This paper provides an overview of the status of design (upper level courses and related industrial and governmental support) in the undergraduate biomedical engineering curriculum in the United States. A brief history and overview of the biomedical engineering curricula at Vanderbilt is given as an example of the genesis of such a program. The content and structure of the design course at Vanderbilt is then covered, with mention of the structure and topics covered by other representative universities. Several recent phenomena that will impact all such programs, but largely the design courses, are then discussed. These include internships, the new accreditation criteria, and private and governmental support of research and design activities in biomedical engineering programs.