This is a mixed review despite all the critical points to follow. With a thorough editing pass I think The Last Medic could be excellent, but as things stand it's hard to recommend to anyone but the most forgiving precision platformer fans.
I will praise the variety of platforming ideas even if I personally dislike some of them. Almost every world introduces a new main concept around which most of the obstacles are designed. There also seems to be a great variety of music tracks and the visual presentation feels clean.
However, checkpoints are typically placed after multiple segments, not after each segment, which is problematic for multiple reasons. The game often makes the last segment in a group the hardest one, which makes replaying the easier segments to even try that last one again feel awfully rote. There are times basic platforming unrelated to the level's theme will either follow a checkpoint before you get to the main obstacles, or follow the main obstacles before you reach the next checkpoint. Also, sometimes the game has a bad habit of placing a spike or sudden drop just after a sudden camera shift, or arranging certain obstacles in such a way that you will likely fail on the first try. All of this leads to a lot of replaying segments you cleared on the first try just to access the trickier obstacles again. I understand that thematically the people you save are supposed to function as major checkpoints you can access from the world map, but there could have also been minor checkpoints only used while actually playing through the level.
There are other issues with the general level design and architecture that compound the checkpoint problem by making the game feel too trial-and-error at times, or unnecessarily punishing or lengthy. Some level elements don't reappear after use, forcing a restart, and unless I've missed something, there's no quick-retry button, so you have to restart through the pause menu. Sometimes, mind, you'll have to manually restart because you fall out of bounds endlessly without dying. Permanently disappearing level elements are especially irritating when the game asks you to quickly react to some complex obstacle combination and there's no safe spot to return to... which is actually a fairly common situation in the game regardless. Sometimes it's unclear you have to save your dash for the end of a segment, and sometimes the camera orientation isn't as helpful as it could be, especially when you're moving downward. That last point is especially odd because some long obstacle rooms do give you a helpfully fixed camera view, so it feels like an oversight that causes too many blind jumps and drops.
There are too many "Surprise!" moments where you're expecting a set of elements to move at the same speed but one is actually faster or slower as you abruptly encounter it. Moving platforms snap to the other direction instead of pausing, or decelerating and then accelerating. For blocks that phase in and out of existence, as far as I know you can only memorize the timing used- there's no assistance from animation or a metronome-like sound effect. For obstacles that only start moving once you pick up an item, you don't know their initial velocities, so you can be immediately ambushed. Portals in underwater levels are sometimes placed right next to spikes such that due to the ambiguity of hitboxes you might suddenly die to spikes after the warp. For that matter, sometimes you'll accidentally re-enter portals (in non-water levels) because you strayed just far enough after the warp for them to become interactable again, which can lead to sudden deaths too. The input to fire from a barrel is the same as your jump input so if you're trying to jump into a barrel from its side, hitbox ambiguity can lead to your input mistakenly firing from the barrel instead, leading to even more deaths that feel unwarranted.
The game also overuses time pressure. Some levels give you a limited air supply (or a period of infinite jetpack fuel) that's so low (or short) for certain segments it sometimes feels like you're being forced to perform blind speedruns upfront. There is an entire world devoted to (sometimes fast!) autoscroll levels with spiky picture frame overlays (instead of distributing those far and wide throughout the other worlds), and plenty of levels where you have to outrun a spike wall without any checkpoints. Many underwater levels have segments in which you have to quickly outrun fish chasing you, and lose them around corners so they can no longer track you.
Many levels feel lengthy for the wrong reasons, interspersing off-theme platforming with the main obstacles, or repeating an obstacle multiple times (consecutively) with little variation. Certain platform formations or obstacle types are inserted into multiple world themes and yet don't feel materially different to traverse even with the new thematic contexts. You'll see a lot of architecture that looks like seemingly random small platforms and spike balls scattered about, which feels unfocused. Some levels, like the ones with lava flows moving up and down, have a very stop-and-go pacing that makes repeating segments after a death tedious. Other levels are literally labyrinths that tend toward basic platforming, and while I understand these were probably mixed in for variety's sake, I personally found them unengaging. Still other levels have secret exits that will typically make you replay segments to access them, and oddly the levels they lead to often feel disproportionately easier and/or redundant in their design, which makes me wonder whether the game really needed branching paths on maps (though incidentally it's worth mentioning I haven't found any level skip option so apparently you have to play stuff in order).
As a summarizing point, I personally felt there were countless cases where a segment could have been just slightly more lenient and yet still would have been challenging enough for a precision platformer. A game can be both hard and accessible but I often felt The Last Medic was unapologetically focused on the former.
For reference, to my knowledge I've cleared everything except for one secret ending that (disappointingly) has very little to do with precision platforming.
