The Department of Neurosurgery at Washington University School of Medicine offers clinical neurosurgical training in a seven-year residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME). The aim of our program is to provide trainees with the skills for lifetime excellence in the clinical practice of neurosurgery, either in an academic or community practice career. To accomplish this, the program integrates extensive practical exposure to all aspects of current clinical neurosurgery with a firm grounding in underlying scientific principles and the methods of clinical investigation. The challenges of neurosurgery practice in the next century will require familiarity with a rapidly expanding body of neuroscience information, sound clinical judgment, technical excellence in the operating room, communication skills and an appreciation for the ethical and compassionate side of medicine. Our neurosurgery faculty is comprised of both full-time clinicians and basic scientists. In addition, the training program benefits from the availability of an internationally renowned community of neuroscientists throughout Washington University, as well as from a long tradition of close ties with clinical colleagues in the departments of neurology and surgery.