Richard steps down as Chief of Surgery and Owen steps in. The residents are skeptical, especially Bailey. She is furious with Richard for lying and accuses him of doing that to save Meredith. Owen is determined to make Bailey a supporter.
Cristina and Owen have been acting very awkward towards each other. Meredith tells Cristina it is because they haven't talked about the abortion but Cristina doesn't know how to bring it up. Her and Owen order Chinese take out one night for another awkward dinner. They both end up getting food poising, which ends up breaking the ice while they're helping each other out in the bathroom. They end up having a deep conversation.
It is the first day that fifth-year residents will perform their own surgeries. April has difficulties taking command of her residents. While she assigns her residents which skills lab they will be teaching, they discuss amongst each other that the person that performs the worse surgery has to teach all the labs. Frustrated, April goes to Callie for advice. She tells April that she has to get them on her side in order for them to listen to her.
Cristina goes into a surgery which she thinks is a very complicated one, but it turns out to be an appendectomy. Cristina actually doesn't know how to perform this basic procedure and pretends to quiz the interns for guidance. Teddy calls her out for not knowing the basics and takes over. Teddy then realizes that she doesn't know how to perform that procedure either. Luckily one of the surgical nurses does and steps in.
Jackson is supposed to be operating on a baby's cleft palette. Arizona wants Mark to do it, but Jackson is determined that he is capable. In the OR, he realizes that he can't do it so Mark steps in and does it for him. Alex has a bowel surgery to perform. April realizes that he is terrified and she gives him a pep talk. When they compare notes, Alex looses the contest but April protects Alex by saying that Jackson didn't even perform the surgery so he loses.
Meredith's surgery is very complex. She doesn't think she can do it herself so she asks Derek to go into the OR with her. He thinks she's ready to do a solo procedure. Through the process, he is yelling at her and telling her what to do. She is frazzled, but the surgery turns out to be a success, and she receives a round of applause to Derek's dismay. Back at home, Derek realizes that he does not trust Meredith, particular in the hospital. They decide to not work together anymore.