Contribution: This paper examines ideation practices of biomedical engineering (BME) students in a capstone design course during a designated team ideation session and provides recommendations for structuring idea generation instruction. Background: Capstone courses provide students with opportunities to engage with open-ended and complex engineering problems requiring knowledge from multiple disciplines. Limited work has focused on how BME students engage in idea generation in capstone courses. Yet, success in solving problems depends on how students engage with and organize their idea generation efforts. Research Questions: What design activities do BME students engage in during a session designated for idea generation? What factors impact how students approach their ideation sessions and select the ideation approaches to use in a design course? Methodology: Five student teams were recorded during their idea generation sessions. Post-session interviews were conducted with a subset of students. Qualitative analysis of transcripts revealed themes related to design activities and factors impacting idea generation. Findings: Students commonly moved into convergent idea evaluation activities during generation. Their approaches to ideation were influenced by course activities and structures, design requirements, and sponsor feedback.