The Carpal and Tarsal Bones of the Human Body

Memorising human anatomy structures remains a challenge for nursing students. Educators endeavour to make human anatomy interesting and easy to memorise. Various instructional approaches can be used to help students enhance their memory. Mnemonics, for example, are well-established educational strategies that have proven useful in the encoding, retention and retrieval of anatomical terms. The carpal and tarsal bones are some of the anatomical structures that prove challenging to nursing students’ study of anatomy. Although available online to students, most of the accessible mnemonics are in English and non-native English-speaking students (students who are native Arabic-speakers) might find them difficult to understand. Therefore, we have created two simple Arabic mnemonics that can simplify the memorisation of the carpal and tarsal bones. We believe that Arabic mnemonics effectively enhance memorisation by linking the new learning material to familiar information.

A s nursing instructors, we must equip our students with the necessary competencies to meet the challenges of 21 st century healthcare. Worldwide, leading nursing educators agree that an understanding of anatomy and physiology (A&P) is critical to ensuring good nursing practice. 1,2 However, it is well documented that nursing students struggle with A&P because they find it arduous to memorise huge numbers of anatomical terminology. 1 Over the years, as Gray's anatomy (the most extensive and detailed book on anatomy) grew to over 1,500 pages, educators have tried to find different strategies and apply new technologies to facilitate the teaching of anatomy. 3,4 Both students and educators have managed to abbreviate anatomical structures into mnemonics, which are systems used to facilitate easy and effective retention of information. 5 As previous students ourselves, mnemonics helped us immensely in retaining anatomical terms and recalling them more easily at a later time.
Mnemonics are a great teaching strategy which has shown to increase memorisation of human anatomy. 6 In nursing education, a previous study has shown the effectiveness of mnemonics in facilitating the memorisation of an "Introduction to Nursing" course. 7 Koksal et al. used mnemonics to help students remember basic knowledge about the healthcare system. 7 Results have shown that nursing students who studied with mnemonics performed better in a retention test than the control group who did not employ the aforementioned technique. Through mnemonics, associations are created between new, unknown information and old information that have already been mastered. 8 By acting on working memory, these mnemonics lower the introduced cognitive load and enhance the attainment and encoding of new information. Mnemonics use familiar words to form a cue that can be better encoded into memory. By using these familiar cues, the load is minimised while allowing an enhancement of the long-term memory. 9 e224 | SQU Medical Journal, May 2020, Volume 20, Issue 2 Different forms of mnemonic strategies such as acronyms and acrostics have made it easier to remember new information by making it more familiar and meaningful. 10 Acronyms are words in which each letter stands for a piece of information to be remembered. For example, "RICE" is an acronym that is used for a sprained ankle treatment where "R" stands for rest, "I" for ice, "C" for compression and "E" for elevation. 9 On the other hand, an acrostic is a sentence where the first letter of each word plays the role of a cue for the information to be recalled. An anatomical acrostic was used by Larson to memorise the bones of the orbit: "many friendly zebras enjoy lazy summer picnics" was used, where the acrostic represents the maxillary, frontal, zygomatic, ethmoid, lacrimal, sphenoid and palatine bones, respectively. 11 Other acrostics have been used to remember the branches of the facial nerve. For instance, the sentence "To Zanzibar by motor car" helped students to recall the order of the nerves correctly as temporal, zygomatic, buccal, mandibular and cervical. 9 A vast amount of mnemonic examples are readily available with a quick internet search. However, all these mnemonics are in English and sometimes contain complicated words which increase the difficulty for non-native English students.
Undergraduate nursing students need to be knowledgeable about the skeletal system. In fact, one of the first systems that is taught at Sultan Qaboos University in A&P is the skeletal system. Learning the names of the bones of the human body is particularly important since students need this information to be able to find these landmarks when assessing patients. Students must memorise the 206 bones of the human body, a task which have often perturbed nursing students.
Traditionally, the names of the bones of the human body are taught to undergraduates by means of didactic lectures. Teaching these names can be challenging for many educators. Consider the carpal and tarsal bones, students need to learn the names of the eight carpal and the seven tarsal bones in order. These short bones can be difficult to distinguish from one another due to their similarities in size and shape. 12 Using didactic lectures to teach the names of these bones often fail to engage students and, consequently, many students feel overwhelmed. Therefore, the use of mnemonics can provide a better and more engaging way of learning.

