Virtual environments provide medical professionals a risk-free setting to practice their skills. Within these environments, medical professionals receive training to reinforce triage, communication, and treatment protocols. Recently, researchers created a medical virtual environment geared towards Combat Medics, focusing on step-by-step training for individual medical procedures. The software requires trainees to manage their aid bag and utilize the appropriate equipment for each procedure. To introduce a ‘crawl-walk-run’ training modality, researchers implemented a difficulty system into the simulation. In the novice level, simulated patients present readily apparent symptoms with no complications. In the intermediate level, simulated patients have multiple injuries with complications occurring throughout the scenario. The advanced level includes multiple casualties, requiring triage skills, in addition to the skills required at the intermediate level. By altering the difficulty level, researchers studied the impact on trainees in terms of cognitive load and performance. Researchers then conducted a usability study to further evaluate the performance of the system. The results of these studies are reported, including conclusions and discussion regarding successful implementation of difficulty systems within virtual training applications.