Depending upon a point of view critical thinking has different meanings. From a philosophical perspective, critical thinking is the norm of good thinking. From a psychological perspective, critical thinking is higher order thinking skills, while from a sociocultural perspective, critical thinking skills are the “capacity to recognize and overcome social injustice.” 67 Paul claims that critical thinking is not an aim of education but the aim.68 In this toolkit, CT has been predominately described as a set of skills and dispositions. However, it is important to point out, that while CTS can be taught, whether CTS is learned is dependent upon a host of factors such as students’ pre-dispositions, developmental readiness, the nature of the learning environment, and learning activities, and whether instruction is tailored to students’ developmental levels, among others.

Another concern related to this discussion is the transferability of CTS.  Some scholars assert that CT is the same across disciplines 19, 68 Others argue that there is no set of generalizable thinking skills and that CT cannot be taught in isolation from subject matter.21 Brown posits that students cannot progress in the development of their thinking unless they are given something to think about.69 Giving students something to think about is central to the development of CTS. Some instructional strategies that can promote the development of CTS are paying attention to students’ epistemological beliefs, promoting active learning, using a problem-based curriculum, and stimulating interactions among students in the study of real-life problems. Allowing students to contribute their insights with other students and the instructor as well as having students formulate their ideas in written essay exams rather than in multiple choice exams so that their thinking becomes public rather than private is also likely to have a significant influence on the development of CTS.

From an organizational perspective, there will need to be a commitment to teaching in ways that support CTS. While some instructors will buy in to this transformation, others will need professional development, consultation to re-write learning experiences and expand teaching repertoires, administrative support and supervisors’ expectations that teaching which supports CTS is a requirement in the academy.

From an external level, ADEA can maintain a database of evidence-based best practices and serve as a resource for faculty across the US and Canada. ADEA could also maintain an open source for web-based cases, tutorials, and teaching technique videotapes to support professional development. To acquire a database of evidence-based practices, dental schools may need to think differently about conducting research and collaborate with other scholars in colleges of education and health and human performance to study teaching and instructional practices.

From a programmatic perspective, dental education programs will need to become learner-centered. This means that the curriculum will need to engender actively engaging students and helping them assume greater ownership for their learning.70 Professors will need to use strategies that build self-regulated learners. Moving away from teacher-centered and discipline-focused instruction, professors will need to encourage student dialogue, discovery and curiosity. The curriculum will need to be designed so that students have ample opportunities to analyze tasks, set appropriate goals, monitor and control their behavior during performance, make judgments of their progress and alter their behavior based on these judgments.71 Professors will need to develop a curriculum that moves towards an integrated contextualized delivery of content that embeds basic science as well as treatment planning and patient care. With enough problem-solving activities and opportunities to reason aloud, students can learn to emulate professors, unlearn poor problem-solving skills, learn appropriate problem-solving skills, self-monitor, and learn how to diagnose and treat patients’ oral health problems.71 To assist student development of CTS, faculty will need to model the value of scientific discovery and life-long learning in their interactions with students, patients, and colleagues.63

From an individual perspective, teaching students how to use critical thinking skills will also require dental educators to reflect upon their beliefs about how they teach. It is crucial to recognize that both students and faculty make decisions based upon their current frame of reference.2 Thus understanding an individual’s attitude and willingness to consider and weigh alternative points of view becomes an essential component of teaching students how to develop and use critical thinking skills. Some faculty may fear their own imperfections. Thus making these types of changes to teaching described throughout this portal may create discomfort. Others may show an aversion to making any type of change.72 However, it must be stressed that the type of teaching that fosters critical thinking skills not only has implications for the quality of education. It also holds implications for the quality of patient care given by the dental providers, how likely they are to educate dental patients in self-care, and may influence the overall systemic health of patients in our society. Asking students to share what their thinking is aloud will aid in understanding their frame or reference and selecting appropriate strategies to expand their capacity for critical thinking.

Teaching students how to use critical thinking requires careful planning prior to instruction, selecting instructional strategies that are matched to desired learning outcomes, offering ongoing opportunities for students to think aloud or in writing among others, to show how and what they know and challenging students who demonstrate simplistic or unreasonable thinking. When faculty model thinking processes out loud, students can learn how to utilize similar thinking processes on their own. Showing students how to use critical thinking skills will also aid students in their development of self-regulated learning.

The combined number of empirical studies on critical thinking and coursework remains small. There is a need for better quality and more studies in this area to create a sufficient bank of evidence that teaching critical thinking, even a moderate investment, can lead to enhanced reasoning skills.40 Once again, dental education has an opportunity to change the course of its history.

Recent Studies on Critical Thinking

Authors reviewed 42 empirical studies of teaching of critical thinking skills in postsecondary education published between 1994 and 2009 (Behar-Horenstein, & Liu, 2001)73. They analyzed the instructional intervention, test measure, and research design of the studies. The authors found that: (1) the same instructional interventions lead to different results, depending on the implementation; (2) most studies were disadvantaged by research design, sample size, or sample representativeness;  (2) qualitative data is needed to researchers illuminate intervention effects not easily captured by quantitative instruments. They recommended: (1) not relying solely on statistical significance as criterion for when choosing new teaching methods; (2) using multiple test measures, — quantitative and qualitative, — to assess changes in students’ critical thinking skills; (3) that prospective research address internal validity threats, by adopting a quasi-experimental design, in order to establish causal relationship between intervention and changes in students’ critical thinking skills. Liu, Behar-Horenstein, and Garvan (in press) conducted a meta-analysis of empirical postsecondary and professional schools publications and dissertations that were designed to promote measurable changes in students’ critical thinking skills using instructional interventions.74 Using a hierarchical linear model, results showed that student major area of study and treatment length explained part of the variability among treatment effects. There was a statistically significant but small average effect size and evidence of heterogeneity among studies. Although the average effect of critical thinking teaching in college is small, critical thinking teaching interventions are effective and lead to improvement in students’ critical thinking skills.

67 Dam G, Volman M. Critical thinking as a citizenship competence: teaching Strategies. Learning and Instruction 2004; 14: 359-379.

68 Paul RC. Critical thinking: What every person needs to survive in a rapidly changing world. Santa Rosa, CA: Foundation for Critical Thinking. 1992.

69 Brown A. Transforming schools into communities of thinking and learning about serious matters. Am Psychologist 1997; 52: 399-413.

70 ADEA CODA Task Force. Accreditation Standards for Dental Education Programs. November 17 2007.

71 Pape SJ, Smith C. Becoming a self-regulated learner. Theory into Practice. 2002: 41(2): 93-101.

72 Prentice ED, K.Metcalf W, Sharp JG, Hard WL. Training teachers in the anatomical sciences. J of Med Educ 1976; 51: 1006-1009.

73 Behar-Horenstein LS, Niu L. Teaching Critical Thinking Skills In Higher Education: A Review of the Literature J College Teach and Learning 2011; 8(2): 25-42.

74   Liu N, Behar-Horenstein LS, Garvan CW. (in press). Do Instructional Interventions Influence College Students’ Critical Thinking Skills? A Meta-Analysis Educational Review of Research