The real magic happens in their music driver, which takes the sound effects, multi-track MIDI music, along with track priority infomation and dynamically down-mixes it to however many tracks the current audio device has. Just one in the case of the PC speaker.
I assume they would have had a setup that allowed them to quickly hear what the track sounded like on all their target audio devices.
The tracker music/custom sequencer formats operated in a parallel universe alongside the MIDI workflow and were more often the provenance of scrappy demosceners and independents who saw an opportunity to completely control the output quality(as long as it was sample-based). Not everyone literally used a tracker type of workflow and there are examples like MML(Music Macro Language) as another idea of source formats, as well as the low-level "enter hexcodes in a machine language monitor while the playback routine is running" (used by some C64 composers.) If you played a DOS game made with QBasic it probably used the PLAY statement to control the beeper, with an MML-style syntax. This style of syntax would appear again with programmable mobile ringtones.
In the mid-90's the balance shifted again towards CD audio, ushering in simple drum loop sequences as the quick-and-dirty audio filler of choice, and everything since then has largely been variations on that theme with more tracks and processing.
It was seeing a bunch of .MOD files on the floppy that first prompted me to download a mod tracker back in the BBS days.