Purpose
To elucidate the key qualities and behaviors that distinguish top- and low-performing surgery faculty based on medical student feedback.

Methods
De-identified evaluations were collected for general surgery faculty from a single institution over six years. Forms included 5-point Likert scale evaluations of four domains of teaching behaviors (learning climate, feedback, facilitation of learning, and professionalism), an overall teaching score, and teaching strength/weakness comments. Quantitative data was analyzed using SPSS and utilized to stratify faculty to the top and bottom 10%. Faculty with fewer than five evaluations were excluded from the stratification. Two researchers completed content analysis of the comments using a grounded theory approach with NVivo. The researchers developed a codebook inductively, coded a subset of evaluations, subsequently refined coding and themes, and coded the stratified data.

Results
2,089 evaluations for 91 faculty were included in the analysis, representing 24.0 average evaluations (SD 15.1, range 2-58) per faculty. The overall teaching score was 4.6/5.0(SD 0.3, range 2.8-5.0) which significantly correlated with each teaching behavior domain(R =0.714-0.946, p<0.001), and was used as the main quantitative metric representing teaching effectiveness. In qualitative analysis, three major themes of Creating a Welcoming Environment, Teaching Strategies, and Modeling Professional Behaviors were identified. When comparing the highest and lowest-performing faculty using independent t-tests, there was a significant difference in the overall negative statements(5.0% vs 23.0%, p<0.05). For the top 10%, positive statements were most commonly sub-themes of interest and engagement, relevant teaching points, and personality traits. For the bottom 10%, negative statements were most commonly themes of interest and engagement, respect and value, and autonomy, responsibility, and opportunities.

Conclusions
This study identifies key characteristics of high-performing faculty educators and areas of improvement for low-performing faculty based on medical student evaluations, providing a framework for understanding effective teaching elements. This can inform faculty development and enhance clinical teaching quality in medical education.