Padlet is a web-based tool for online collaborative learning (OCL), resembling a bulletin board where users can share multimedia content [1, 2]. Recent studies have highlighted the advantages of Padlet-mediated learning in enhancing student engagement and facilitating positive collaborative learning experiences [3,4,5,6]. Additionally, other research [1, 7] has shown that Padlet technology promotes user engagement and cooperation. However, despite its proven effectiveness, Padlet remains underutilized in higher education, particularly within healthcare professions. To bridge this gap, our research pursued three core aims. We sought to design an intervention program that leverages Padlet for student collaboration and assess how health management students perceived this intervention’s impact on collaborative learning.
This study also delved into the influence of students’ flexible thinking on their inclination to embrace Padlet-based learning and recognize its benefits for OCL. Flexible thinking is vital in online learning due to increased autonomous interactions. It involves adaptability, openness to different views, and balancing various needs to optimize outcomes [8, 9].
However, the pivotal role of flexible thinking in learning has received relatively limited attention in the context of healthcare disciplines and online collaborative learning through Padlet, prompting the need for this investigation.
Thus, this study explored the utilization of a Padlet-mediated online tool as a vehicle for collaborative learning among undergraduate health management students. It aimed to evaluate how the adoption of technology-enhanced collaborative practices intersected with students’ cognitive flexibility . This study’s results can enhance our understanding of tech-supported OCL, especially using lesser-known tools like Padlet, in achieving educational goals and promoting higher-order learning among undergraduates. A thorough understanding of the factors shaping students’ perspectives on technology integration in their courses and OCL is essential for academic institutions. This is key to navigating the changing healthcare landscape shaped by demographics, technology, and politics. With the surge in medical demands and technology, global health systems must adopt digital innovations like AI and telemedicine. Modern challenges require new skills, underscoring the urgency for health and academic entities to adapt [11,12,13]. This research not only fills a critical research gap but also underscores its significance in shaping the future of healthcare education and online collaborative learning practices.
In this section, we will review the advantages as well as challenges of collaborative and online learning. We will also address Padlet-mediated learning and flexible thinking in technology-enhanced environments by reviewing relevant recent literature. Further, we will present the use of this teaching methodology in the healthcare professions and examine how it impacts the skills required of today’s healthcare students.
Online collaborative learning
Collaborative learning is a growing pedagogic approach where learners work with peers, engaging in activities like questioning, discussion, brainstorming, reflection, and decision-making to promote active learning . Collaborative learning has been shown to improve performance in a variety of fields by making learners actively engaged in learning and increasing their satisfaction, motivation, and well-being .
This form of learning was found to be effective for coping with the challenges of active teaching, especially in big courses where only a handful of students are active participants . Collaborative learning fosters a supportive environment, ensuring equal opportunity and encouraging participation through small group work . This emerging pedagogy turns learning from an individual activity into a collaborative process, offering benefits like enhanced knowledge acquisition, self-regulation, positive interdependence, and increased engagement [1, 17, 18].
In recent years, with the improved performance and increased accessibility of digital technologies, many academic institutions have begun to assimilate OCL into their courses [14, 19]. The constraints of social distancing imposed by the Covid 19 pandemic have enhanced that trend. OCL is defined as a goal-oriented activity of a group of students that are committed to achieving a shared target and creating new knowledge by interactively learning in a digital environment . Numerous studies have indicated the advantages of OCL [21,22,23]. These benefits encompass enhanced study motivation, better learner communication, fostering social activism, cultivating advanced thinking skills, and being inclusive for students from varied backgrounds. As learners engage with peers, they brainstorm, assess suggestions, gain feedback, and experience peer tutoring .
Social interaction in a learning environment includes interactions with peers (classmates or team members), interaction with the instructor, and academic involvement. Such interactions are considered central to achieving learning goals and improving academic performance in OCL [25,26,27,28]. Research has indicated that online learning technologies and distant learning increase learners’ motivation because the material becomes accessible anytime and from anywhere [29, 30]. Furthermore, online learning technologies invite constant interaction with instructors and peers, thus enhancing internet-based interpersonal relationships with fellow learners, which leads to better learning outcomes .
In CL, outcomes progress through stages. Initially, there’s idea-generating (IG) involving brainstorming and discussions, introducing learners to varied viewpoints [32, 33]. Next is idea organizing (IO), where initial ideas are analyzed and synthesized by the group . Here, the instructor guides learners on tools and encourages higher-order learning . The subsequent phase, intellectual convergence (IC), focuses on information processing, including reflections, discussions, and critical thinking, fostering a collaborative learning environment [35, 36]. Due to the advantages specified above and to meet the demands of the 21st century and deal with the limitations of face-to-face education, OCL has become central in the evolution of academia as it adjusts to the changing reality [37,38,39].
Online collaborative learning in health management education
Global changes and easy information access have reshaped the health industry, prompting new challenges for health workers. This demands new behaviors from both healthcare providers and administrations [12, 40]. Training for health administrators must now prioritize competency-based learning, emphasizing the development of capacities such as cognitive and interpersonal skills. Given the substantial interactions within ever-shifting health systems, suitable training can enhance the industry’s capacity to navigate current dynamic demands [41, 42]. Recently, cognitive skills like digital literacy and critical thinking, along with personal and interpersonal skills like communication, flexibility, creativity and teamwork, have become vital for shaping administrations that can meet the needs of 21st-century health systems .
OCL research in the health professions, including health administration, has shown that digital environments improve the training of students through collaborative learning and problem-solving, enabling students to acquire knowledge and higher-order thinking . The health industry’s practical nature necessitates skills like flexibility and decision-making due to diverse team compositions . Early exposure to collaborative online learning environments is essential for honing these skills during professional training . It’s widely agreed that adopting these pedagogies across all learning levels will enable the health system to meet market demands, benefiting both the system and its patients in the coming decades .
