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For 20 years, the Harvard-MIT Division of Health Sciences and Technology (HST) has offered a graduate-level course on Biomedical Signal and Image Processing (HST582J). This course takes a practical, hands-on approach to learning about signal processing and physiological signals through the application of digital signal processing methods to biomedical problems. It is by all accounts a successful course, with steadily increasing enrollment and high student satisfaction. In recent years, we have instituted a number of changes in the course, motivated by our awareness of new pedagogical strategies and assessment techniques. The purpose of this article is to use HST582J as a case study, demonstrating how incremental changes can improve an already successful course and ensure that hands-on exercises are not only fun and interesting but also achieve the desired learning objectives.