and reporting of adverse reactions among pharmacy students in Malaysia suggests that these students may not fully understand the facts related to reporting of adverse reactions and may require more information on the national pharmacovigilance system and the adverse reaction reporting process [40]. The results of the study carried out at the University of Aden showed that students did not have sufficient knowledge of pharmacovigilance practices and that final year pharmacy students showed greater knowledge of ADRs and have developed more positive attitudes to manage and report ADRs [41]. The results of another study showed a low level of knowledge among university students in Sana’a and a positive perception of pharmacovigilance and the reporting of adverse effects. This survey suggested that there is a significant need to increase knowledge and educate pharmacy students so that they can be able to identify the type of adverse reactions to report. In addition, they may need more information about local pharmacovigilance systems and the reporting process for side effects [41]. In the same context, another study in Nigeria revealed that pharmacy students had insufficient knowledge of pharmacovigilance activities; but have positive perceptions of reporting adverse events [42].

In India, a study carried out among pharmacists has shown that they have very little basic knowledge of pharmacovigilance. This same study recommends incorporating the concepts of pharmacovigilance into the diploma curriculum, since they constitute the major part of the exercise in community pharmacies [43].

In our study, after the implementation of the new teaching method and the dissemination of the course in the form of video sequences, the majority of students said that they will start by notifying ADRs and felt that it is easier declare an ADR online rather than on a notice. Pharmacy students also pointed out that there are several reasons that discourage healthcare professionals from reporting an ADR, such as lack of training in this area, difficulty distinguishing between an ADR and symptoms of illness, lack of time to report an ADR, lack of compensation, and some believe that a single unreported case may not affect the PV database.

The results obtained confirm the need to train health professionals in PV.

Conclusion

The study showed that the inverted classroom is an innovative and effective teaching method for Moroccan pharmacy students with a fairly high satisfaction rate. The results suggest that students have understood the importance of PV in detecting and preventing ADRs and most of them have expressed their motivation to participate in reporting activities.

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