Most of the time I use a digital use compact, and I shoot with about a stop of underexposure whether I use program or aperture priority. Exposure is either trial and error, or learning how to fool the camera into giving you what you want.
The basics of metering haven't changed since film days .. the camera will always want to make things grey / midtone. If it does that with the average scene, then any small highlights will be blown. The old rule was 'expose for the highlights' .. i.e. expose so you preserve the highlight detail, i.e. underexpose the highlights .. and 'develop for the shadows' .. i.e. you can lift enough detail out of the shadow areas even when, af first glance, they seem to have blocked up completely. That all still holds for digital .. digital just gives better tools for retrieving shadow information.
As has been said, once highlights have been blown, that's it. Depending how much time you're willing  to spend on it, you can draw in detail where the information has gone .. a simple way is to paint a light grey tone over the blown highlight and then clone in a suitable texture from an area that's correctly exposed. Having created your fake highlight information on a separate layer, you can play with the opacity to get something that looks ok.
Very often there is actually some highlight detail around the edges of the blown area .. it can be virtually invisible to the eye. It is possible to effectively amplify that information, and that can sometimes significantly reduce the area that looks blown. Pick a very light tone and having loaded your brush with it, set the brush to multiply, with opacity around 10%, and paint carefully in around the edges of the blown area. The amount of information you can  recover can be surprising. As before, you do it on a separate layer and then play with layer opacity.
If I want to work critically, as I would shooting a model, I use an incident light meter. You are measuring the amount of light falling on the scene, not the amount reflected from one particular bit of the scene. Incident meters are inexpensive and you can learn to use one in less than an hour, then it's just practice and experience. You still have to make judgements about what in the scene you want to look dark or bright, but you should quickly start to get much more accurate exposures faster. So long as the light levels stay reasonably constant your exposure shouldn't need to change from shot to shot. With any reflected light reading you are at the mercy of the accident of how the particular things you're aiming at are interpreted by the camera .. how wide the metering area / how large the area you want to correctly expose is relative to the overall frame. It will change even as you zoom in and out on a particular target.
It sounds more complicated to use an incident meter, but in reality, with a little practice, it's easier, quicker and more accurate.
A large format camera has an aperture control and a shutter. Otherwise it's an unthinking empty box. The camera is very, very simple so you have to do everything yourself. A digital camera does everything for you; you only have to press the button .. it couldn't be more simple. You just have to decide which sort of simple you want.