head to head
Fallout: New Vegas asks more than The Medium, and the gap is execution.

Optimization · Pure Optimization
A faction-driven RPG-shooter where build and route planning shape every ending.

Optimization · Pure Optimization
A fixed-camera horror puzzle game solved by methodical dual-world navigation and item sequencing.
Fallout: New Vegas leans Optimization (Pure Optimization); The Medium leans Optimization (Pure Optimization).
Fallout: New Vegas leans clearly harder on execution.
Fallout: New Vegas
Shooter inputs with VATS assist
The Medium
Third-person movement and simple stealth; very low twitch demand
Fallout: New Vegas leans a little harder on reads, though the gap is small.
Fallout: New Vegas
Scripted factions and enemies
The Medium
No adaptive opponents; Maw is a scripted threat
Same score on variance - which means the number cannot separate them. The difference is in what each one asks of you.
Fallout: New Vegas
Some loot and crit RNG
The Medium
Some item locations hidden on first run
Fallout: New Vegas leans a little harder on optimization, though the gap is small.
Fallout: New Vegas
Faction routing, perks, builds heavily rewarded
The Medium
Dual-world puzzle solutions are deterministic and fully learnable
A matching score does not mean a matching test. Two games can both sit at 10 on execution and demand completely different things of you - which is why the reasoning above matters more than the number beside it.