Although The Medium isn't a particularly difficult game, especially if you have played similar titles like Silent Hill or Resident Evil before, there are some aspects of gameplay that aren't as easy as they first appear to be. Taking part in these elements can usually be improved over time, though there will be many players who will need to play the game multiple times in order to achieve them.
Some of these elements are also tied to achievements, giving the player an incentive to get better at the intricacies of The Medium and play the game multiple times in order to see everything the game has to offer.
10 Find All The Memory Shards
There are several collectibles in The Medium, though few are as necessary for story progression as the Memory Shards as they are also usually tied to energy sources that allow Marianne to move forward in that particular area. Finding every Memory Shard will not only grant the player more insight into the lives of the people who lived in Niwa, but will also unlock an achievement if they manage to find all of them in a single playthrough, something that many players won't be able to do without a guide.
9 Find All The Echoes
Like Memory Shards, Echoes give the player some insight into the lives of the people in Niwa, though unlike Memory Shards, Echoes aren't always needed for progression and are much easier to miss when playing the game. Unless the player has Insight active at all times, which can become very annoying if you are playing on a controller with vibration turned on, there is a good chance that you will miss at least one on the first playthrough of the game.
8 Find All The Postcards
While Francis' Postcards aren't necessary for story progression or learning anything of note that happened in Niwa, they do give the player insight into the life of a casual observer in the horror that was the Niwa Massacre. As the caretaker, and without any knowledge of the supernatural things going on in Niwa, Francis ended up being responsible for Maw escaping and Thomas calling Marianne in the first place.
After all of the Postcards have been found, it will reveal that Francis realized too late that letting Lilianne out of her containment was a bad idea, though he later succumbed to the effects of being possessed by Maw and died alone in his tent in the woods.
7 Find All Of Thomas' Notes
Francis wasn't the only character to leave information just lying around Niwa where anyone could find it, as Thomas left several notes about his time running the resort and his interactions with several characters, most notably with Ursula and Richard. Some of his final notes, found in and around the bunker, also have him speculating on the nature of Maw and other similar monsters, giving the player some insight into what they actually are and how Thomas managed to stop them from running amok.
6 Escape Maw Without Being Detected
One of the more difficult recurring features in The Medium is the Maw escape sequences, where the player needs to traverse confined spaces while also avoiding being caught and possessed by Maw in the process. In some cases, escaping Maw is a matter of simply sitting still and waiting for them to move on to the next room, though in most others, the player needs to move around the area while Maw is patrolling, all the while avoiding running into them or alerting them to Marianne's presence. If the player manages to go through an entire playthrough without getting caught once, they will receive an achievement, which is easier said than done.
5 Deflect Every Tentacle
A phrase that only makes sense in The Medium, there are several sequences where the player takes control of Spirit Thomas while he is infiltrating either Richard or Henry's mind. In Richard's case, there are several tentacles that will try to strike Spirit Thomas down and cast him out of Richard's mind, which Thomas can deflect with his medium powers. On a first playthrough, getting the timing right to not only take no damage from the strike but also destroying the tentacle every time can be quite difficult, though there isn't an achievement tied to this unlike with Maw's encounters.
4 Finish The Game Without Dying
If the player isn't familiar with The Medium or any game like it, chances are that they will die at least once while playing the game. For the most part, these deaths will come about as a result of trying to escape from Maw, particularly in their final escape sequence, but once the player knows how to approach each scenario, this becomes much easier.
There are also several chances to die inside Richard or Henry's minds, though these sequences are a lot harder to screw up and most players will be able to finish them without any issues.
3 Explore Every Inch Of Niwa
Several parts of Niwa that hold some interesting features are off the beaten path, which many players may not want to explore in favor of following where the story is directing them. While this means that you will finish the game sooner, it also means that you will miss some aspects of the game early on, such as the World War II memorial found by taking the right fork in the forest after Marianne first arrives on Niwa's grounds and has to follow Sadness' footprints to the hotel.
2 Speedrun The Game
Unless you know how to complete every puzzle without messing up, there aren't many players who will be able to speedrun The Medium without multiple attempts at the game. While the main story can take anywhere from five to eight hours to complete, if you know exactly where to go and what to do at every turn, this can easily be shaved down to a few hours at most, though this isn't something that most players will be able to do without serious practice.
1 Unlock Every Secret Achievement
Most Xbox games have some amount of secret achievements, usually tying to story elements that the game doesn't want to spoil for anyone who wants to see what they have to do to unlock the achievements. Unlike PlayStation's trophies, however, you aren't able to force your way through the hidden requirements to spoil the game and see what you need to do, meaning there are many achievements that players won't be able to unlock without a guide, simply because they don't know what they need to do to unlock them.