Depending upon 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, and from a sociocultural perspective, critical thinking skills are the "capacity to recognize and overcome social injustice."86 Paul claims that critical thinking is not an aim of education, but the aim 87. In this toolkit, CT has been described predominately as a set of skills and dispositions. However, it is important to point out that, while CTS can be taught, whether CTS are learned is dependent upon a host of factors, such as students' predispositions and 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.88, 89 Others argue that there is no set of generalized thinking skills and that CT cannot be taught in isolation from subject matter 90. Brown posits that students cannot progress in the development of their thinking unless they are given something to think about.91 Giving students something to think about is central to the development of CTS.

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 to discussion with other students and the instructor is likely to have a significant influence on the development of CTS. Asking students to share their thinking verbally aids in understanding their frames of reference and selecting appropriate strategies to expand their capacity for critical thinking. Also, having students formulate their ideas in essay exams rather than identify known information in multiple choice exams will stimulate public thinking. This can also produce an influential effect.

It is necessary for organizations to commit to teaching in ways that support CTS. Some instructors will buy in to this transformation, but others will need professional development, consultation on rewriting learning experiences and expanding teaching repertoires, administrative support, and revised expectations among supervisors that teaching supporting CTS is a requirement in the academy.

ADEA can maintain a database of evidence-based best practices and serve as a resource for faculty across the United States and Canada. ADEA can also be a source for web-based cases, tutorials, and teaching technique videotapes to support professional development. To create a database of evidence-based practices, dental school faculty may need to think differently about conducting research and collaborating with scholars in colleges of education, health, and human performance to study teaching and instructional practices.

From a programmatic perspective, dental education programs need to become learner-centered. The curriculum will need to engender actively engaging students and helping them assume greater ownership of their learning.92 Professors need to use strategies that build self-regulated learners and move away from teacher-centered and discipline-focused instruction. They need to encourage student dialogue, discovery, and curiosity.

Curricula 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 about their progress, and alter their behavior based on these judgments. Professors need to develop curricula that move toward 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, strengthen poor problem-solving skills, learn appropriate problem-solving skills, self-monitor, and diagnose and treat patients' oral health problems.93 To assist student development of CTS, need to model the value of scientific discovery and lifelong learning in their interactions with students, patients, and colleagues.94

Teaching students 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 frames of reference. Understanding an individual's attitude and willingness to consider and weigh alternative points of view is an essential component of teaching students how to develop and use critical thinking skills. Some faculty may fear their own imperfections. For some, making the changes to teaching described in this toolkit may create discomfort. Others may show an aversion to making any type of change.95 However, it must be stressed that teaching that fosters critical thinking skills has implications for the quality of not only education, but also patient care, education of patients in self-care, and overall systemic health in our society.

Teaching students to use critical thinking requires careful planning prior to instruction, selection of instructional strategies matched to desired learning outcomes, provision of opportunities for students to think aloud or in writing among others to show how and what they know, and challenges for students who demonstrate simplistic or unreasonable thinking. When faculty model the process of thinking out loud, students learn how to use similar thinking processes on their own. Showing students how to use critical thinking skills aids in 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 even a moderate investment in teaching critical thinking can lead to enhanced reasoning skills.96 Once again, dental education has an opportunity to change the course of its history.