<Tr> <Td> ← Previous "Didn't We Almost Have It All?" </Td> <Td> Next → "Love / Addiction" </Td> </Tr> <Tr> <Td_colspan="2"> Grey's Anatomy (season 4) List of Grey's Anatomy episodes </Td> </Tr> <P> "A Change Is Gonna Come" is the fourth season premiere of the American television medical drama Grey's Anatomy, and the 62nd episode of the overall series . The premiere focused on the aftermath of the main characters' promotion to residency, following the conclusion of their internship . The episode was the first not to feature Isaiah Washington, portraying Preston Burke, due to his being fired from the series at the conclusion of the third season . The installment marked Chyler Leigh's promotion to series regular status, following her guest appearances in the last two episodes of the previous season . Also featured were one - time guest actors Mark Pellegrino, Stephania Childers, Sandra Thigpen, and Steven Porter . </P> <P> The story arcs which provided a particular focus on individual characters include Cristina Yang (Sandra Oh) dealing with the aftermath of Burke's (Washington) departure, and the dissolution of their engagement, Izzie Stevens, (Katherine Heigl) struggling with her romantic feelings towards the married George O'Malley (T.R. Knight), and Callie Torres (Sara Ramirez) learning to deal with her new position of Chief Resident . Also dealt with was Alex Karev (Justin Chambers) coping with Rebecca Pope's (Elizabeth Reaser) departure, and Meredith Grey (Ellen Pompeo) facing the conclusion of her relationship with Derek Shepherd (Patrick Dempsey), while dealing with the arrival of her half - sister, Lexie Grey (Leigh), who enrolls in the surgical program at the hospital . </P>

When do the interns become residents in grey's anatomy