Methodology: Creating Arabic mnemonics
A handful of mnemonics addressing the order of carpal and tarsal bones have been published online, yet none are in Arabic. Furthermore, mnemonics cannot be translated. Therefore, we have composed Arabic mnemonics that could be used by nursing and other Arabic-speaking healthcare students to enhance the memorisation of the names of these bones.

Discussion
Students and educators can find a plethora of mnemonics on online databases. However, the majority of these mnemonics are in English, which is unfortunate for nonnative English-speaking students. 14 Therefore, there is a need for creating Arabic mnemonics to make the recollection process easier for these students.
It is imperative to stress the limitations of these tools. Mnemonics are useful merely for memorisation; they are not strategies for understanding, application or analysis. 10 They encourage surface learning rather than developing in-depth learning. Some nursing educators might abstain from teaching mnemonics because of their perception that this method is a lazy way to study. Some even believe that using mnemonics for patient-care might damage the humanistic approach by condensing patients' symptoms into a 'laundry list'. 9 In addition, various mnemonics use humour to increase retention and some teachers decline their use, describing them as unprofessional or even uncivil. 14 It is worth mentioning that students can find mnemonics everywhere and it is likely that they are using them without the educators' knowledge. Therefore, it would be appropriate for teachers to be aware of the mnemonics their students are using and to check these learning aids for mistakes.
When considering the benefits of mnemonic strategies, it is necessary to mention that many experiments show the beneficial effect of these aids on facilitating learning and memory of students. 15 Although the benefits of mnemonics use have been documented in many research articles, it must be considered that mnemonics do not address all levels of Bloom's taxonomy and cannot cover all courses' objectives. [5][6][7] Therefore, these memory tools should not be considered as the only study aid needed for learning anatomy. However, we believe that mnemonics could allow students to establish a baseknowledge that could be developed and built upon. Furthermore, they allow students to memorise the   information quickly, leaving more time for higherorder learning. Whenever students show difficulties in memorising lists of information, mnemonic devices constitute a powerful tool in the array of instructional resources and strategies. It is worth noting that not only mnemonics can facilitate the learning of the carpal and tarsal bones. Knowledge of the terminology used for the nomenclature of these bones can also be helpful. Carpal and tarsal bones' names reflect their shape which can be additionally useful for learning and identification.
The English name of each carpal and tarsal bone is derived from either Latin or Greek. For example, the scaphoid name stems from the Greek word skaphidion meaning "a small ship". Due to its boat-like shape it is commonly referred to as the "boat bone" in Arabic ‫القاريب(‬ ‫.)العظم‬ The lunate was named for its resemblance to a crescent, which is derived from the Latin word luna. In Arabic, it is known as the crescent bone ‫اليل(‬ ِ ‫اهل‬ ‫)العظم‬ [Table 3]. 16,17 Therefore, understanding the terminology might help in recognising the morphological characters of the carpal and tarsal bones.
Finally, in-depth analysis should be carried out in the future to test whether these Arabic mnemonics will improve students' learning and enhance their recollection of the names of bones. In addition, students' perception of the use of Arabic mnemonics should be investigated. The observation in the classroom, however, indicated that students enjoyed the use of these tools.
The two created mnemonics were found to be helpful in teaching the anatomy of carpal and tarsal bones. The students can now use a simple aidemémoire to simplify the memorisation of these bones. We encourage our students to create their own Arabic mnemonics. We also encourage the readers to publish more of these tools to help our non-native Englishspeaking students to improve their retention.