I guess 4th Med is really designed to let you have a taste of what a real life is, to step out from 'student' perspective, to a real life perspective. Ideal need to be analyzed and evaluated with God-given calculator in your mind. Whatever formula you used, risks need to be calculated in every given situation. To talk or to shut up, to stand or to sit down. To do it now, or to do it later. To ignore or to take it to heart. To ask now or to ask later.
Then come the harder decisions, patient's management. And everything you have been taught all your life need to be screen all at the same time, but sometimes the efficiency of the brain processor, is not up to the current rate (whatever it is now).

.......

But the bottomline is, you need to learn to be a safe doctor, how stressful it is. Save to sometimes ignore your ignorance. Zero tolerance to ignorance and uncertaintiness. Need to be confident.
Even when you don't know what to do, you should know what you need to do when you are in that situation. (i.e You can't be ignorant when you are ignorant at things to do...). It doesn't mean that you just blindly do things to cover your ass, but you have to know the right way to do things, i.e call for help, call for a senior help, google things or etc. Nothing ends. sigh.