1) The residents of Seattle Grace Hospital take a bus trip to Chicago to take their board certification exams which will determine if they can become fully licensed doctors. 2) In Chicago, Meredith becomes sick with a gastrointestinal illness while Christina helps her check into their hotel. April is nervous and crying that she won't pass the exam. 3) Back in Seattle, Alex misses part of the exam because he went to help a premature baby at the hospital, angering the examiners. 4) After a grueling exam, Alex, Christina, and Meredith pass but April does not, sadly having to retake the exams next year.