A report released Tuesday by the U.S. Government Accountability Office finds that doctors, nurses and other military health-care providers are inconsistent in treatment of sexual assault victims because of guidance lacking from the top.

Required training for health-care professionals is not always done, leaving some doctors and nurses unfamiliar with how to treat injuries stemming from sexual assault and protect victims’ confidentiality, the report said.

GAO auditors found that the Office of the Assistant Secretary of Defense for Health Affairs, the department tasked with carrying out guidance for sexual assault response, has failed to communicate enough information to medical professionals in the field to help victims recover and guide them through reporting assaults.

“Left unaddressed…limited health care guidance and first responders’ inconsistent knowledge about available resources…. can undermine DOD’s efforts to
address the problem of sexual assault in the military by eroding
servicemembers’ confidence in the department’s programs and
decreasing the likelihood that victims of sexual assault will turn to the
programs or seek care and treatment when needed,” GAO wrote.

DOD officials told auditors that they disagree with their conclusions, although they agreed that they need to improve compliance with annual refresher training on sexual assault prevention and response.

Defense officials told auditors they have been working for two years on procedures to improve the military’s prevention and response to sexual assaults. But they did not provide any details.