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Approximately ten years ago a group of Chiefs of General Internal Medicine met at the National SGIM Meeting to discuss significant mutual needs and interests. During this exploratory meeting it became clear that the Division Chief and leaders have complex roles. Many have risen to their positions without any specific training or peer group from whom to learn.We concluded that we needed to develop a formal organization for Chiefs of General Internal Medicine. Beginning in 2002 we have held a yearly meeting centered around the ACLGIM Management Training and Leadership Institute. In 2006, the organization started a tradition of gathering in late fall to discuss policy matters impacting the field of GIM.