Difficulty is a dimension of the games that were introduced with Second Opinion and New Blood. The main change in difficulty for each mission is the ease of obtaining the special bonuses after the end of the operation, and the speed at which vitals drop. Injecting stabilizer also increases vitals by 24 with a full injection on easy mode rather than 12.

Difficulty LevelsEdit


  • Vitals drop at a slow pace
  • A MISS will only drop the vitals by a little
  • GUILT, Stigma, and Neo-GUILT will be easy to defeat, attacking and moving slower
  • Stabilizer raises vitals by about 24 points
  • Special bonuses are simple to obtain
  • Hemorrhaging wounds will form blood pools less often
  • Known in Trauma Team as the "Intern" difficulty


This is the only difficulty setting for Trauma Center: Under the Knife.

  • Vitals will drop at a brisk pace
  • Open lacerations start to do noticeable damage to the patient
  • A MISS will lower the vitals by a mild amount
  • Special bonuses are more difficult to obtain
  • Hemorrhaging wounds will form blood pools quickly
  • Known in Trauma Team as the "Resident" difficulty


From this difficulty on, you can get an XS rank for the mission.

  • Vitals will drop rather quickly
  • Lacerations will cause significant vital damage over time
  • GUILT, Stigma, and Neo-GUILT present will be more difficult to defeat
  • Special bonuses are even harder to obtain
  • Hemorrhaging wounds will form blood pools much quicker


The Extreme difficulty is reserved for X-missions and challenge missions. In the Extreme difficulty:

  • Vitals will drop extremely quickly
  • Lacerations cause more vital damage quicker
  • Any GUILT, Stigma, or Neo-GUILT present will be much stronger
  • A MISS will drop the vitals by a significant amount
  • Special bonuses are very difficult to obtain
  • A smaller margin for error is present
  • Known in Trauma Team as the "Specialist" difficulty
  • In Trauma Team, every miss will lower the maximum vital capacity in Surgery


The Special difficulty is present only in New Blood, either in tutorial missions or in Challenge missions. In Challenge missions:

  • Vitals drop as if the game is being played on Normal difficulty
  • Vital count is kept the same when going from patient to patient
  • Getting a "Good" will break your chain
  • XS rank is also obtainable on this difficulty
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