Purpose: "Content Representations" (CoRes) is an instrument that links content with aspects about its teaching and is recognized for its utility designing lessons and elucidating teachers' knowledge. Lesson study (LS) is a practice through which teachers collaborate to plan, teach and reflect on a lesson. Both have been acknowledged separately as being valuable for teachers' training; however, there is little research addressing the consequences of combining them. This study filled in that gap by examining how higher education (HE) teachers used the CoRes and perceived its integration within LS. Design/methodology/approach: The authors performed a multiple case study with features of ethnomethodology and conducted an inductive content analysis of the data gathered through document analysis, in-depth semi-structured interviews and participant observation. The research was approved by the ethics committee of the host university, and participants were faculty members from different health sciences disciplines. Findings: The authors found that participants considered that the use of the CoRes during LS allowed them to organize their ideas, consider more details for lesson design, address new topics and engage in greater reflection. However, participants (specially senior faculty) showed a superficial dedication to filling in the CoRes and considered the instrument bothersome, urging caution when engaging in the combined practice of CoRes and LS. Originality/value: This is the first research in the international literature approaching the integration of the CoRes and LS with HE teachers. Its results fill a research gap and can help LS practitioners make an informed decision about whether to incorporate CoRes into it.