Carter engages in competition with new surgical resident-in-training Dale Edson upon learning that residents will be evaluated and graded; only the top ones advancing to second year. It doesn't help that Dale once had a relationship with Harper. Mark flirts with infomercial director Iris. Peter faces the fallout from his altercation with Doug when surgeons begin dropping him from procedures. Shep begins exhibiting uncontrolled hostility, first to a patient being abusive with Carol, then a pedestrian. Susan and Chloe try to reach an agreement regarding Little Susie.

Susan throws herself into her work to escape her stressful personal life, earning recognition from Kerry and Mark, who begins preliminary discussions on next year's chief resident. Carter needs a pedes rotation, and fast, with Doug to graduate med school. Doug takes up with his father's girlfriend. Shep overreacts and attacks an Asian boy interfering at a scene. Mark and Jenn try to discuss their divorce amicably, with unforeseen results. Benton is named Resident of the Year. Harper leaves for an OB rotation at Parkland in Dallas.