Everyone is trying to get in on the most impressive surgeries in preparation for the upcoming boards. Meredith ends up working in OB. She gets a patient with an inoperable brain tumor. She thinks Derek can save this patient's life. Playing by the rules, she asks Lexie to ask Derek to perform this surgery. Lexie does a horrible job selling this surgery to Derek so Meredith has to talk her through it. Meredith (through Lexie) ends up succeeding, Derek performs the surgery, saving the woman's life.
After Richard stumbles on Cristina and Owen having sex, he tells Owen he has to start acting like the Chief. Cristina and Callie have a very complex operation, to rebuild a patient's spine. They run into some problems and Cristina decides to take the safer route that may leave the patient partially immobile. Something goes wrong and she freaks out and pulls her name off the case so she doesn't have it on her record. It turns out it was a minor error and everything is fine again, Cristina wants back on the case. Callie won't let her, and lectures Cristina on how she has to take risks to be great.
Alex's patient wants to have an experimental surgery because it would leave him without a scar. Alex does some research and decides that it isn't safe. Teddy thinks it is a good idea and performs the surgery without Alex. Arizona and Mark have been getting really close, and Callie gets annoyed. Callie kicks Mark out of her house to give her and Arizona some alone time.
Bailey picked April to help with her clinical trial. April is stumped when the mice are coming back with diabetes. She has problems delegating tasks since no one will listen to her. She tries out a deeper, more authoritative voice and gets Meredith to help out. Richard asks Bailey how the trial is going and she refuses to tell him. He uses Meredith as an inside spy to keep him in the loop. Bailey finds out that April has enlisted Meredith's help and is furious. She calms down once she finds out that Meredith may have solved the problem.