Decades of research have demonstrated the correlation of spatial abilities to chemistry achievement and career selection. Nonetheless, reviews have highlighted the need and scarcity of explicit spatial instruction to promote spatial skills. Therefore, the goal of this literature review is to summarize what has been done during the past decade in chemistry and biochemistry education to promote spatial skills at the college level. In this review, we compare and contrast how these fields of study have used external representations and visualization tools in their instructional practices as well as the kinds of interventions and assessment efforts directed to promote and evaluate spatial skills. Our findings show that explicit instruction to promote spatial skills has been on the rise but not at the level of other cognitive skills. Therefore, implications for teaching and potential areas for investigation are suggested.