The concept of academic engagement has recently been introduced to draw attention to important ways in which universities interact with society that are not considered when focusing on licensing of university research and academic entrepreneurship. Previous studies of academic engagement have focused on its antecedents and outcomes, but in this paper we study how academic engagement is built and maintained over a long time period. We do so by examining collaborative research projects in the context of advanced graduate education at Chalmers University of Technology and the Sahlgrenska University Hospital, both in Gothenburg, Sweden, over seven decades, between 1948 and 2022. We find the academic engagement under study to follow a remarkably stable pattern for a long time. The stability of the engagement was maintained by a principle of pairing engineering with medicine during a process of scientific research, technological development, and clinical use. However, the principle was recurrently challenged by a series of institutional, technological, organizational, and generational changes, which have, with time, made it increasingly difficult to follow. © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.