The Internet Web Site on Virtual Clinical Applications and Disease Management is a hypermedia, case-based open learning environment that was designed to promote cognitive flexibility in college students at The University of Georgia College of Pharmacy. With a key objective of pharmacy education being patient problem-solving skills, this environment exposes students to a variety of resources on the Internet that can be used in solving virtual patient case studies. Literature suggests that such environments promote complex knowledge structures in students with complex epistemic beliefs, but may cause students with simple epistemic beliefs to struggle. This paper describes cognitive flexibility and epistemic beliefs, and suggests that the combination of social constructivist approaches with cognitive flexibility hypermedia environments will promote learning for students with varying epistemic beliefs. The key benefit to using social mediation in cognitive flexibility hypermedia is in further scaffolding the complex, ill-defined knowledge structures found in these environments. If students rely on social structures too heavily, they may fail to develop flexible knowledge that arises from active engagement, personal struggles, trials, and errors with the complex environment. Any method providing students with answers rather than suggesting alternative means of addressing a given task should not be considered. (Contains 14 references.) (SWC)