Background <p>Adverse Practice Experiences (APEs) are a frequent experience for residents worldwide and are associated with adverse occupational outcomes. This study aimed to explore the prevalent characteristics of APEs and the association between APEs and positional competence among residents in China.</p> Methods <p>A multi-stage stratified random sampling method was used to conduct an online survey of 1,300 residents from 18 residency training hospital in Guangxi, China. One-way analysis was used to examine differences in positional competence among different exposure groups. Multiple linear regression analyses were employed to examine the association between APEs and positional competency.</p> Results <p>895 residents (68.85%) reported having encountered at least one APEs. The most common reported form of APEs was verbal abuse(51.92%), followed by being required to perform personal services and gender discrimination, with prevalences of 49.62% and 47.54% respectively. Compared to the non-exposure group, participants 参与者 in the exposure group generally scored significantly lower positional competency scores. The experience of APEs was associated with lower positional competence scores (<i>β</i> = -0.044, <i>P</i> &lt; 0.001). Results from the multiple linear regression analysis revealed that emotional abuse (from “Low-exposure group” to “High-exposure group”, <i>β</i> = -0.045 ~ -0.110, <i>P</i> &lt; 0.001) showed the strongest negative association with positional competence.</p> Conclusion <p>This cross-sectional study indicates that APEs occur frequently among residents in China and are significantly negatively associated with positional competence. Although causality cannot be inferred from this cross-sectional study, the observed negative associations highlight that mitigating APEs may be a crucial component of efforts to support residents’ well-being and training quality.</p>