OBJECTIVES: To assess stress and burnout, and identify common stressors, among medical students in the Kingdom of Bahrain. STUDY DESIGN: A cross-sectional study with students being evaluated from March to September 2017 at two medical colleges in the Kingdom of Bahrain. METHODOLOGY: Survey conducted on a total sample of 533 clerkship-training students with a total of 347 respondents. The instruments used were Cohen’s Perceived Stress Scale; the Maslach Burnout Inventory; and a common stressors questionnaire. RESULTS: 65% (347/533) of the students from the two medical colleges responded to the questionnaire. It was found that the mean (SD) of Cohen stress score in this study was 21.76 (5.60), with a stress and burnout prevalence of 47% and 43.43% respectively. A high percentage of respondent students (68%) also exhibited high emotional exhaustion scores > 14. More than half of the respondents (53.3%) exhibited high cynicism score > 6. Statistically significant differences were observed across gender categories with Cohen mean score, emotional exhaustion and cynicism. Multiple linear regressions revealed gender to be the only statistically significant predictor of the Cohen score (p. value 0.042). CONCLUSION: Clerkship medical students displayed high levels of both stress and burnout prevalence. Medical educators must be aware of the early signs, causes and consequences of student stress. They should also be able to encourage students to improve their mental and physical health, promote mental well-being and teach stress management.

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• AimTo educate family physician about early stages of psychological and emotional stages in marital divorce for early prevention and management.The stages of the psychological and emotional divorce are five transitional zones such as: [4,8]. Stage one: Blaming the spouse and disillusionment of one partyThe couple started to blame each other for past, present and even future problems in their life. The initiator developed negative self-image, vague feelings of dissatisfaction, stored angers, greater distance, lack of mutuality, anxiety, depressed mood, feel upset, guilty feeling and experiences a low energy level. Moreover he/she has masked feeling of blame, fear, anger, depression, stubborn behaviour. While the receiver developed feeling of disbelief, denial, divorce opposed helplessness, lack of control, fear of the unknown and shock feelings.The counsellor or mediator roles are many; the counsellor should fosters couple sense of control on their lives, neutralizes their fear from physical and emotional separation process, In addition, supports making short-term decisions concerning the physical separation. The counsellor should maintain structures information gathering for better parenting skills and have good support system for roller coaster couple feelings.

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proper patient's spirituality and health in many domains; physical, mental, physiological and behavioral health statuses. In the physical domain, it will aggravate hypertension, cardiac arrhythmias, chronic body ache, premenstrual syndrome, migraine and cluster headaches. While in the mental domain it will exacerbate anxiety, insomnia, depression and low self-esteem. Although in the physiologic effects, it will worsen metabolism, rate of breathing, blood pressure, muscle tension, heart rate and increased brain waves. Whereas in the behavioral domain, it will increase drug abuse, alcohol consumption, smoking addiction, and increase destructive behavior [14][15][16].There are many barriers for physicians to practice spiritual medicine including; lack of physician time, experience, and suspicion of the role of physician in spiritual medicine respectively (71%, 59%, 31%) [17]. Spirituality vs. ReligionSpirituality is a multifaceted, multidimensional human experience that includes religious and nonreligious. Spirituality has three components; cognitive, experiential and behavioral dimensions (Figure 1). The cognitive is the mental framework, which consists of meaning, purpose, truth beliefs and values [18][19][20][21][22][23][24][25][26][27][28][29].Experiential is the quality of an individual's inner resources which consists of hope, love, connection, inner peace, comfort, support, the ability to give and receive spiritual love, and the types of relationships [26][27][28][29].Behavior perspectives are the way a person externally manifests individual spiritual beliefs and their inner spiritual state [16,[30][31][32].

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Medical doctors need the skill to acquire how they are responding to inappropriate patient's requests. The FAVER approach starts with recognizing inner uncomfortable feelings, which signals that the patient's request is inappropriate. Assuming that the patient doesn't know that their demands are "immoral." The medical doctors need to say "NO" in an explicit state and give excuses such as inadequate medical care, illegal, dishonest, or against policy and avoid lengthy explanations.

A sixty-seven-year-old female patient presented with symptomatic hypercalcemia as the first manifestation of primary hyperparathyroidism due to parathyroid adenoma. Initially the chronic hypercalcemia was investigated and then subsequent parathyroidectomy was done. She is doing very well six months following the surgery and the hypercalcemia has resolved completely. Asymptomatic hypercalcaemia due to primary hyperparathyroidism is a common condition in primary care1. Most commonly primary hyperparathyroidism is caused by a solitary parathyroid adenoma (80%), and less frequently multi-glandular adenoma, parathyroid hyperplasia or carcinoma2. Patients rarely present with symptomatic hypercalcemia (mnemonic “stones,” “bones,” “abdominal moans,” and “psychic groans”) whereas usually patients remain asymptomatic and the condition is discovered during routine checkup investigations3. The disorder can occur at any age, yet is more common in the middle age group (≥50 years). The ratio of such cases is equivalent to 1:1000 in males, whereas it is 3:1000 in the female population4.