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In general, med school admissions committees will forgive a little bit of under acheivement in the first year of college. Many students under estimate the work necessary to excel at the University level, in part due to relatively low standards at the K-12 level.
That said, places like Yale, Hopkins, Harvard, Stanford, etc., don't have to be forgiving, so she shouldn't count on that forgiveness.
You should all understand that those Tier 1 schools *could* fill their entire classes with students with 4.0 GPAs and 40's on the MCAT, but as a generalization, they don't. The reason is simple. Students at the highest levels of academic acheivement don't necessarily make the best physicians. In fact, at least one important study on the subject suggests that they make the worst physicians.
So what are they looking for? Obviously your niece will have to do well academically from here on out, but she'll need to do more than that. She needs to demonstrate to them that she has an insatiable desire to help people, particularly in a medical setting. That means volunteering, taking on leadership roles if she's inclined, and accomplishing things outside of the classroom. Some of my (former) students who've managed to get into such places have participated in research leading to published papers, started their own charities (no kidding), been professional dancers (with interests in ortho for example), and so on.
While it's best if these accomplishments are "in field," they don't have to be. What's important is the demonstration of the ability to master the depths of a field, thus illustrating that you have the ability to delve deeply beyond the introductory.
Last comment... Her college/university undoubtedly has a pre-health professional advisor or committee with experience in this area. She should consult with them EARLY to get the best advice and individualized help along the way. Good luck!
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