To identify problems in how medical school faculty are evaluated, from the perspectives of faculty and administrators, and to understand how perceptions of the problems differ among those with varying roles within the medical school. In March 1992 seven copies of an open-ended questionnaire were sent to each dean at the 126 accredited U.S. medical schools and 16 affiliated Canadian schools. The deans were instructed to complete one form themselves and to distribute one copy each to (1) a faculty affairs dean, (2) a basic science chair, (3) a clinical chair, (4) a member of chair of the school's promotion and tenure committee, (5) a senior faculty member, and (6) a junior faculty member. The authors conducted a content analysis of narrative comments in response to a question that began "Please identify and briefly describe the most salient problems you observe at your institution in how faculty are evaluated." Of a possible 994 responses, 455 (46%) were received. The respondents were from 102 of the 126 U.S. medical schools (81%) and eight of the 16 Canadian schools (50%). Response rates for the respondent subgroups ranged from 27% for the deans to 57% for the clinical chairs. Overall, the most frequently mentioned problems concerned the evaluation of teaching. General complaints about the inadequacy of current methods to evaluate teaching performance were most common--more than one in four respondents raised this issue--but the respondents also had specific complaints about student evaluations of teaching and the insufficient recognition given to teaching in the academic reward system. The frequencies with which other concerns were expressed tended to be related to the respondents' roles. These problems included concerns about the methods and measures used to assess research and scholarship and the quality of clinical care, the nonuniformity of evaluation processes and criteria for promotion among departments, the absence of regular evaluations, and the failure to link the results of evaluation to salary. The study population was not random; indeed, it was probably biased toward those who felt strongly (and perhaps negatively) about the current evaluation system. Still, the intensity with which views were expressed was striking. Improving the evaluation of faculty teaching undoubtedly remains one of medical education's greatest challenges.