 In 1788, following the passing of ""An Act or Ordinance to prevent persons practising physic and surgery within the Province of Quebec,or Midwifery in the towns of Quebec or Montreal, without Licence"" the province of Quebec began to insist on doctors producing their credentials or passing an examination.As Laterrière could not produce a medical degree and failed to pass the oral examination he went to study medicine at Harvard University in Massachusetts where a medical school had recently opened and qualified to practice medicine one year later, in 1789.He was Harvard Medical School's first foreign graduate.