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I mean, the trolley problem is just a starting point. It's literally one of the simplest thought experiments

The next set of thought experiments goes something more like "say you have 5 people in need of organ transplants, and 1 health person with those organs, do you kill them and take their organs to save 5 others?"

And even later you got another like "there is a dirty nuclear bomb in the middle of the city, and you got someone who you think might be responsible, do you torture them to maybe get a way to defuse the bomb out of them?"

And so on

The trolley problem is literally just a starting point in philosophy class, the experiments get more elaborate, closer to the real world, and less certain as you move towards greater understanding. Until at some point you just deal with real issues such as abortion or animal welfare (like whether veganism is the morally correct choice, which is a lot more controversial than I think it ever should be, but I digress), and the shortcomings of ethical systems and which ones maybe come closest to our intuitions (and then you got philosophers such as Hume which thought that our moral intuition is the only thing that matters), and so on.

Things are a lot lot more nuanced than just the trolley problem, and there are some really tough bullets to bite for utilitarianism in thought experiments. Or at least showing the need to rework the system somewhat, but then it isn't just a simple "best outcome" even in clear-cut situations.

In practice though, nobody really follows a strict ethical system, and it does show an interesting problem of trying to codify morality into a rational and consistent system. And we get to these edge cases typically by thought experiments, and then try to go from there. Breaking our theories by pushing them to the limits.

But while nobody follows a strict system, you still see elements of these systems in people's behaviours and choices. Such as maximizing a moral quantity (utilitarianism), or doing what is considered to be a good person thing to do (virtue), or Kantianism, or any numerous of subcategories and other systems which don't fall neatly into the typical categories. But, for example, in hospitals under triage, they typically follow a kind of utilitarian system

A good dramatic breakdown is the movie Eye In The Sky (2015, one of the last films featuring Alan Rickman), which portrays an opportunity to stop a terrorist attack via a drone strike, but the Hellfire Missile attack risks additional civilian casualties.