When this happens, no matter what the score was and what special objectives were completed, this rank will always be given.
In Trauma Team, this rank is achieved in some surgeries by failing the operation and choosing to continue from the point of failure. Before an X mission is completed in Under the Knife, a C will always be given, even before the operation begins. If a Challenge operation is failed in New Blood, a C will be instantly given. If a C is given, mistakes have been made, the time limit was nearly up, the vitals dropped pretty low, and many other things. To get a C, the player requires to do minimal work. Only certain qualifications have been met. To get a B, no misses must be performed in most operations. On rare occasions, a player can achieve all the special bonuses but not have a high enough score to attain S rank. Normally, three out of the four special bonuses have been achieved. To get an A, most qualifications are met, but not all of them have been achieved. To get an S, the player would require all the special bonuses to even be reached, but at times the total score itself would be too low to go to XS. S is the highest rank in Under the Knife, and the Easy and Medium difficulties on the other three games. Cools must be scored wherever they can be scored, and in certain cases the Healing Touch is required to be able to get a good time bonus. Because there are no difficulty levels in Under the Knife, an S is the top rank possible in any mission, even the X missions.To get an XS, All the special bonuses must be achieved, and the operation bonus, the vital bonus, and the time bonus must be high enough. XS is only achievable in Hard (for Second Opinion onwards), Special (for New Blood), Specialist (for Trauma Team) or Extreme difficulty. In all Trauma Center games, at the conclusion of every operation, a rank is given out depending on the ability of the player and the degree of success of the operation. The Results screen in Under the Knife 2, with the prestigous XS rank.
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