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The growing prevalence of chronic illness will be the predominant challenge to the American health care system in the coming century. Patients with chronic conditions account for three fourths of U.S. health care expenditures, and considerable growth of these costs is likely as the population ages. Despite the enormity of this problem, the management of chronic illness has received little attention in undergraduate and graduate medical education. This paper describes the competencies required to develop curricula in the management of chronic illness.