Online collaborative learning mediated by Padlet
Padlet, an OCL platform, functions as a virtual bulletin board for various multimedia posts and is always accessible to learners [1, 2]. Research shows its value in enhancing student engagement and positive collaborative learning experiences [3,4,5,6]. Further, studies like Gasmi and Thomas  emphasize its role in fostering user cooperation. For example, Padlet was found to enhance engagement among health and science students, fostering collaborative learning. Its use improved learning efficiency and provided a comfortable platform for communication and teamwork. Similarly, Garnham and Betts  detected a rise in students’ engagement in seminar courses when Padlet was used; In Beltrán-Martín’s study , students expressed satisfaction and improved academic performance using Padlet. Its advantages include ease of use, long-term content accessibility, and access to diverse resources. Given these features, Padlet supports a holistic, student-centered approach, allowing students to engage using their preferred medium and create content .
Flexible thinking in health management studies
Spiro and Jehng  have initially defined cognitive flexibility as “the ability to adaptively re-assemble diverse elements of knowledge to fit the particular needs of a given understanding or problem-solving situation”. More recently, Tseng et al.  defined flexible thinking as “a person’s awareness of interaction and solution alternatives, ability to adapt to new situations, willingness to consider different opinions, and self-efficacy in being flexible” (p. 2289). Cognitive flexibility, encompassing open-mindedness and adaptability, is key to handling challenges and thriving in dynamic learning environments. Spiro and Jehng emphasize its importance for learning and problem-solving. It’s essential for online learning with autonomous interactions, making it a pivotal 21st-century skill . Cognitive flexibility is a continuous process involving interactions with one’s environment, consciousness, embracing new perspectives, and adaptive behavior for improved results . It’s considered higher-order thinking and part of executive functions . It allows reevaluation of problems from unique angles  and aids students in understanding varied opinions, leading to solutions in diverse settings .
Cognitive flexibility positively influences teamwork . In academia, it aids learners in adapting to new content and problem-solving [55, 56]. In medical fields, this skill is crucial, especially in therapeutic and managerial roles, making it vital for health professions . Ernawati and Bratajaya  emphasized the importance of flexibility for nurses due to their interactions with patients and families. Flexible thinking enhances resilience in healthcare professionals  and is crucial in training mental health experts and adaptive therapies .
Flexible thinking in technology-enhanced learning
Successful OCL implementation relies on factors like suitable technology, peer collaboration, and social engagement, which influence how learners and teachers adopt these technologies . Another central precursor shown in previous research is student flexible thinking. Flexible thinking in learning is comprised of three main factors, which lie at the core of the model used for this research . The first factor is technology acceptance. As technology integrates into education, students must show increased adaptability and cognitive flexibility . The second factor, considered an integral part of cognitive flexibility, is open-mindedness. The ability to weigh various options and opinions and consider alternative solutions . Individuals or teams with this ability are open to new ideas and capable of processing new knowledge when coping with evolving realities . Open-mindedness is vital in education. Learners often rely on basic generalizations, which aren’t suitable for complex environments. To foster cognitive flexibility, students should be challenged with intricate problems and exposed to diverse opinions and views . A key component of cognitive flexibility is adaptability to new situations, which involves one’s ability or motivation to adjust to changing contexts. In today’s education, rapid adaptability to novel methods and learning environments is crucial .
Adaptability in learners is shown when faced with new situations or challenges . These abilities are essential for teamwork, as those with cognitive flexibility adjust well to new roles, diverse tasks, and various team dynamics. They excel in compromising and valuing diverse opinions in teams .
Research question and hypothesis
The surveyed-above literature review illustrated that Padlet is still underutilized in higher education, specifically in healthcare professions. Moreover, the pivotal role of flexible thinking in learning has prompted much less research interest in the context of healthcare disciplines and online collaborative learning via Padlet. To address this gap, the primary objectives of this study were threefold. First, it aimed to design an intervention program (outlined below) that utilizes collaborative learning facilitated by Padlet. Secondly, it sought to evaluate how health management students perceived this intervention and its impact on their collaborative learning experiences. The third goal of the study was to evaluate the impact of students’ flexible thinking in the context of learning might influence their perception of the benefits derived from this instructional activity in the realm of online collaborative learning.
The following research question and hypothesis were examined:
Q1. How health management students might perceive an intervention program facilitated by Padlet in relation to their collaborative learning experiences. Based on the literature review, which indicated a positive impact of Padlet usage on collaborative learning, it was hypothesized that the participants would acknowledge the advantages of the intervention for their collaborative learning. Furthermore, an effort was made to identify the collaborative learning constructs most significantly affected by the intervention.
Q2. How might students’ flexible thinking in learning inform their different perceived collaborative learning on Padlet? Previous studies indicated the centrality of students’ flexible thinking in determining their tendency to embrace new technology-enabled learning tools (e.g., [10, 60]). Therefore, we hypothesized that students’ flexible thinking might contribute to their perception of Padlet utilization as beneficial to OCL – students who perceive themselves as more flexible would be more receptive to adopting the proposed technological tool (Padlet) and hence would tend to appreciate its function as a collaborative learning platform enabler. An effort will be made to identify the most contributive factor/s of flexible thinking in learning (learning technology acceptance; open-mindedness in learning; and adapting to new learning situations,  to their perceived collaborative learning performance on Padlet.
Confounding variables that might affect the research variables (e.g., age, ethnicity, grade point average [GPA], gender, and year of study) were addressed to examine and control their potential effect on the research constructs thereby allowing the examination of the associations between the research constructs over and above potential individual differences that might have existed between the students.