In an effort to share best practices in undergraduate engineering design education, we describe the origin, evolution and the current status of the undergraduate biomedical engineering design team program at Johns Hopkins University. Specifically, we describe the program and judge the quality of the pedagogy by relating it to sponsor feedback, project outcomes, external recognition and student satisfaction. The general pedagogic practices, some of which are unique to Hopkins, that have worked best include: (1) having a hierarchical team structure, selecting team leaders the Spring semester prior to the academic year, and empowering them to develop and manage their teams, (2) incorporating a longitudinal component that incudes freshmen as part of the team, (3) having each team choose from among pre-screened clinical problems, (4) developing relationships and fostering medical faculty, industry and government to allow students access to engineers, clinicians and clinical environments as needed, (5) providing didactic sessions on topics related to requirements for the next presentation, (6) employing judges from engineering, medicine, industry and government to evaluate designs and provide constructive criticisms approximately once every 3-4 weeks and (7) requiring students to test the efficacy of their designs. Institutional support and resources are crucial for the design program to flourish. Most importantly, our willingness and flexibility to change the program each year based on feedback from students, sponsors, outcomes and judges provides a mechanism for us to test new approaches and continue or modify those that work well, and eliminate those that did not.