Why do we need Royal Colleges?

Today's Royal Colleges can be traced to the guilds that arose during the 13th and 14th centuries. They fulfil similar roles: to maintain the highest standards of practice, professional integrity and self-regulation. This paper traces the development of the Royal Colleges, together with the emergence of specialisation within medicine, with particular reference to anaesthesia as a modern specialty. It considers whether these functions are still appropriate for the rapidly changing practice of medicine today. The colleges have unique strengths, but they also have weaknesses and must be prepared to counter threats to their professional function.